The Saga of the Delirium MOC Performance in Practice Tool Begins

Unbelievable. I just saw Psych Practice blogger’s latest post on the issue of the chronic lack of relevance of most of the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification (MOC) Performance in Practice (PIP) assessment tools currently available.

Emily Morse DO

Emily Morse DO

It’s true that one of the residents who is interested in consultation psychiatry and I are working on a PIP activity which we hope to submit soon. It’s on the evaluation and treatment of delirium, which I see every day as a consultant in the hospital. Three cheers for the resident, Dr. Emily Morse, D.O., who has delivered several excellent Clinical Problems in Consultation Psychiatry (CPCP) presentations already this year! Good luck to her on RAGBRAI 2015 which starts today. At least two of the residents are riding that I know of, including Dr. Aubrey Chan, another CPCP star.

It’s based on the NICE Guidelines for delirium, and they really are nice. The tool would be most relevant to many internal medicine and surgical specialists as well as consulting psychiatrists–admittedly less relevant to private practice clinic psychiatrists–especially psychoanalysts.

This project is intended to accomplish a couple of aims. It would fill a need by finally making a PIP product directly relevant to Psychosomatic Medicine specialists who work in general hospitals and it would also highlight a fundamental flaw in the whole Part IV MOC PIP activity…the difficulty of making it practically useful in the modern era of multiple medical specialists in health care.

I realize that one of my surveys didn’t support the idea of a PIP product for delirium. But that was mainly because few doctors supported the idea of the PIP at all. I thought the internist’s comment was ironic since delirium really could be considered a challenge most relevant to internal medicine (click to enlarge).

Delirium PIP Survey

And there might be a snag. If it requires a sponsor, we may be up a creek. I contacted the Academy of Psychosomatic Medicine and asked them about it. Unfortunately, they have a policy that prohibits such sponsorships unless they are authorized by one of their own Council directives.

That said, they asked if we could share it with them in their ongoing efforts to make MOC products more accessible to the membership. That reminds me, the APM annual meeting is in New Orleans this November and the theme is “The Art and Science of Communication in Psychosomatic Medicine.”

Sure, if it’s approved by the ABPN without a sponsor. I’m reluctant to ask either the American Medical Association (AMA) or the American Psychiatric Association (APA) to sponsor it because I’ve decided not to renew my membership in either organization. They’re getting way too expensive. Along those lines, I just got my renewal notice for the Focus Journal of Lifelong Learning in Psychiatry (actually a product sponsored by the APA)–$394 for 4 issues or $710 for 8 issues. I’m doing what I usually do with that every year, which is to toss it on my desk and frown disgustedly at it while mulling over what my alternatives are to having my pocket picked by the APA.

I still think the CPCP is superior in every conceivable way to Part IV of the MOC and that ABPN President and CEO, Larry Faulkner should just make it optional. Quit worrying about Dr. Nora at the American Board of Medical Specialties (ABMS)! If the American Board of Internal Medicine (ABIM) can do what they want with performance improvement projects, so can the ABPN.

red pants at work 2OK, so this Delirium PIP project isn’t really support for PIP treadmill itself as currently designed. It’s support for the principle of lifelong learning…here it goes again, my Red Pants Revolution for Lifelong Learning.

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Comments

  1. Good luck with the PIP module. I’m a little confused. Why would sponsorship be required?

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    • That’s a great question. I don’t know why sponsorship would be required either; I’m just guessing that the ABPN would expect it. Just quickly checking through the ABPN list of approved MOC PIP products, I couldn’t find one that was not backed by a large organization. I’ve asked one of the ABPN MOC Managers about it, and waiting for a reply.

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