The American Board of Internal Medicine (ABIM) encourages diplomate participation in continuing certification (also known as MOC) as a demonstration of their commitment to lifelong learning. Certification engenders public trust, is meaningful, and is valued by diplomates.
Since the MOC process can be confusing and seems to be ever changing, this column addresses frequently asked questions about navigating MOC, especially relevant for new graduates and those considering alternatives to the traditional 10-year MOC exam.
What Is the Evidence that MOC Matters?
While there is ongoing debate about the utility of participation in MOC, studies reveal convincing correlations between MOC and quality of care provided by general internal medicine (GIM) physicians. McDonald, et al,1 found that passing the Internal Medicine (IM) MOC within 10 years of initial certification was associated with decreased state medical board disciplinary actions, an important quality outcome for patients and the profession. In this historical cohort study of more than 45,000 GIM physicians, the risk for disciplinary action—such as loss of licensure among physicians who did not pass the IM MOC examination within the 10 year requirement window—was more than double that of those who did pass the examination. In a separate study of 1,260 GIM physicians by Gray, et al,2 quality of care as measured by annual comparisons of HEDIS performance measures differed according to physician MOC status. Specifically, physician maintenance of certification 20 years after initial certification was positively associated with meeting HEDIS measures for patients with diabetes, coronary artery disease, and some preventive care services.
What Are the Basic MOC Requirements?
Diplomates of the ABIM are publicly reported on the website abim.org/verify as to whether or not they are participating and/or certified in MOC. “Participating” in MOC is defined as follows:
- Completing one (1) MOC activity every two (2) years, such as: a Medical Knowledge Module or Knowledge Check-In, QI/PI activity, utilizing decision support with tools such as UpToDate, or attending a live group learning session (e.g., SGIM meeting).
Points earned will count toward the five-year requirement of 100 MOC points.
Certified is defined as:
- Earning 100 MOC points every five (5) years.
Twenty (20) of these points must be in the Medical Knowledge category.
- Passing either the traditional MOC Exam within ten (10) years of when you last passed OR remaining on a successful path of Knowledge Check-Ins (KCI) every two (2) years.
Your specific assessment deadline is noted in your ABIM physician portal.
What Changes Have Recently Been Made Regarding MOC Exams and What Does the Future Hold?
In 2018, the shorter, lower stakes KCI exam was launched. This biennial exam, available every even-numbered year, is three hours long and is taken either remotely or at a testing center by virtual proctor. Five KCIs or one traditional MOC exam is the same cost over 10 years—$650.00. Test results are immediately available upon completion of the KCI, with a complete score report available 3-4 weeks later. In comparison, the traditional MOC exam is required every 10 years at a center with a live proctor; complete score reports are available 6-8 later. Both exams provide free access to UpToDate during testing sessions.
In April 2020, due to COVID-19, the ABIM announced that all currently certified physicians with a MOC 2020 requirement will now have until the end of 2021 to complete it. Spring MOC examination dates were cancelled, but fall 2020 MOC assessments remain available. Updates due to COVID-19 are available at https://www.abim.org/media-center/Coronavirus-Updates.aspx.
The ABIM met in August 2019 to discuss further changes to MOC and unveiled the plan to provide a longitudinal assessment option starting in 2022.3 With this option, physicians will be able to answer a question utilizing resources they use in practice and at their own pace, receive immediate feedback as to whether it was correct or not, along with the rationale, and links to educational material. The longitudinal option will replace the current KCI that will end at the close of 2021. Longitudinal assessment, a five-year cycle that includes a longitudinal participation and performance standard requirement, was developed in response to physician feedback to ABIM asking for more flexibility, relevancy, and higher educational value in the process of MOC. Over the course of five years, physicians will be offered 600 questions and can skip 100 of them to meet the participation requirement. While feedback is provided along the way, a determination is made at the end of the fifth year if you’ve met the performance standard. To maintain certification if you don’t meet either of these requirements you must pass the traditional MOC exam in the following year.4
What Strategies Does the ABIM Employ to Improve the MOC Process?
The ABIM continually strives to improve the process and quality of exams. Part of this improvement process includes surveying diplomates about their perception of assessment fairness. In November 2019, ABIM diplomate survey results showed that perception of the fairness of assessment continues to improve and is the best it has been since this metric started being collected.5 This may be related to new methods that have been instituted to develop exam content in response to feedback from the internal medicine community.
ABIM staff and its exam committees are currently collaborating with a group of physician volunteers assembled as the Item-Writing Task Force which aims to improve the relevance and validity of assessment questions to clinical practice while meeting the increased demand for content associated with the longitudinal assessment option. This Task Force is represented broadly with physicians from across the country who work in diverse practice settings and are engaged in all aspects of clinical practice. In addition, new model-based question development techniques involve establishing a set of specifications for creating exam questions in a certain area. These specifications are then used to produce high-quality questions in that content area. Finally, as ABIM works towards implementing this longitudinal assessment option, they are engaging with Family Medicine and Pediatrics, to learn from their specialties’ already piloted, as of 2018 and 2017 respectively, longitudinal assessment experiences.5
What MOC Qualifying Activities Does the Society of General Internal Medicine Offer?
Regional and national SGIM conferences are wonderful ways to learn and network with colleagues. Since 2019, they have also become an excellent way to earn MOC points. MOC points usually arrive within six weeks of providing your ABIM number and requesting MOC when filling out after-meeting evaluations. SGIM2020 On-Demand offers a cost-effective option for purchasing approximately 30 MOC points after answering viewed session questions. Additional opportunities to earn MOC points through SGIM-related experiences are likely coming.
How Can Physicians Earn MOC Points for Their Institutional CME-Eligible Programs?
ABIM’s collaboration with the Accreditation Council for Continuing Medical Education (ACCME) provides the opportunity for ABIM Board Certified physicians to earn MOC points for thousands of accredited CME activities. These collaborations increase the number and diversity of accredited CME activities that meet the requirements for MOC and streamline the process for accredited CME providers and physicians. Many doctors are currently getting most of their CME/MOC points searching decision support tools like UpToDate.
For institutional CME-eligible programs not currently granting MOC points, physicians can contact their institutional CME provider and advocate for their participation in the educational activity to be reported to the ABIM. Physicians should also leverage the support and resources provided by the ACCME by reaching out to firstname.lastname@example.org. The ACCME will then follow up with the institutional CME provider to explain how the process works and encourage their participation in MOC.
ABIM MOC is valuable and currently offers physicians options for satisfying the requirements of both MOC participation and certification. A longitudinal assessment option is scheduled to begin in 2022 and will replace the KCI assessment option. ABIM’s new processes for question development hopes to achieve less reliance on rote memory and a more valid and relevant assessment of the physician knowledge and clinical judgment. SGIM and local institutions are excellent sources for GIM physician MOC participation.