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Contemporary Surgery REAL WORLDMaintenance of Certification:
Your questions, our answersSteven
C.
Stain,
MD;
Neil Lempert Professor and Chair, Department of Surgery, Albany Medical College, Albany, NY Michael
S.
Nussbaum,
MD;
Department of Surgery, University of Cincinnati, Cincinnati, OH Frank
Lewis,
MDExecutive Director, American Board of Surgery, Philadelphia, PA
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What does it all mean for the typical general surgeon? Here are answers to your questions.
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Editor’s comment
Maintenance of Certification (MOC) is truly real world for each and every practicing surgeon in the country today. There are arguments on both sides of the MOC fence which are hotly debated by many. It is here to stay though, and shall not fade like the morning mist. All three of the authors are experts in this field…listen to their words carefully…there are many pearls for all who take the time to digest their thoughts.
—Jon van Heerden, MD, Co-Editor-in-Chief
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Surgeons are committed to continuously finding ways to improve patient care and validate their own expertise. The latest professional development program to attempt this is called Maintenance of Certification, or MOC, engineered by the 24-member Boards of the American Board of Medical Specialties (ABMS).
These boards, of which the American Board of Surgery (ABS) is a member, have committed to move beyond the traditional 10-year recertification examination to a process of lifelong learning, assessment, and improvement.
 A little history
The ABMS was established in 1933 to create uniformity of physician certification and increase public awareness of the value of specialty certification. The ABS was founded in 1937 as one of ABMS’ 24-member boards to certify surgeons who meet a defined standard of education, training, and knowledge.
In 1973, the ABMS established a recertification policy for the continued evaluation of competence. In 1976, the ABS decided that diplomates should pass a written recertification examination every 10 years.
Q. How do I enroll in MOC?
A. Since July 2005, ABS diplomates have been automatically enrolled in the MOC program upon certification or recertification. Like recertification, MOC is a voluntary process, required only if a diplomate wishes to maintain ABS certification. MOC requirements take effect on July 1 following certification or recertification, which is the start of the ABS fiscal year.
Q. How does MOC differ from regular recertification?
A. Traditional recertification required a diplomate to apply, take, and pass a secure recertification examination toward the end of each 10-year cycle. The ABS now requires the completion of MOC activities every 3 years along with the secure examination every 10 years (TABLE). 214
TABLE.MOC requirements timeline1
| Year of certification or recertification |
Diplomate initially certifies or successfully recertifies |
| Year 1 |
CME (minimum 30 hrs Category I, 50 hrs overall every year) |
| Year 2 |
CME |
| Year 3 |
CME plus self-assessment: Reference letters and evidence of CME and self-assessment sent to ABS; license status and participation in practice assessment (Part 4) also verified. |
| Year 4 |
Same as year 1 |
| Year 5 |
Same as year 2 |
| Year 6 |
Same as year 3 |
| Year 7 |
Same as year 1 |
| Year 8 |
Same as year 2 |
| Year 9 |
Same as year 3 |
| Year 8–10 |
Secure examination |
Q. Are there fees to participate in MOC?
A. The ABS is currently evaluating fees for the MOC process.
Q. Why should I participate in MOC?
A. MOC allows ABS diplomates to document their commitment to ongoing learning, assessment, and improvement, and demonstrate a concerted effort to sustain and improve the quality of care he or she delivers.
Q. If I don’t participate in MOC, what will happen?
A. Diplomates who fail to provide the necessary documentation after 3 years of MOC will be given a warning and a 1-year grace period, and will be flagged as not participating.
Q. I recently certified and am now a fellow. Does MOC apply to me?
A. While you are in a fellowship, your training fulfills MOC. The fellowship must be approved by the Accreditation Council for Graduate Medical Education (ACGME) or a recognized surgical society. Once you complete your fellowship, you will then have to begin to fulfill standard MOC requirements.
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Fast Track
Keep your contact information up to date with ABS so you will receive reminders your about MOC deadlines.
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Q. What proof do you need for CME/self-assessment?
A. Currently the ABS accepts copies of certificates from the primary source or sponsor of the educational activity stating that the educational activity is Category I and accredited by the Accreditation Council for Continuing Medical Education (ACCME) or AMA. Category II CME does not require documentation. For the future, the ABS is working with the ACS to allow diplomates to electronically transfer CME credits gained through the ACS directly to MOC database.
Q. What if I am certified in more than one specialty?
A. The ABS allows evidence of professional standing, lifelong learning and self-assessment, and evaluation of performance in practice—Parts 1, 2, and 4 (BOX) obtained for one certificate to be credited toward any other certificates a diplomate might hold. However, the diplomate will have to fulfill the cognitive expertise requirement of a secure examination (Part 3) in each discipline in which one maintains certification.
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The four components of MOC
1. Professional standing
Surgeons must document evidence of professional standing—that is, have a valid, unrestricted medical license. Surgeons with an active practice must also provide:
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Evidence of membership on a hospital staff with valid credentials.
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Letters of recommendation from the chief of surgery and the chair of the credentials committee at the institution where the surgeon does most of his or her work.
2. Lifelong learning and self-assessment
The ABS is working with the American College of Surgeons (ACS) and specialty surgical organizations to develop more specialized CME and self-assessment tools. Available resources include:
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ACS Evidence Based Reviews in Surgery.
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ACS Surgical Education and Self Assessment Program (SESAP).
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ACS Surgical Index.
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Journal of the ACS CME.
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Medscape Surgery CME.
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Selected Readings in General Surgery.
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Vascular Self Evaluation Program (for vascular surgery only).
3. Cognitive expertise
There is no change in the requirement of successful completion of a secure examination at 10-year intervals. Diplomates may take the examination up to 3 years before their certificate expires.
4. Practice performance assessment
The assessment of surgical outcomes is the standard the ABS would like to attain. Although several outcomes tracking and quality assessment programs are under way, the ABS recognizes that these are not available to all diplomates, so it is exploring other national or regional programs to satisfy this requirement. Programs the ABS already accepts are:
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ACS case log reporting system (if complications are tracked and documented).
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Bariatric Surgery Database (ACS or ASBS).
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Burn Registry (NTRACS or other).
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CMS Physician Quality Reporting Initiative (PQRI).
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National Trauma Data Bank (NTDB).
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Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Outcomes Initiative.
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Society of Thoracic Surgeons (STS) National Database.
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Surgical Care Improvement Project (SCIP).
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United Network for Organ Sharing (UNOS).
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Vascular Surgery Board Defined Outcomes Report (for vascular surgery only).
Where such programs are not available, the ABS will consider individual practice data.
Although the ABS recognizes that performance assessment programs are still limited, applicant data has shown an encouraging trend. In the 2005 recertification examination, 54% of applicants participated in outcomes studies, up from 48% in 2004 and 34% in the 2003. Further, applicants who participated in outcomes studies had a 6% failure rate on the recertification examination versus 9% for those who did not report participation in outcomes studies.
—SCS, MSN, FL
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Q. Once I’m enrolled in MOC, how will I know when I have to submit something?
A. The ABS will send you periodic reminders via e-mail and a specific reminder when documentation is due. Your reference letters and evidence of CME and self-assessment will be required by June 30 of your third year in MOC. Keep your contact information with the ABS up to date.
Q. I recertified in the fall of 2005. What do I need to do right now?
A. MOC went into effect for you on July 1, 2006. You will have to submit reference letters and evidence of 3 years of CME (30 hours Category I, 50 hours overall yearly) including self-assessment, by June 30, 2009.
At that time, the ABS will also verify your medical license status and participation in a practice assessment activity. Currently you should be acquiring yearly CME to meet these requirements and saving all documentation regarding your Category I CME activities. 215Q. My certificate expires in 2010. What do I need to do now?
A. Diplomates are automatically enrolled in MOC upon certification or recertification, but you are not presently enrolled in MOC because you haven’t retested since 2005.
You will be eligible to recertify 3 years before your certificate lapses. If you successfully complete the recertification examination, you will begin MOC July 1 after passing the examination. Diplomates are welcome to begin MOC early. However, starting MOC earlier than required will not change the expiration status of your certificate.
The authors are all officers of the American Board of Surgery.
- Maintenance of Certification.
American Board of Surgery. Available at: http://home.absurgery.org/default.jsp?exammoc. Accessed April 15, 2008.
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