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FEATURE offer people an opportunity to take a less terrifying assessment that they could do at home or in the office , but would still be a valid , credible assessment .”

This two-year assessment will be available for the hematology specialty starting in spring 2019 . Two test dates will be available in the spring ( April 23 or 27 ) and two in the fall ( October 15 or 19 ). See TABLE 2 for more information about upcoming testing dates .

ABIM also is exploring ways to assess subsets of knowledge relevant to physicians ’ practice – a common request from MOC participants . 3 For instance , as part of its “ principled but pragmatic ” approach to improving MOC for hematologists , ASH is in the process of negotiating with ABIM to develop “ focused ” Knowledge Check- Ins targeting specific subsets of hematology practice , such as general hematology , nonmalignant hematology , and malignant hematology . More information about these proposed programs will be announced later in 2018 .

While the program gets off the ground , ABIM has decided to make the first year that a Knowledge Check-In is offered a “ no-consequence ” year , meaning physicians who do not pass will be able to retake the exam in the next two years without a change to certification status – a policy for which ASH strongly advocated .

A recent announcement from the American Society of Clinical Oncology ( ASCO ), however , added a layer of confusion by introducing yet another format into the mix : In spring 2018 , ASCO and ABIM announced a partnership to create shorter , two-year assessments that will replace ABIM ’ s two-year Knowledge Check-In for Medical Oncology , which was originally planned to roll out in 2020 . 4 The organizations are co-developing content for the assessments in hopes of creating a test that “ keeps pace with rapidly evolving cancer science , research , and oncology practice ,” according to an ASCO press release announcing the new pathways . Oncologists will not need an ASCO membership to take the shorter , two-year assessment pathway .

Similarly , the American College of Physicians and the American College of Cardiology ( ACC ) have partnered with ABIM to develop collaborative pathways through which physicians can maintain board certification . For instance , in the field of cardiology , the ACC would provide clinicians with learning material and assessments modeled after its lifelong learning self-assessment program . 5

Much of the recent MOC evolution has been in response to feedback from medical societies representing diplomates . “ ABIM sent inquires to diplomates , asking them to choose what they believe are the most important and most commonly seen topics in practice ,” said Marc S . Zumberg , MD , professor and section chief of nonmalignant hematology at the University of Florida Health . “ For rare topics , they could then grade their importance .”

Based on feedback to these surveys , which ASH encouraged its membership to participate in , the blueprints for exams have been updated to be more relevant to physicians ’ day-to-day practice , explained Dr . Zumberg , who is a member of the ABIM Hematology Board and former chair of ASH ’ s MOC Working Group . “ In fact , in the hematology MOC , the pass rate has gone up from 79 percent in 2015 , to 90 percent in 2016 , to 95 percent in 2017 ,” he said . 6 “ Either we are doing a better job of testing what is relevant to hematologists or we are educating hematologists better .”

A Learning Process

ASH favors a system that offers periodic , low-stakes , formative assessments that facilitate lifelong learning by helping identify knowledge gaps and providing ongoing feedback . As part of this goal , the society is engaged in open and candid discussions with ABIM regarding the future of the hematology Knowledge Check-Ins that will be rolled out next year , particularly in making them less cumbersome and daunting .

“ The idea of forcing people to take exams is not in concordance with adult learning theory ,” said Alan Lichtin , MD , a hematologist at Cleveland Clinic and chair of ASH ’ s MOC Working Group .

Adult learning theory , or andragogy , postulates that adults learn and assimilate new information through self-directed learning and from internal rather than external factors . 7 These theories , to a degree , run counter to the idea of mandatory , periodic , summative assessments . But , according to Dr . Baron , ABIM is committed to this idea : “ Our view is that having summative assessments over the course of a career to assess individual skills and knowledge is important . We think it adds value .”

To support this idea , Dr . Baron pointed to recently published research that found that maintaining certification was positively associated with physician performance scores on Healthcare Effectiveness Data and Information Set ( HEDIS ) measures . 8 The researchers compared annual HEDIS scores between more than 1,000 internists who were initially certified in 1991

TABLE 1 . Tentative Rollout Timeline for Knowledge Check-Ins 2018 2019 2020

Internal Medicine Nephrology

Cardiovascular Disease Geriatric Medicine

Endocrinology , Diabetes , and Metabolism

Gastroenterology Hematology Pulmonary Disease Rheumatology

but who did ( n = 786 ) or did not ( n = 474 ) maintain certification 20 years later . Those who were consistently meeting MOC requirements were slightly more likely to have better scores on a set of performance measures for mammography screening , diabetes , and cardiac disease care . However , the analysis was potentially confounded by several factors , like unobserved patient , physician , and practice characteristics and the inability to determine the clinical significance of observed differences in HEDIS score . 8

Other studies have found that ABIM certification is associated with a lower likelihood of state medical licensure disciplinary actions , greater adherence to diabetes management guidelines , and $ 5 billion lower annual costs for Medicare . 9-11

However , in Dr . Lichtin ’ s view , there is not much evidence that MOC aids in learning , changes patient outcomes , or provides value . He also identified another confounding factor : “ The literature is mostly from people involved with ABIM . We are submitting ourselves to a testing process that is not proven to demonstrate that people taking the test are truly learning .”

This is particularly concerning for the specialty of hematology , which focuses on the care of patients with rare diseases . “ Patients do not seek hematologists out or go see them because they have maintained certification , but for their expertise ,” Dr . Lichtin said .

In response , Dr . Baron argued that if physicians are very specialized and engaging only in self-directed learning , those activities might not result in much learning at all . There would be no assessment to see what , if anything , had been learned .

Advanced Heart Failure & Transplant Cardiology

Clinical Cardiac Electrophysiology Critical Care Medicine Hospice & Palliative Medicine Interventional Cardiology Medical Oncology Sleep Medicine Transplant Hepatology

TABLE 2 . Upcoming ABIM MOC and Knowledge Check-In Dates

SIDEBAR 1

The ASH Self-Assessment Program

The American Society of Hematology Self-Assessment Program ( ASH-SAP ) encompasses both adult and pediatric hematology , and both malignant and non-malignant disorders .

The most recent edition includes 23 updated chapters , newly rendered illustrations , and nearly 300 questions . It is designed for self-directed learning and review with case studies , key points , graphics , animation , audio , and glossaries .

To learn more about ASH-SAP and to take advantage of the new onlineonly features , including animation and audio , as added enhancements to the Sixth Edition by visiting hematology . org / ashsap .

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