science

Maintenance of certification

Maintenance of certification is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Maintenance of certification rather than just read about it. In short: Maintenance of certification (MOC) is a process of physician certification maintenance through one of the 24 approved medical specialty boards of the American Board of Medical Specialties (ABMS) and the 18 approved medical specialty boards of the American Osteopathic Association (AOA). Variously implemented between 1990 and 2000 in response to quality concerns in the healthcare system, the MOC process is a voluntary…

Key takeaways

Maintenance of certification belongs to science; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Maintenance of certification to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Maintenance of certification from memory before moving on to harder problems.

Reference excerpt

Maintenance of certification (MOC) is a process of physician certification maintenance through one of the 24 approved medical specialty boards of the American Board of Medical Specialties (ABMS) and the 18 approved medical specialty boards of the American Osteopathic Association (AOA). Variously implemented between 1990 and 2000 in response to quality concerns in the healthcare system, the MOC process is a voluntary certification process and is controversial within the medical community. The ideal behind it is that physicians formally measure and demonstrate that they are doing adequate continuing medical education to stay current in their fields as the state of the art in each field continually advances beyond what it was when each person was initially educated and trained. Some physicians disagree that the programs as implemented in reality uphold this ideal well enough to be a net positive to the profession rather than a net negative. Starting with Oklahoma in 2016, a growing number of states have passed or are considering passage of legislation prohibiting use of participation in Maintenance of Certification as a reason to exclude a physician from hospital staff appointment or from insurance company physician panels.

Medical community Some major medical organizations gain profit from and have expressed support for the Maintenance of Certification program including the following:

American Board of Medical Specialties (ABMS) American Osteopathic Association (AOA) American Medical Association (AMA) American Hospital Association (AHA) National Board of Medical Examiners (NBME) Federation of State Medical Boards (FSMB) Council of Medical Specialty Societies (CMSS) Accreditation Council for Graduate Medical Education (ACGME) Association of American Medical Colleges (AAMC) Educational Commission for Foreign Medical Graduates (ECFMG) Some major medical organizations do not gain profit from and do not support the Maintenance of Certification program, including the following:

Association of American Physicians and Surgeons (AAPS) National Board of Physicians and Surgeons (NBPAS) Docs 4 Patient Care Foundation (D4PC) Physicians for Certification Change Independent Physicians for Patient Independence (IP4PI)

Competencies The ABMS Program for MOC involves ongoing measurement of six core competencies defined by ABMS and ACGME:

Practice-based Learning and Improvement Patient Care and Procedural Skills Systems-based Practice Medical Knowledge Interpersonal and Communication Skills Professionalism These competencies, which are the same ones used in the ACGME's Next Accreditation System, are measured in the ABMS Program for MOC within a four-part framework:

Part I: Professionalism and Professional Standing Part II: Lifelong Learning and Self-Assessment Part III: Assessment of Knowledge, Judgment, and Skills Part IV: Improvement in Medical Practice

Studies and criticism Some health plans are implementing programs that recognize and reward physicians who are actively participating in Maintenance of Certification activities. ABMS member boards are actively working with other health care organizations to advance quality initiatives and reduce measurement redundancy through recognition of physicians' Maintenance of Certification program participation. A growing number of hospitals and health systems are beginning to use Maintenance of Certification components to engage physicians in quality improvement. Many hospitals are now endorsing and accepting certification from the National Board of Physicians and Surgeons (NBPAS) instead of ABMS board certification. Studies suggest that board-certified physicians provide improved quality of patient care and better clinical outcomes than those physicians without board certification, including a 15% reduction in mortality rate among heart attack patients treated by board-certified physicians. Considering a recent meta-analysis that shows a decline in physician performance associated with the time elapsed since the physician's initial training, it is essential for physicians to participate in programs such as Maintenance of Certification in order to keep current with medicine's expanding knowledge base and technical advances, and to apply this knowledge to quality improvement in their medical practice. There is, however, no evidence MOC participation has any effect on this alleged age-related decline in performance and no evidence MOC is as good as any other intervention or no intervention. Maintenance of Certification strives to help physicians and other health care stakeholders address the critical need to enhance patient safety and patient care quality. There is no evidence to support any efficacy for maintenance of certification in enhancing patient safety and patient care quality. It is important to recognize the extensive conflicts of interests in studies funded by and performed by ABMS and specialty board employees. Studies have shown that a physician's ability to independently and accurately self-assess is poor, that more clinical experience does not necessarily lead to better outcomes of care and that fewer than 30% of physicians examine their own performance data and try to improve. The MOC program structure strives to address these concerns with a sound theoretical rationale via the six ACGME competencies framework and a respectable body of scientific evidence, and to address its relationship to patient outcomes, physician performance, validity of the assessment or educational methods utilized and learning or improvement potential. A study presented at the AcademyHealth conference in June 2013 found a correlation between an MOC requirement and reduced cost of care and emergency department visits; this paper is currently under review. There are no data suggesting MOC is in any way superior to a number of self-assessment programs, sponsored by physician specialty societies, that are significantly less expensive than MOC.

See also American Board of Medical Specialties (ABMS) American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS)

References

External links Official ABMS Maintenance of Certification Website http://www.changeboardrecert.com http://www.nbpas.org National Board of Physicians and Surgeons

Worked examples

Example 1 — a first encounter with Maintenance of certification

Start with the simplest possible case. Write down what Maintenance of certification claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Maintenance of certification before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Maintenance of certification ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Maintenance of certification

In research: Maintenance of certification appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Maintenance of certification in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Maintenance of certification is common in secondary-school and first-year university syllabi. It links to neighbouring topics Medical credentials, so understanding it makes those chapters shorter.
In everyday life: Look for Maintenance of certification outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Maintenance of certification in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Maintenance of certification means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Maintenance of certification out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Maintenance of certification in simple terms?

Why does Maintenance of certification matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Maintenance of certification?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Maintenance of certification.