Interview
Revisiting Maintenance of Certification:
Updates from ASH and ABIM
Interview with Marc S. Zumberg, MD,
and Michael E. Williams, MD, ScM
In 2015, the American Board of Internal Medicine (ABIM) issued a
statement in response to numerous criticisms from diplomates
and specialty societies, including the American Society of Hematology (ASH), about the ABIM Maintenance of Certification (MOC)
program. Since then, ABIM, specialty societies, diplomates, and
other stakeholders have been involved in multiple discussions regarding the challenges of the current MOC process and the design
of a new process for maintaining certification.
In response to these discussions, ABIM
has taken steps to address stakeholders’
concerns, including engaging with the
stakeholder community; freezing MOC
fees; placing the MOC requirement of engaging in a quality
improvement project on hiatus;
engaging in a review of the MOC
examination blueprint to improve its relevance to test-takers;
initiating a study of an “open
book” examination; and releasing the ABIM Assessment 2020
Task Force’s report, which called
Marc S. Zumberg, MD
on ABIM to move away from
an every 10-year examination
system to one with shorter, more
frequent, but lower-stakes assessments of medical knowledge.
ASH has been and remains
critical of certain ABIM policies and procedures. However,
the Society is encouraged that
Michael E. Williams,
multiple interactions among
MD, ScM
ABIM, ASH, and the ABIM Hematology Board have occurred
and believes creating a dialogue around
the future of MOC is a positive step for
these organizations.
ASH Clinical News invited Marc S.
Zumberg, MD, chair of the ASH MOC
Working Group, and Michael E. Williams, MD, ScM, chair of the ABIM Hematology Board, to share details about
this dialogue and the future of MOC for
hematologists. Dr. Zumberg is section
chief of non-malignant hematology in
the Division of Hematology/Oncology
and the Department of Medicine at the
University of Florida Health in Gainesville, Florida. Dr. Williams is the Byrd S.
Leavell Professor of Medicine and chief
of the Hematology/Oncology Division
58
ASH Clinical News
at the University of Virginia School of
Medicine in Charlottesville, Virginia.
Dr. Zumbe rg: On behalf of ASH, I’d like
to start by saying how happy we are to
be developing a dialogue with the ABIM
and the ABIM Hematology Board to
help restructure MOC for hematologists.
Dr. Williams: Absolutely, and as chair
of the ABIM Hematology Board, I can
tell you that we are as excited about this
collaboration with ASH. On the ABIM
side, our goal is to continue to improve
the certification and MOC process and
assessment of knowledge, which we view
as critical components of a board certification that tells patients that a physician
is meeting a standard of performance
and capability.
We can both agree that ASH and
ABIM have a shared interest in ensuring
that hematologists are well-informed,
up-to-date, and engaging in continuous learning. This is particularly vital
in a field as dynamic as hematology,
where we are seeing rapid progress in
diagnostics, therapeutics, and disease
monitoring.
Dr. Zumberg: I must say, for some
period of time, ASH and other medical
specialty societies felt separate from the
board certification and maintenance
process; it seemed that ABIM made the
MOC product and the societies just had
to accept it. Creating a dialogue is one
mechanism to change this dynamic. In
a short amount of time, we have worked
together, which I don’t believe had happened in the past.
One of our main efforts has been to
open the channels of communication
between ASH, other societies, and
ABIM. We frequently email each other
about certification issues, and, on a
society-wide level, we have had multiple
conference calls to discuss these issues.
This was also something we embraced at
the 2015 ASH Annual Meeting, where
ABIM and ASH leaders met to talk
through some of the certification and
MOC concerns of diplomates.
The goal of open communication
is to have a channel through which the
concerns of hematologists can be heard
and have the opportunity to influence
ABIM policies and procedures to
address those concerns.
Dr. Williams: While there were limited
interactions between ABIM and ASH in
the past, the focus of those interactions
shifted a year ago when we had the first
of a series of meetings between ABIM
leadership and ASH leadership, culminating in an important and helpful meeting at the 2015 ASH Annual Meeting.
We’ve also welcomed ASH representatives to the twice-yearly ABIM Hematology Board meetings in Philadelphia,
to offer the ASH perspective and to drive
collaboration. Obviously, that had an
impact on trainees and the physician–
scientist workforce – a key demographic
of ASH’s membership.
Dr. Zumberg: Right, and these meetings
are certainly a step forward for us working together. For ASH and our members,
our main concern is to have an MOC
process that is meaningful, affordable,
convenient, and – most importantly
– reflective of what diplomates should
do in everyday clinical care. We want
an MOC exam that adds to diplomates’
knowledge and, ultimately, helps us better serve our patients.
ASH, like many other medical specialty societies, has been anticipating
changes to the MOC exam that would
address the concerns of test-takers. We
heard from many of our diplomates that
the MOC exam – in its current, every10-years state – is very high-stress. It
requires a lot of preparation and, some
would argue, is not that valuable. Hematologists, like most internists, like CME.
As such, many diplomates were calling
for a lower-stakes exam, or more frequent exams at shorter intervals. Ideally,
the new exam also would include a feedback mechanism; if you answered questions incorrectly, you could be directed
to resources that would help increase
your knowledge. Alternatively, if you did
well, then perhaps you did not have to
take a recertification exam.
Other common concerns we heard
were about the inconvenience of taking
the exam at a Pearson testing center,
the cost of the MOC program (and not
knowing where that money goes), and
the opportunities to earn MOC points.
ABIM requires that physicians earn
a certain number of MOC points, but
these were previously limited to few activities. Many argued that clinicians are
already participating in activities to expand our knowledge base, such as CME
at our workplaces, that should earn
MOC points. Now, thankfully, there are
many different avenues through which
diplomates can earn points toward
MOC. I recently attended a meeting to
review and critique questions for ASH’s
Hematology In-service Examination; I
earned 10 MOC points for this activity.
Of course, one of the most pertinent
concerns was that the MOC exam is
not reflective of the day-to-day practice
of most hematologists. In addition, in
today’s world, the way physicians access
information and practice medicine has
changed. With the internet and smartphones, information is available at their
fingerprints; the real-world isn’t a closedbook situation, as reflected by the MOC
examinations.
Dr. Williams: ABIM has heard and
is addressing those concerns with the
recently announced modifications to
the MOC program. All the potential
changes you laid out are under active
consideration. Our goal is that, by January 2018, we will have the first alternative MOC approach in place, which will
include:
September 2016