ABIM to Launch 'Longitudinal' MOC Test

Physicians can choose between periodic brief assessments or single high-stakes exam.

This article was first published on Wednesday, August 21, 2019 in MedPage Today.

By Joyce Frieden, News Editor, MedPage Today

The American Board of Internal Medicine (ABIM) said it would offer a new form of maintenance of certification (MOC) exam that allows internists to answer a single question at a time and get immediate feedback on their answers, although no launch has yet been set.

The "longitudinal assessment option" for MOC is "part of our ongoing evolution at ABIM," Marianne Green, MD, chair of ABIM's board of directors, and Richard Baron, MD, ABIM president and CEO, wrote Tuesday in a blog post. "We recognize that some physicians may prefer a more continuous process that easily integrates into their lives and allows them to engage seamlessly at their preferred pace, while being able to access the resources they use in practice."

Under the new option, rather than taking an all-day test at a testing center or a 2- or 3-hour test at home, physicians could answer a single question at a time, accumulating a required number of questions within a given time period. "This would be something people don't do at a center; they would do it in a self-paced way one question at a time, accumulating their performance over time to make assessment decisions, rather than having everybody do everything at one point in time," Baron said in a phone interview.

In addition, "one of the things we have heard is that people want an assessment that has more educational value directly built into it, so when people answer a question [in this type of assessment], they'll [find out] what the correct answer is -- their answer will [also] be scored, and they'll get references and some discussion of why that's the right answer, and even in the process of doing the assessment, they'll have educational opportunities," he explained.

The timeline for launching the longitudinal assessment is still being worked out, Baron said. "There are a lot of operational issues, and we want to work those through in co-creation with the community rather than put it out there fully formed ... We expect a timeframe soon, but we need to work out operational details before we can commit to that."

As for the cost, "We expect there's going to be an annual fee and we need to develop a fee structure to support the program," he continued. "We don't expect that the overall cost over 10 years is going to be higher than what it is now."

This idea isn't completely new, Baron added. "Some other boards have done versions of this -- the first one was [the American Board of Anesthesiology], which released the MOCA Minute. It was a question a week," which was a little more frequent than ABIM diplomates seem to want, he said. "There is probably an expectation of a certain number of questions in a quarter that people can do weekly, monthly, or wait until the end of the period. These are the kind of questions we need to get feedback from people on how to do this." In addition, "we need to be sensitive [to the fact that] people get sick and people have life events, and how do you manage those sorts of things? We need to work through all of that."

In terms of developing specific test questions, internal medicine has special challenges because of the number of subspecialties involved, Baron said. "We're in the process of having conversations with a number of professional societies, so people could get content that was enriched for the kind of practice they do ... If a practice is focused on breast cancer, they will be able to do an assessment that has lots of breast cancer questions on it," although they will still also be tested on core internal medicine areas.

Initial reaction to the announcement has been positive -- at least in one corner. "ASH [American Society of Hematology] applauds ABIM's recognition that MOC can take many forms," ASH President Roy Silverstein, MD, said in a statement. "This new direction for MOC is a welcome change because it will better align with the needs of hematologists. For many years, the Society has advocated for assessment options that enhance medical knowledge through ongoing feedback outside of examination settings. We are thrilled to see this long-overdue reform being made."

Silverstein noted that "this change was recommended earlier this year by an independent 'Vision Commission' appointed by the American Board of Medical Specialties to improve MOC. These new assessments are expected to offer more interactive, less time-bound methods of assessment that allow physicians to continuously assess their knowledge, fill knowledge gaps, and demonstrate proficiency."

One group likely not happy about today's announcement, however, is the Practicing Physicians of America, a group of physicians that is currently supporting a lawsuit seeking to force ABIM to drop its MOC program entirely.

"Many of us believe Maintenance of Certification is not only discriminatory against younger, more economically vulnerable physicians who are increasingly comprised of females and physicians of color, but was fraudulently promoted to physicians, hospitals, insurance companies, medical corporations, health care employers, and the public to force working physicians to provide lifelong payments to the American Board of Medical Specialties member boards to serve personal, political, and promotional agendas," Westby Fisher, MD, a co-founder of the group, said Monday in a video opinion piece for MedPage Today. Fisher did not respond to a request for comment on Wednesday's announcement by ABIM.