“…The Matrix is everywhere, it is all around us. Even now, in this very room. You can see it when you look out your window, or when you turn on your television. You can feel it when you go to work, or when go to church or when you pay your taxes. It is the world that has been pulled over your eyes to blind you from the truth…””

Plato (427-347 BCE) – The First MatrixAllegory of the Cave

Plato (427-347 BCE) – The First MatrixAllegory of the Cave

Departure from the CaveDeparture from the CaveImprisonment in the Cave Imprisonment in the Cave

…… Socrates insists that the enlightened must return to Socrates insists that the enlightened must return to the cave in order to share their enlightenment with the the cave in order to share their enlightenment with the prisoners, even if it results in deathprisoners, even if it results in death……

Return to the CaveReturn to the Cave

How does MOC work?

http://www.theabr.org/

Four (4) Components Four (4) Components …… ... in Six (6) Competencies... in Six (6) Competencies1. Professional Standing1. Professional Standing

2. Lifelong Learning & Self2. Lifelong Learning & Self--assessmentassessment

3. Cognitive Expertise 3. Cognitive Expertise

4. Assessment of Performance in Practice4. Assessment of Performance in Practice(Practice Quality Improvement (Practice Quality Improvement –– PQI)PQI)

a. Medical Knowledgea. Medical Knowledge

b. Patient Care b. Patient Care

c. Interpersonal & Communication Skillsc. Interpersonal & Communication Skills

d. Professionalism d. Professionalism

e. Practicee. Practice--based Learning & Improvementbased Learning & Improvement

f. Systemsf. Systems--based Practicebased Practice

Part 3: Cognitive Expertise(The exam will become available to diplomates in 2010)

Part 3: Cognitive Expertise(The exam will become available to diplomates in 2010)

OneOne proctored, timed, closedproctored, timed, closed--book examinationbook examination

When: When: to be scheduled during the to be scheduled during the 8th, 9th or 10th year8th, 9th or 10th year(10(10thth must pass!!!)must pass!!!)

Specific details about the cognitive exam include: Specific details about the cognitive exam include: Proctored, secure, administered in a nationallyProctored, secure, administered in a nationally--recognized computer testing center. recognized computer testing center.

New exams will be offered once each year. New exams will be offered once each year.

MultipleMultiple--choice format covering:choice format covering:A. A. Core knowledge (approximately Core knowledge (approximately 3030%)%) and and

B. B. Current evolvingCurrent evolving technologies (approximately technologies (approximately 7070%).%).(Image guided LINAC, IMRT, Cyber(Image guided LINAC, IMRT, Cyber--Knife, Proton Beam, etcKnife, Proton Beam, etc……))

If you fail anIf you fail an exam, you will have the opportunity to take exam, you will have the opportunity to take the examination offered in the next year. the examination offered in the next year.

******DiplomatesDiplomates holding multiple certificates must:holding multiple certificates must:Complete the exam for each of the disciplines for Complete the exam for each of the disciplines for

which they hold certificates.which they hold certificates.

AAPM ReportACR: TG - 35 / 40 / 43 / 51+51A/ 53 / 66 / 103 / 106 / 119 / 142ABR-MOC: 61 / 62 / 75 / 76 / 101 / 148 / 166 / 179 ICRU: 50 / 62QUANTEC and Dr. Emami (Normal Tissue toxicity)TG-166 (BED)TG -103 - On Peer-Review in ClinicalTG-45 (Code of practice)SHIELDING = NCRP: 151 (Therapy)/147 (Radiology)

LINAC-basedTG - 51 (AAPM QUIZ) / 51UTG- 71 (Monitor Units)

CTTG - 66 (CT QA)Shielding

Brachytherapy (LDR and HDR)TG - 43/ 43U1 / 43S1 (Absolute Calibration)TG - 56 (HDR Treatment Delivery)TG - 59 (Code of Practice for Brachytherapy)TG - 60TG - 64

TG - 186 (Model-based algorism in inhomogeneity) IGRTTG - 179 (QA IGRT)TG - 75 (Management Image Dose)TG - 76 (Tumor Motion)

TPSTG- 53 (QA for TPS)

SBRTTG - 142, 40 , 21 ( Comprehensive QA in Radiation Oncology)TG - 101 (SBRT)TG -135 (Cyber-Kinife)TG - 148 (Tomotherapy)TG - 65 (inhomo)TG - 119 (IMRT Commissioning)

IORTTG - 72 (IORT)TG - 39 (Calibration PP chamber)

TG - 106 (Beam data collection)

TG 53 - TPS QA

TG - Air (Reference/Absolute) / 106 / 21TG - 128TG - 61 (kV)TG - NRC-99 / 25TG - 25TG - 41TG - ICRU-38TG - ABS guidelinesTG - 50TG - 52TG - 83TG - 166 (BED)

AAPM 55th Review CourseAAPM SBRT Summer SchoolTG - 42 (Stereotactic Radiosurgery)

AAPM Radiotherapy:External Beam

www.abms.orgwww.abms.org

www.theabr.org

www.aapm.org

www.campep.org

In March 2000, the 24 member boards of the In March 2000, the 24 member boards of the ABMS representing all medical subspecialties in ABMS representing all medical subspecialties in the USA agreed to initiate specialtythe USA agreed to initiate specialty--specific specific maintenance of certification (MOC) programs. maintenance of certification (MOC) programs.

How do we measure competency

How do we measure competency

when practices are diverse

when practices are diverse

and roles are unique?

and roles are unique?