Tips from the ABOS about navigating the MOC process

Maintenance of Certification™ (MOC) is far from being a pointless chore or record-keeping exercise, says Shepard R. Hurwitz, MD, executive director of the American Board of Orthopaedic Surgery (ABOS). Instead, he notes, MOC plays a pivotal role in ensuring that orthopaedists provide excellent care.

AAOS Now recently sat down with Dr. Hurwitz to discuss MOC.

AAOS Now: Why did the ABOS make the move to MOC?

Dr. Hurwitz: Patients today want their physicians—particularly those who obtained their board certification 10 or 20 years ago—to demonstrate that they are keeping up with treatment trends, techniques, and guidelines. When the American Board of Medical Specialties (ABMS), the parent board of all medical specialties, decided to move toward MOC, the ABOS had no objection to the change.

Although MOC may require a certain amount of additional work on the part of the certificate holder, it’s a valuable process that ensures that board-certified orthopaedists are up-to-date on the best strategies for providing care. It also demonstrates to the public that our profession holds itself to the highest standards of safety and accountability.

AAOS Now: How similar is MOC to the former recertification process?

Dr. Hurwitz: The MOC process evaluates applicants on the following four components on a continuing basis:

• evidence of professional standing
• commitment to life-long learning and self-assessment
• evidence of cognitive knowledge
• evidence of performance in practice.

Many elements of the MOC process are quite similar to those in the former recertification process. Both have a 10-year timeline, both require accumulation of a certain number of continuing medical education (CME) credits, and both require the applicant to take an examination.

Under MOC, however, we have added some requirements, including the need to obtain 20 credits of scored and recorded self-assessment examinations (SAEs). MOC also breaks down the process in greater detail.

MOC requires applicants whose board certification expires in 2010 through 2016 to obtain 120 AMA PRA Category 1 CME Credits™ in one 3-year cycle prior to taking the cognitive examination. Diplomates whose certification will expire in 2017 and beyond must obtain 120 CME credits in two consecutive 3-year cycles, totalling 240 credits over 6 years, before taking the secure cognitive examination.

Each applicant must submit proof of having obtained 20 credits from scored and recorded SAEs as part of the total 120 CME credits required for each 3-year cycle. Scored and recorded SAEs are available from the Academy and several specialty societies. These exams differ from “self-scored” exams because the answers must be submitted to the exam provider for scoring.

AAOS Now: Are there any added benefits to satisfying the MOC requirement for CME credits?

Dr. Hurwitz: In most states, licensure and relicensure require a certain number of CME credits. Because our requirements for CME credits dovetail very nicely with state requirements, orthopaedists who obtain and/or maintain their board certification through MOC can renew their licensure without taking a state medical exam. Successful participation in MOC also helps board-certified orthopaedists who move out of state obtain licensure in their new state of residence without taking a state medical exam.

AAOS Now: What about the case list requirement?

Dr. Hurwitz: Those who choose the computer examination pathway must submit a 3-month list of surgical cases, with a maximum of 75 cases. Those who choose the oral examination pathway must submit a case list from 6 consecutive months.

When fellows compile and review their case lists, they can note whether they signed the site before surgery and gave preoperative antibiotics, both of which are in line with pay-for-performance (P4P) protocols. They may have good reasons for not administering preoperative antibiotics in certain cases, and that can be reaffirmed by looking at their results. If, however, they’re seeing a few infections that most orthopaedists in practice wouldn’t see, the case list review can prompt them to comply with this P4P measure.

AAOS Now: How does the peer review component work?

Dr. Hurwitz: After the ABOS receives an application for the cognitive examination, we send evaluation forms to the people named as being able to evaluate the applicant’s performance. Peer reviewers may include orthopaedic surgeons; the chiefs of the anesthesia, radiology, or emergency departments; operating room nurses; administrators; and others.

The evaluations measure whether the applicants are fulfilling all their obligations. For instance, if they are supposed to be on-call, do they come in and take call? Do they communicate well with their patients and other physicians? So, we’re really asking whether applicants are good citizens as well as good surgeons.

AAOS Now: What happens after the ABOS receives the case lists and peer review information?

Dr. Hurwitz: The ABOS Credentials Committee meets in the fall the year before an examination to review the information and determine whether the applicant meets the professional and ethical standards for being a board-certified orthopaedist. Committee members also determine whether the applicant is performing enough operative procedures to be considered an active orthopaedic surgeon. They look for any recurring problems that may indicate the need for performance improvements, such as a high number of returns to the operating room or many infections.

AAOS Now: How is MOC updated?

Dr. Hurwitz: Each year we write new questions and invite new examiners. We’re constantly getting younger people on board to get input about the skills and knowledge diplomates should be able to demonstrate.

AAOS Now: How do you respond to those who say that MOC is too time-consuming?

Dr. Hurwitz: We know some orthopaedists are not entirely comfortable with MOC yet. It does take time to enter a case list, and it takes additional time and a little bit more money to complete scored and recorded self-assessment examinations. We believe, however, that these are extremely worthwhile endeavors and resources are available to provide assistance. Practically every activity related to the MOC process is in line with the trend in American medicine to be more reflective about how we practice and what our outcomes are. Some of our colleagues, in fact, find it a stimulating process that improves their skills. I know that not everyone feels that way, but the ABOS has always seen MOC as a quality improvement process rather than a set of hurdles to jump over.

AAOS Now: Where can AAOS members find those MOC resources?

Dr. Hurwitz: They can sharpen their skills by obtaining educational products from the AAOS and specialty societies, as well as by attending appropriate CME courses. It’s also helpful to consult with other surgeons.

AAOS Now: Is there help with record keeping?

Dr. Hurwitz: The AAOS has a free transcript service (www.aaos.org/transcript) for all members. It automatically logs CME credits earned through Academy-sponsored courses, multimedia programs, and exams, as well as programs offered by many of the specialty societies. It also allows orthopaedists to add information about any CME earned from other sources. Fellows should be sure to retain all documentation from any organization that has sponsored their CME activities.

Because the transcript service lists the maximum number of credits for which an activity qualifies, fellows must access the transcript and actively claim the credits they’ve earned.

Any and all questions about MOC and specific deadlines should be directed to the ABOS, either online at ww.abos.org or by phone at (919) 929-7103. Also, be sure to read all communications sent by the ABOS and maintain current e-mail and address information by alerting the ABOS office in Chapel Hill, N.C., of any address changes.

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org

Maintenance of Certification for Diplomates of the American Board of Orthopaedic Surgery with certificates expiring in 2011 who want to take the 2011 examination (PDF)