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Published 3/1/2016
Shepard R. Hurwitz, MD; David D. Teuscher, MD

Looking to the Future of MOC

By now, diplomates of the American Board of Orthopaedic Surgery (ABOS) are familiar with the Maintenance of Certification (MOC) process. The ABOS instituted the process—which first went into effect for diplomates whose board certification expired in 2010—in response to a directive from the American Board of Medical Specialties (ABMS), of which the ABOS is a member.

Since MOC's implementation, the shift from a single test to the MOC process has shown the public—including patients, payers, hospitals, health systems, and regulators—that certification is not static, but is instead an ongoing process of both knowledge- and skill-based education that improves quality and patient care. Although orthopaedists certified before 1986 are encouraged to participate in the MOC process, they are not required to do so. All diplomates certified later, however, must take part in MOC to maintain their Board certification.

Diplomates should know that the AAOS does not control the ABOS; rather, the organizations have a rich history of collegiality. The AAOS was one of three founding organizations of the ABOS, along with the American Orthopaedic Association (AOA) and the American Medical Association (AMA). Through a closed ballot process, two new directors are elected to the ABOS annually by the ABOS Board of Directors. (Rotating nominations are proposed by the AAOS, AMA, and AOA, with each organization nominating individuals in two of every three years.) Today, leaders from both organizations meet regularly to share opportunities for improving processes and the orthopaedic profession.

MOC, today and tomorrow
Currently, MOC maintains the 10-year certification time limit that began in 1986. There are two 3-year recording cycles that require diplomates to earn and submit evidence of 120 Continuing Medical Education (CME) credits. Of these, 20 credits must come from a list of ABOS-approved, scored and recorded self-assessment examinations (SAE). At the end of the second 3-year cycle, diplomates submit a case list. The case list was made a part of the process to meet the ABMS requirement of self-improvement, with the rationale being that by entering a list of recent cases, diplomates have the opportunity to reflect on their surgical outcomes. A secure examination—either computer-based or oral—is also part of the MOC process.

In the last 5 years, the ABOS has modified its MOC process several times to make it more efficient and effective. Drawing on significant input from the ABOS/AAOS Combined Task Force on MOC, the ABOS has incorporated changes aimed at simplifying the process and adding value for the ABOS diplomate, while demonstrating evidence of MOC's ability to help orthopaedic surgeons provide high-quality care to patients.

In 2014, the ABOS and the Accreditation Council for Graduate Medical Education (ACGME) began requiring basic surgical skills education for residents. As a result, a set of 17 modules on the fundamentals of orthopaedic surgery were made available at no cost to orthopaedic surgical residents and faculty. The ABOS, in partnership with the AAOS, the AOA Council of Orthopaedic Residency Directors (CORD), the Arthroscopy Association of North America (AANA), and other organizations aim to create new modules that cover more advanced orthopaedic surgical concepts and skills. Building on this teaching experience will help the ABOS work with many of these same organizations to develop methods for teaching and evaluating competence in patient safety, as well as surgical and communication skills, in a nonpunitive way.

In the future, better methods of assessment are likely to evolve that may be focused on surgical competence and the "soft" skills needed for communicating effectively with patients. Although it can be challenging to acquire enhanced communication skills, doing so is an essential part of being a fully competent physician.

As the ABOS continues to refine the MOC process—which was designed by orthopaedists, for orthopaedists—the ABOS will maintain its commitment to collaborating with the AAOS and other organizations, always striving to improve orthopaedists' ability to deliver high-quality care and help patients attain positive outcomes.

Resources from AAOS
The AAOS, in collaboration with the ABOS, has invested heavily in services and tools that help orthopaedists keep track of deadlines and requirements of the MOC process and to submit CME and SAE credits to the ABOS. Orthopaedists can visit www.aaos.org/moc to learn more about MOC and start using the AAOS Learning Portfolio to monitor their progress.

Shepard R. Hurwitz, MD, is the former executive director of the ABOS. David D. Teuscher, MD, is president of the AAOS. He can be reached at dteuscher@me.com

Questions about MOC? Contact the ABOS
The ABOS is the authority on MOC. Diplomates should visit the ABOS online at www.abos.org to view their customized MOC dashboards or call the ABOS at 919-929-7103.