Maintenance of Certification: Current Status and Future Considerations
Maintenance of Certification (MOC) is the process by which a board-certified physician in the USA demonstrates on an ongoing basis his/her continuing expertise in the chosen specialty. The MOC process was defined by the American Board of Medical Specialti
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Key Concepts • Approximately 6–12 % of physicians “fail to meet professional standards of practice” as defined by deficits in knowledge, disruptive behavior, systems problems impeding physicians’ care of patients, increasing physician age, problems unrelated to medical care (i.e., licensure issues or allegations of insurance fraud), physical illness, psychiatric illness, and substance abuse. • The American Board of Colon and Rectal Surgery (ABCRS) ended time-unlimited certificates in 1989, and began issuing certificates that required diplomates in Colon and Rectal Surgery to pass a secure “recertification” examination every 10 years intended to demonstrate continued mastery of content sufficient for specialty practice. • Parts I (maintenance of unrestricted license and good professional standing), II (lifelong learning and selfassessment), and IV (practice performance assessment and improvement) of the Maintenance of Certification (MOC) were designed to run concurrently in repeating 3 to 5 year cycles, with successful performance on the Part III secure specialty examination required at or about every 10 years to maintain specialty certification. • Part II and Part IV of MOC continue to evolve, with Part II requiring a defined number of CME credits that incorporate a self-assessment activity, which physicians have to pass with a 75 % correct grade. • ABCRS’ Part II of MOC self-assessment requirement may be satisfied with, among other activities, completion of the Colon and Rectal Self-Assessment Program (CARSEP) every 3 years, or completion of the Surgical Education and Self-Assessment Program (SESAP), a product of the American Board of Surgery (ABS). • Part III of MOC consists of the secure high stakes examination designed to assess broad knowledge of the specialty (previously the “recertification” exam).
• ABMS and member Boards continue to receive criticism regarding the financial and time burden of MOC requirements, redundancy with other professional and regulatory requirements, and most especially lack of relevance to physicians’ practices and an absence of proof that MOC produces improved patient outcomes. Rules are not necessarily sacred; principles are. — Franklin Delano Roosevelt
Introduction: How We Came To Be Here Evaluation of the literature dealing with medical error shows three major potential sources: healthcare delivery systems, insurer practices, and individual practitioners at various levels— physicians, nurses, pharmacists, and other healthcare workers [1]. The physician remains the single most identifiable individual in the healthcare system—the individual who directs and coordinates the activities of nurses, pharmacists, and other healthcare workers according to the plan of care. However, exponential growth of innovation in technology, pharmacology, and new scientific knowledge has produced a medical care system that is far more complex than ever before, and many discrete parts of the whole must interact smoothly to deliver healthcare that is safe, timely, and cost-effective. Within the complexity of the m
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