Exploring Alternatives to the MOC exam: Physicians Invited to Participate in ABIM Research on Open Book Assessments

This past fall and winter—with an eye toward moving away from a mandatory 10-year Maintenance of Certification (MOC) exam for all ABIM diplomates while seeking new ways of assessing physicians throughout their careers—ABIM has been discussing the Assessment 2020 Task Force recommendations with physicians and societies and getting feedback from them. We have heard clearly that the community wants to move forward very quickly to explore alternatives to the current every-10-year MOC exam. We have heard the passion behind this urgency, and we are grateful for it. It shows how many diplomates and organizations want ABIM to get this right.

You, our diplomates, and the public we serve, care about improving MOC because the credential matters. The process through which diplomates get and maintain certification has meaning and signals that a board certified internist is working with current knowledge and that patients can trust in that certification. While we can improve the current process, individual physicians who hold an ABIM credential have achieved certification based on a substantive national peer-driven process that recognizes achievement and competency in a specific discipline beyond the basic requirements of licensure. That is why it is important for physicians to continue to participate in MOC and complete requirements, including the current every-10-year exam.

As ABIM continues to work with physicians to create alternatives to the current exam, it is critical that we do it in a way that preserves meaning and value for those who go through the program and says something important and relevant about physicians to themselves, their colleagues and the patients we collectively serve.

The future starts now: Exploring open-book assessments

One proposed change—suggested repeatedly from medical society leadership and in broad community dialogue—is to make at least a portion of ABIM’s assessment “open-book,” offering the ability to access online resources when taking MOC assessments. Many have told us that doing so would be truer to a physician’s every day experiences. Based on this input, we have launched a study today to examine ways ABIM diplomates might have access to online resources during a portion of the MOC assessment.

We are seeking physicians who have passed the Internal Medicine Certification exam or have taken the Internal Medicine MOC exam within the last five years to participate. Today, we reached out to a sample of eligible physicians with further details, inviting them to help us understand how we might incorporate an open-book feature.

Understandably, physicians want to know when this option and any other alternatives to the current MOC assessment might be implemented across the entire program, and what such alternatives might mean for them. Though we have made significant progress, we don’t have definitive answers right now, but an important component of our work to address these questions began today.

We are also already taking a number of other steps that create a foundation on which to enhance our existing assessment process, including:

• Modeling and developing new approaches to assessment and getting your input about these through upcoming spring society meetings, focus groups, design sessions and more on-line surveys.
• Surveying all ABIM Board Certified physicians about the MOC experience and alternative assessment ideas. Thousands of physicians responded, and, once we compile those responses, we will share the results broadly.
• Inviting all diplomates within a specialty to participate in blueprint review, a key building block to future assessments being discussed.
• Inviting more physicians to participate in the standard setting process, which assists in setting the passing standard for peers.

Communicating next steps

Next month, the ABIM Board of Directors and Council will be meeting jointly to consider physician-guided recommendations about the best options for updating the MOC assessment process. Together, we will refine a timetable to pilot, test and ultimately implement changes in the process. We look forward to sharing our timetable and plan, based on what we have heard from the community conversations, in the next few weeks. As you might imagine, alternative assessments will require analysis and piloting to ensure that the approach is impartial, fair and respectful. Input from physicians and societies will remain essential to move us forward in a timely and thoughtful manner, so we will continue to update and engage you.

We have learned there is a broad diversity of opinion as to what this ought to look like, and we know there are no simple answers. We all have an interest in assuring that whatever results from this evolving process continues to be meaningful and based on something substantive about who we are and the hard earned set of skills we have.

The Board of Directors and I are grateful to the many individuals and professional societies that have joined us in trying to make the process better and who are urging us to move faster. We share the sense of urgency, and commit to move forward simultaneously on as many fronts as possible. We commit to issuing quarterly progress reports so that everyone knows what to expect when to expect it from the process.

Please continue to e-mail me with your thoughts and ideas about MOC and I encourage you to subscribe to the Transforming ABIM blog for opportunities to provide input.