Am Board of Path Maintenance of Certification Update 2009

Maintenance of Board Certification in Pathology: A Summary from an ABP Meeting in May

2009 with Cooperating Societies

Maintenance of Board Certification in Pathology: A Summary from an ABP Meeting in May

2009 with Cooperating Societies

Mark R. Wick, MD

Maintence of ABP CertificationHistory

Maintence of ABP CertificationHistory

• In the late 1980s and early 1990s, several health agencies began to focus public attention on “error” in the practice of Medicine

• One of the main responses to this movement by the AMA and the ABMS was to initiate and require or recommend recertification in many areas of specialty practice

• A “domino effect” ensued-- once some specialties began the process, others joined in quickly

• The ABP was the last specialty board to require recertification, among all members of the ABMS

• In the current climate of tightening third-party payment for medical services, and heightened regulation of medical practice, many insurers and hospital administrations are requiring proof of MOC to retain practice privileges and/or approved-provider status

Requirements For MOC

Part I: Professional Standing

Part II: Life-Long Learning and Self-Assessment

Part III: Cognitive Expertise

Part IV: Evaluation of Performance in Practice

Maintence of ABP CertificationUpdate: May 2009


• Basic requirements:– Satisfactory professional standing

• Unrestricted licensure• Current medical staff appointment/privileges

(documented at years 4 and 8 in cycle)– Evidence of ongoing learning and self-

assessment activities• 70 Category I ACCME-accredited credits in each 2-

year cycle, with at least 20 from self-assessment modules (SAMs)

• At least 80% of CME credits must pertain to the individual’s current area of practice

• Maintenance of a suitable electronic record of CME, transmitted to the ABP

– Objective evidence of cognitive expertise (passage of MOC examination + SAMs)

– Objective evaluation of performance in practice from peers and supervisors



• Self-Assessment Activities: Attributes of Ideal Modules

– Requirements for minimum proficiency must pertain

– Immediate feedback on performance should be available to the examinee

– More than one chance to pass exercise may or may not be available, or a “remedial” exercise may be tied to it

• If examinee does not meet minimum performance requirement, CME credit can still be claimed but the exercise will not count towards MOC requirements for SAMs

• Currently, SAMs are offered online by USCAP, CAP, and ASCP; other groups desirous of being SAM-providers must obtain approval of ACCME

Self-Assessment Modules (SAMs)

• Elements of SAMs• Educational product

• Self-administered exam

• Minimum performance level

• Feedback

• SAM requirement for 2006-09 period waived because of insufficient offerings

• Certificates issued by societies should reflect regular CME versus CME / SAM

Life Long Learning- Self-Assessment

• 70 Category 1 CME credits / 2 year cycle

• 20 CME credits / 2 yr cycle must be SAMs

• 80% CME related to individual’s practice

• Updated electronic record of activities every 2 years

• A fellowship fulfills Part II requirements for 2 year period

• Incomplete fellowships prorated



• Topic lists for emphasis in MOC/SAM activities are published annually by the ABP, beginning in 2008, on its website

• The main goal of such lists is to emphasize practically-important topics as well as new developments in Pathology

• Other aims of topic lists--– Template for CME activities– Preparation for MOC examination– Guideline for MOC question development– Provide a focus for “need to know” issues

• ALL disciplines in Pathology will be represented in the topic lists

Life Long Learning-Self-Assessment

• Intersociety AP and CP Content Committees produce “Content Outlines” available on line and updated annually

• Outlines emphasize fundamental information for daily practice and important, validated new knowledge

• Outlines should not be construed as templates for exam or endorsements of certain authors

• These will: – Serve as a template for CME and self-assessment– Assist pathologists to prepare for MOC exam– Direct MOC test question development– Focus on practical “need to know” information that is used in daily practice and

required for competence– Cover all disciplines of pathology



• Details of assessment procedure for cognitive expertise in MOC--

– MOC examination will be mandatory, and will be given at least once per year

– The examination will be “closed-book”– Examinees must complete the MOC exam

within a 10 year period after their last ABP certificate was issued; it can be as early as year 8 in the cycle, and year 9 is the recommended point for usual examination

– Potential 3-year period of qualification, extending from Jan. 1 of year 8 to Dec. 31 of year 10

– Written examination will be offered for the first time in the year 2014



• AP/CP diplomates may choose to maintain certification in AP/CP, AP only, or CP only

• Subspecialty certificate holders may choose to recertify only in that area

• HOWEVER, the ABP recommends that certificate holders try to maintain ALL of their certificates by MOC examination; this will maximize practice opportunities for everyone in the future

• The Board is committed to helping all diplomates achieve this goal, even if they currently do not practice in a particular certificate area (e.g., pathologists currently practicing CP only who also hold an AP certificate)



• Modular format is intended for MOC cognitive examination, keyed to individual practice areas and settings

• Examinees will complete “core” modules in AP and/or CP, and then also in their subspecialty areas if they so choose

• Examinations will generally include:– New developments in each area of practice– Clinically-valid, practice-related knowledge and

decision-making scenarios– Necessary practice-related information on

regulations, billing procedures, coding, etc.– Management questions concerning personnel,

equipment, information science, and health systems in general

• The 6 ACGME “core competency” areas will (somehow) be tested as well



• Content of cognitive examination:– If examinees are “current” in their practice

areas, MOC examination should be straightforward

– Content areas will be aimed at assurance of quality practice as well as assimilation of new information that is pertinent to practice

– Input as to what is “current quality practice:”• “Expert” consultants• Input from generalists, by poll or survey• Information taken from published reviews

and other important journal articles• Current textbook outlines and tables of

contents



• Content of cognitive examination (cont):– Information taken from SAMs– National meeting course contents– Questions will be derived from:

• CME-connected journal articles• SAMs• Questions synthesized by ABP committees• Problem-solving or “process” questions will

likely be included, based on actual practice• Written and “practical” sections will be

included in examination• A question bank may eventually be provided by the

ABP, possibly linked to web sites• Focus will be on fundamental knowledge rather than

esoteria• Emphasis will be placed on common sources of error

and medicolegal liability

Cognitive Expertise: MOC Exam

– Consists of 6 modules of 25 questions (150 total questions)

– 80% practical (virtual microscopy, case-based questions etc); 20% written

– Blends and grades modules as one exam



• Assessment of Performance in Practice:–Attestations regarding interpersonal

skills, ethics, moral character, and overall practice proficiency, from at least 4 specified reference personnel (the specific individuals can be chosen by the diplomate)

–Documented participation in ongoing interlaboratory quality-improvement programs (e.g., PIP, Check-Path, etc.)

–Participation in at least one laboratory quality-improvement activity each year by each diplomate



• What about diplomates who currently hold voluntary time-limited recertification?

– They may continue to recertify by a non-examination-based process, predicated on documented CME activity and maintenance of suitable licensure, practice privileges, and competency in practice, AT LEAST FOR THE PRESENT TIME

– A voluntary, “secure” recertification examination will be offered as of 2008, but it will be necessary for diplomates to come to Tampa, FL to take it

– The latter offering was developed because state medical boards, hospital administrations, and medical insurers are increasingly refusing to accept non-examination-based MOC as valid

AP/CP MOC Exam

+

+

+

+ 4 add. = 6 total

+ 3 add. = 6 total

+ 3 add. = 6 total

AP

CP

Option 1

Option 2

Option 3

General Modules

Specialty Modules

AP only MOC Exam CP only MOC Exam

General module

Specialty module

AP

CP 6 total 6 total

or or

or

or

or

or

or

or

or

or

3 max

+

+

ModulesClinical Pathology

General CP I, II, III, IV Hematology I, II

Blood Bank I, II Immunopathology

Blood Bank-Coagulation Microbiology I, II

Coagulation Chemistry I, II

General Modules

ModulesAnatomic Pathology

Gen AP I,II Breast

Gen Surg Path I,II Cardiovascular

General Cytology I, II Dermatology I, II

Cytology, Gyn Endocrine

Cytology, Non Gyn GI-Liver-Biliary

Bone-Soft Tissue Autopsy

General Modules

Revised 11/08

ModulesAnatomic Pathology (con’d)

Genitourinary Pediatric Pathology

Gynecologic Pulmonary-Mediastinal

Head-Neck Transplant pathology

Medical Renal Forensic Pathology

Neuropathology

Revised 11/08

Common Modules*Anatomic and Clinical Pathology

* May be used to fulfill AP or CP specialty modules

General Hemepath I (Lymph node-Spleen)

Flow Cytometry

General Hemepath II (Bone Marrow)

Molecular Pathology

Molecular-Cytogenetics Lab Manag / Informatics

Revised 11/08



The ABMS has made statements leading the ABP to believe that even NON-time-limited AP/CP certificate holders (i.e., diplomates from 2005 or prior) may be REQUIRED to recertify by examination in the future, even if this is not the current policy of the ABP



• FAILURE to meet MOC requirements will result in an “implementation plan” to improve performance by the examinee; this is one important reason why taking the MOC examination in year 8 of the 10-year cycle is strongly recommended

• Ultimately, inability to successfully achieve MOC by examination and other requirements, by the end of year 10 of the recertification cycle, would result in a LOSS of primary certification

• Remedial processes to deal with that eventuality (e.g., retraining, reexamination after completing a prescribed study program, etc.) are being developed but are not yet solidified

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• Miscellaneous information--– CME/SAM providers must communicate

with ABP at least once per year to provide information on diplomate activities

– SAM credits will parallel CME credits, BUT they are not necessarily the same

– SAM content will be vetted by the ABP, vis-à-vis relevance to the MOC examination

– 1 year of fellowship training will “count” for 2 years of SAM/MOC activity, with respect to recertification in AP/CP, IF it culminates in a subspecialty examination given by the ABP



• Miscellaneous information (cont.)--– Subspecialists will be examined on

the entire gamut of AP and/or CP-related topics in the recertification exam, IF they want to recertify in their primary areas

– People who recertify in a subspecialty area ONLY will have their primary certificates lapse. They will then have a 5-year period to recertify in AP and/or CP via the MOC route. After that, they must re-sit the primary AP and/or CP exam

Am Board of Path Maintenance of Certification Update 2009

Education

Transcript of Am Board of Path Maintenance of Certification Update 2009