American Board of Internal Medicine Assessment 2020 Comments

I notice that the American Board of Internal Medicine (ABIM) is sponsoring a new initiative about their own Maintenance of Certification (MOC) program called “Assessment 2020: What skills will physicians need in the future?” The link to the page is Assessment 2020: What skills will physicians need in the future? : Assessment 2020 – American Board of Internal Medicine

Because I know some physicians’ comments have not been posted, I’m posting my comment here on the assumption the ABIM might not post mine either.

I hope the American Board of Psychiatry & Neurology takes your lead and offers this kind of forum for psychiatrists to provide feedback about the MOC. I support the principle of lifelong learning and I’m afraid the MOC in its current form tends to interfere with that rather than support it. However, I’m participating fully in the ABPN MOC. I also support the candidate running for American Psychiatric Association President-Elect who seems to have a well-developed position on reforming MOC.

 

While I can’t comment about the ABIM MOC process, I can say that I would appreciate working with the ABPN to reform the Psychiatry MOC Performance in Practice (PIP) components so as to make it more relevant to my practice and to consider eliminating or changing the peer and patient feedback features which currently require me to personally solicit them. In my opinion, this makes them vulnerable to cronyism and cherry-picking.

 

Further, the ACA-mandated MOC:PQRS is very complicated and I can only say that I appreciate very much being part of an ACO, which in some ways shelters me from being forced to navigate for myself the byzantine CMS procedures in order to avoid the penalties coming in 2015 and beyond.

 

And while I know that Maintenance of Licensure (MOL), according to the FSMB, is not intended necessarily to be grounded in the MOC itself, many physicians in Iowa believe that MOL will by default be identified with participation in MOC, making MOL duplicative. For that reason, I sponsored a resolution to support lifelong learning and to oppose the implementation of MOL in Iowa. It was co-sponsored by the Iowa Psychiatric Society and adopted by the Iowa Medical Society House of Delegates in April 2013.

 

I want to emphasize, the resolution specifically supports the principle of lifelong learning.

 

Again, I’m pleased that you offer this forum now, and I hope other specialty boards will follow your example.

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Comments

  1. Kenneth Han DO MA says:

    Thanks Jim for this forum !
    Here was my original post ABIM moderator rejected:
    Time stamped: January 30, 2014 at 5:55 pm

    ABIM website:

    Kenneth Han DO MA says: Your comment is awaiting moderation.

    January 30, 2014 at 5:55 pm
    Personal experience:
    I will have to agree with Amit Nahata, MD and Howard C. Mandel, MD, FACOG. I recently recertified last year. This did not improve the quality of care my patients received. I work in a AAAHC accredited governmental medical facility that requires physician metrics, benchmarking and clinical study data. Preliminary raw data thus far reveals that physicians who do NOT recertify actually give better quality care than those who certify. Should we now recommend patients ”CHOOSE WISELY” by making sure their doctor does NOT recertify ?
    If you want to measure the quality of care provided, then look at the care. If you want to measure how physicians answer test questions , test them.
    How can you assume that test questions and doing MOC activities assures quality care ?
    Facts:
    1) The American Board of Medical Specialties has published that the quality of research on MOC does not meet commonly accepted research standards.
    Sharp LK, Bashook PG et al. Acad. Med. 2002;77:534–542
    2) Certification does not “guarantee performance or positive outcomes”.
    http://www.abms.org/maintenance_of_certification/pdfs/ABMS¬_MOCMythsFacts_3-20-13.pdf
    3) Twenty Three (and growing) State Medical Societies ALL oppose MOC.
    4) The American Board of Medical Specialties (ABMS) lobbied Congress to pass legislation linking Board Certification to Medicare and Medicaid reimbursement payment.
    5) “CME appears to be effective at the acquisition and retention of knowledge, attitudes, skills , behaviors and clinical outcomes”
    US Department Health and Human Services: Effectiveness of CME
    Prepared by The John Hopkins University, Evidence based Practice Center
    http://changeboardrecert.com/documents/2007CMEEffectiveness-AHRQREPORT.pdf
    Opinion:
    1) There should be complete overhaul of the Board Certification Process.
    2) There should be complete transparency within the ABIM.
    3) There should be salary caps, term limits and oversight of ABIM CEO and board members.
    4) http://changeboardrecert.com/anti-moc.html

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  2. Jim – you probably know by now that I am not a big tent kind of guy and think that these forums eventually provide justification for the status quo. Some time on the early 1990s, the American College of Physicians came out with a technical manual on the skills that an Internist needed. I can’t find my copy right now but when I do I will post the title. It was very detailed in terms of the necessary skills and knowledge base. It was the definition of professional expertise. I tried advocating for a similar approach through the APA at the time. I think some were put off by the idea that psychiatrists actually needed or had “technical expertise”. It was too much of a hard or scientific term for them.

    I still think that this is the way to go and it can all be packaged in a form like Focus guaranteed to bring all psychiatrists up to speed very year without all of the cost and excess of the current MOC approach. More specifically it should be presented as at home study and answering questions in a CME format.

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    • George, I would like to see the American College of Physicians technical manual reference when you find it. I think we need data-driven articles submitted by psychiatrists to the Focus Journal of Lifelong Learning in Psychiatry for publication in the upcoming new section on MOC and MOL. There’s a call for papers and they should go to Kristen Moeller (kmoeller@psych.org).

      I agree with your suggested approach to changing MOC in favor of using it for home study, at low cost, in a CME format. Do you think the APA would support that, given that an APA leader who was running for President-Elect of APA this year is on the Focus editorial board? They’ve made a lot of money on Focus for MOC credit.

      Like

  3. Kenneth Han DO MA says:

    Lifelong learning ? You need the board to tell physicians to learn ? Interesting.
    Then…. Can you assume that test questions and doing MOC activities assures quality care ?
    Facts:
    1) The American Board of Medical Specialties has published that the quality of research on MOC does not meet commonly accepted research standards.
    Sharp LK, Bashook PG et al. Acad. Med. 2002;77:534–542
    2) Certification does not “guarantee performance or positive outcomes”.
    http://www.abms.org/maintenance_of_certification/pdfs/ABMS¬_MOCMythsFacts_3-20-13.pdf
    3) Twenty Three (and growing) State Medical Societies ALL oppose MOC.
    4) The American Board of Medical Specialties (ABMS) lobbied Congress to pass legislation linking Board Certification to Medicare and Medicaid reimbursement payment.
    5) “CME appears to be effective at the acquisition and retention of knowledge, attitudes, skills , behaviors and clinical outcomes”
    US Department Health and Human Services: Effectiveness of CME
    Prepared by The John Hopkins University, Evidence based Practice Center
    http://changeboardrecert.com/documents/2007CMEEffectiveness-AHRQREPORT.pdf
    Opinion:
    1) There should be complete overhaul of the Board Certification Process.
    2) There should be complete transparency within the ABIM.
    3) There should be salary caps, term limits and oversight of ABIM CEO and board members.
    4) http://changeboardrecert.com/anti-moc.html

    Like

    • Dr. Han–Amen. Where do we take these data? What authority above the ABMS and the specialty boards will hear us and act? Iowa is one of the those states with a state medical society which adopted a resolution opposing MOL. In fact, I’m the one who introduced the resolution. I will continue the dialogue affirming the principle of lifelong learning and opposing MOL in Iowa with my state medical board, which is one of the few pursuing MOL implementation pilot projects. My contact at the state board says MOL for Iowa is on “the back burner.”

      We need more voices added to yours and mine, and I think direct action is needed to oppose a process which has developed a great deal of traction over the years and which has insinuated itself into the ACA law in the form of the MOC:PQRS.

      I see the http://assessment2020.abim.org/2013/12/assessment-2020/ posted my comments. Please share your comments with them. I plan to send the link to the American Board of Psychiatry and Neurology along with a suggestion that the ABPN take feedback not just from diplomates but from leaders in the American Psychiatric Association (APA.

      Along that line, the APA just held elections for 2014 officers, including President-Elect. There is one candidate, Dr. Renee Binder, MD, who has the most well-developed position on reforming MOC. I voted for her, which is the political power I have available to me. If I knew how to stop MOC in its tracks, I would share that information on the spot.

      I’m hoping that psychiatrists will consider writing an article which is as data-driven as your comments to me to the Focus The Journal of Lifelong Learning in Psychiatry, which will be creating a new section on MOC and MOL soon. Papers like (Galliher JM, Manning BK, Petterson SM, Dickinson LM, Brandt EC, Staton EW, et al. Do Professional Development Programs for Maintenance of Certification (MOC) Affect Quality of Patient Care? The Journal of the American Board of Family Medicine. 2014;27(1):19-25) provide a strong counterpoint to those by Hawkins RE, Lipner RS, Ham HP, Wagner R, Holmboe ES. American board of medical specialties maintenance of certification: theory and evidence regarding the current framework. The Journal of continuing education in the health professions. 2013;33 Suppl 1:S7-S19.

      I asked one of my colleagues in my department whether a study similar to that of Galliher et al could be done for psychiatry PIP modules and he doubted it.

      Many voices are raised against MOC and MOL, mine included. But will shouting at just the ABMS be effective?

      Like

      • Kenneth Han DO MA says:

        ABIM did not post my blog above. The moderator must be in China. They are filtering comments.

        Like

      • My concern that ABIM wouldn’t post my comments either led to my posting them on my blog.

        I agree that they are probably filtering comments.

        Like

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