This morning the American Board of Internal Medicine (ABIM) published on its website a press release about new testing options for MOC. The statement is short on details, but promises substantial change.
The plan, arising from the recommendations in last year’s Assessment 2020 Task Force report and created after gathering input from stakeholders and physicians, describes an alternative to the traditional 10-year secure exam. Candidates may either choose the traditional 10-year exam or this new plan. As someone who just last fall suffered through hundreds of study hours and the indignities of the testing center security measures in completing and passing my 10-year exam in Focused Practice in Hospital Medicine Exam, my curiosity is piqued.
The three facets of the new plan from the press release:
1. “Take the form of shorter assessments that doctors can choose to take on their personal or office computer—with appropriate identity verification and security—more frequently than every 10 years but no more than annually;”
Does this mean 10 annual tests? 5 biannual tests? How many questions? Will this be the same question load divided over ten years or will the overall question burden multiply like killer bunnies?
2. “Provide feedback on important knowledge gap areas so physicians can better plan their learning to stay current in knowledge and practice; and”
Feedback is great. Will doctors be able to study what they are lacking knowledge in and retake a failed sub-test?
3. “Allow physicians who engage in and perform well on these shorter assessments to test out of the current assessment taken every 10 years.”
What if you do fail one of the sub-tests? Is each test stand alone or are the total questions answered correctly cumulative over the ten year period? Will failing any sub-test make you fall out of compliance with “Participating in MOC” until you pass the next one?
So, a lot of questions raised by these three seemingly hopeful statements. How will these questions get answered?
Well, further down in the press release we see that the three aspects of the plan are lacking details because the details do not yet exist. Here is what ABIM says will be happening from now until December 31, 2016, by which time the “ABIM expects to provide more specific details about what the alternative assessment option will look like…”
“ABIM will continue to:
• Seek physician input about MOC assessment content through the blueprint review process;
• Study the feasibility of offering “open book” assessments;
• Investigate ways to provide secure assessments at a physician’s home or office;
• Determine how best to offer physicians immediate feedback on their assessment performance
and learning activities to help them improve; and
• Work with societies to expand the number of continuing medical education (CME) activities available for MOC credit.”
So, without specifics, this is really a thought bubble being floated out into the IM community signifying an intent and a potential direction, but without a lot of there there.
This announcement of change, unlike previous ones that simply made superficial changes to the types of “points” needed, I must admit has the feel of real change. But call me skeptical. I know the details and unanswered questions will be everything when it comes to answering the big questions around burden, cost and effectiveness. And of course this doesn’t even begin to answer the questions around the whole “points” structure and the Medical Knowledge modules and Practice Assessments. Will this supplant those or just add on? Ultimately, will this be less of a burden or more of a burden? And the big question around Value and Effectiveness! Will they finally show that this method (or the old one for that matter) of MOC actually signifies a level of proficiency in the real world clinical practice of medicine?
And what of Hospitalists? This plan is for Internal Medicine and “possibly one or two subspecialties starting in January 2018.” Will our Focused Practice in Hospital Medicine exam be part of this new plan? We seem like the perfect group, young, eager, tech savvy to test something like this out, right?
If this parceled out testing protocol does indeed become the preferred method, and our HM test is far down the list to roll out, will all of the gains we have made in getting our members and fellow hospitalists to sign up for the exam and declare their expertise and skill in hospital medicine, be eroded as hospitalists choose the “easier” method of the new general IM exam?
Ugh, dealing with the ABIM has made me such a pessimist. I will try to be better.
So, bravo, ABIM! I commend you for what finally feels like real talk of improvement in the process.
But I will believe it when I see it.
Burke Kealey, MD, SFHM is the Senior Medical Director for Hospital Specialties at HealthPartners Medical Group in Bloomington, Minnesota. Dr. Kealey began his career as a hospitalist in 1995 and has worked in medical leadership since 2000. In 2003 he was awarded SHM’s Award for Clinical Excellence. He has Chaired SHM’s Practice Analysis Committee and helped produce several of SHM’s Compensation and Productivity surveys. Dr. Kealey is a past president of SHM’s board of directors and has served as secretary and treasurer in past terms.
Dr. Kealey has a strong interest in ensuring that hospital medicine practices are effectively managed with a strong focus on the triple aim of affordability, great experience, and best health for our patients.
Raised in Texas, Dr. Kealey received his undergraduate degree from Texas A&M University, his medical degree from the University of Texas at Houston, and then moved north for Internal Medicine training at the University of Minnesota Hospitals and Clinics. While in chief residency he met his lovely wife Samantha, a Minnesota native and current Emergency Medicine physician. Together, they have 4 children.