CME for MOC – What’s Not to Like?

CME for MOC – What’s Not to Like?

Dominick Tammaro, MD, is originally from Brooklyn, New York, and has served as the Internal Medicine Residency Director at the Warren Alpert Medical School of Brown University since 1991. He completed his internal medicine residency at Saint Vincent Hospital in Worcester, Massachusetts, followed by a chief resident year, during which he developed his interest in Graduate Medical Education.

Dr. Tammaro, a board certified internist, is the Internal Medicine Residency Director at the Warren Alpert Medical School of Brown University. He is an Associate Professor and has been on the faculty at Brown since 1988. Dr. Tammaro first began his career in residency leadership in 1991 as the Associate Residency Director, eventually moving to his current position. He practices mostly inpatient medicine as a member of Brown Medicine, Brown’s internal medicine faculty practice organization.

Dr. Tammaro is a fellow of the American College of Physicians (ACP) and is a member of the Governor’s Council of the Rhode Island Chapter of the ACP. He is also a member of the Association of Program Directors in Internal Medicine and the Alliance for Academic Internal Medicine, where he serves as Chair of the Educational Program Planning Committee.

Dr. Tammaro earned his undergraduate degree at Brown University in Providence, Rhode Island, and his medical degree at Brown University Program in Medicine. He completed residency training and was chief resident at Saint Vincent Hospital in Worcester, Massachusetts.

Why is maintaining your certification important to you?

My first sentiment when Maintenance of Certification (MOC) was rolled out was, “Whew…I dodged that bullet!” as I am grandfathered in (a term I am increasingly coming to resent as I get older), having certified in 1987. As I followed the debates surrounding MOC v1.0 from the sidelines, I began to appreciate the fact that certification should not be static and in fact should reflect a professional’s clinical skills and knowledge at a point in time, not indefinitely. I also felt that as the director of a residency program, I had an obligation to my residents (all of whom would be required to re-certify on a regular basis) and to my faculty to be a role model by maintaining my knowledge and skills through self-education. This is a core pillar of our professional obligation to our patients and it felt somewhat hypocritical to opt out while simultaneously promoting lifelong learning to my residents.

What’s surprised you most about the MOC program?

This new version of MOC reflects the input that many of us have provided to the Board, both as individuals as well as through professional organizations such as APDIM, AAIM and ACP. The result is much more practitioner-centric. Most surprising is the ability to count quality improvement work that I and my core faculty and associate program directors engage in on a daily basis toward the maintenance of our certification. This flexibility allows us to get credit for work we are already doing to improve our clinical practices and systems; it seemed unfair and an oversight to exclude this in the original MOC system. CME for MOC is another example of allowing those of us involved in medical education—undergraduate, graduate or continuing medical education—to apply our existing educational activities (with quality controls) toward maintaining certification. While not exactly surprising, these changes are welcomed.

What lead you to practice internal medicine?

I was enticed by every core clerkship during medical school but internal medicine seemed to be the broadest in scope and the most centered around my favorite aspects of medical science. While this latter quality is true in some measure for all medical disciplines, internal medicine combined the science with humanism and a disciplined approach to sorting out clinical problems. I also enjoyed the bedside conversation and care of patients with medical conditions – or in need of the prevention of medical conditions. I considered a fellowship in nephrology for a while but decided that I was a generalist at heart and haven’t regretted it once.

What do you most enjoy about working with residents?

I enjoy witnessing the growth of my residents from the newly-minted MD with a lot of content medical knowledge but lacking in process knowledge to, over time, a confident team leader who can develop a well-prioritized plan of care and identify when we need to question our assumptions. I enjoy watching and helping residents challenge themselves to grow as physicians. As an educator, aside from the professional satisfaction described above, I enjoy the teamwork approach to learning – everyone brings some knowledge and perspective to the table and we learn from each other. I take a great deal of pride in the skill and confidence of our graduates – it keeps my job exciting and fresh.

Why did you decide to lead the charge to offer MOC points for grand rounds and other CME activities at your institution?

I play a role in planning our department’s Grand Rounds and Morbidity and Mortality (M&M) conferences. I also collaborate with my colleague, Surgery Residency Director David Harrington, in a joint M&M conference several times per year. In April, following one of these conferences, I was completing my evaluation form and found a second page attached. This second page explained that, by answering a short series of questions, I could receive MOC credit from the American Board of Surgery. Having not entered the OR since my third-year clerkship, I wondered if ABIM had a similar mechanism whereby existing ongoing high-quality continuing medical education activities could be counted toward my department’s MOC efforts. In the previous MOC configuration, I had always felt that so much of what I do on a daily basis as part of my role as a medical educator was held as off-limits to count toward MOC. This was an opportunity to correct that problem, and I knew it would be a benefit and service to my colleagues and my department and quite possibly would improve attendance at Grand Rounds. This was a win-win in my view.

What about CME for MOC entices you?

What’s not to like? I plan, participate and attend Grand Rounds and M&M conferences in our department weekly. Both are high-quality learning activities and involve current medical content and patient-centered topics. I engage in lifelong learning and in doing so, receive credit toward licensure in the State of Rhode Island. Isn’t that the same as Maintenance of Certification? It’s rare in our profession to have activities “count twice” but in truth, the spirit of CME and MOC is identical, so why not count them for both credentials? Another major benefit is that these activities are free to members of our medical staff and thus are of high value to those practicing medicine.