By Rebecca Kolb, MA, Cincinnati Children’s Hospital Medical Center; Andrea Thrasher, MEd, Cincinnati Children’s Hospital Medical Center; and Laura Werts, MS, MEd CMP, Cincinnati Children’s Hospital Medical Center
In 2016, the American Board of Pediatrics (ABP) announced its collaboration with the Accreditation Council for Continuing Medical Education (ACCME) to increase both the types of activities that can offer lifelong learning and self-assessment (Part 2) of Maintenance of Certification (MOC) and to expand the types of associated assessment mechanisms1. At the 2017 Alliance for Continuing Education in Health Professions Annual Conference, ACCME President Graham McMahon challenged providers to offer as many MOC Part 2 accredited activities as possible. Around the same time, the ABP published the CME Provider Program Manual outlining the new self-assessment mechanisms2. A once narrow opportunity was now wide open for creative educational design.
The Cincinnati Children’s CME team viewed the collaboration, challenge and changes as an opportunity but had reservations about the impact of throwing open the proverbial floodgates. Prior to 2017, we provided ABP MOC Part 2 sparingly to those who could afford both the monitory and time investment to develop the required quiz questions and answers. Moving forward, we knew awarding more ABP MOC Part 2 points would involve additional data management and incorporation of multiple self-assessment mechanisms into educational planning and design. However, we also knew that our physician learners need the MOC points for recertification.
Thus, our team initiated an integration process by developing the following goals:
ABP MOC Part 2 presents a duality of value: enhancing education and providing required points for physician recertification. Most of our educational planners already recognized the value of adding ABP MOC Part 2 from the functional perspective (i.e., the physician learner’s need for MOC Part 2 points). As an educational partner, our goal was to develop additional recognition that self-assessment can add to effective education3. We emphasized using self-assessment as a tool to enhance learner experience, clinical knowledge and interaction between colleagues4. Hesitant educational planning teams were encouraged to survey their learners to determine how they currently fulfilled their ABP MOC Part 2 point cycle requirement. Learner responses indicated a desire for additional and more meaningful ABP MOC Part 2 opportunities. This opened the dialogue for integration process development.
Co-Creating MOC Part 2 Integration
The original ABP MOC Part 2 self-assessment model was modest compared to the multiple options now available; quiz/test was the only accepted self-assessment mechanism. Though appropriate for some education, we struggled with its limitations to serve all activity and learner types. First, it conditioned many physicians to focus heavily on the clinical knowledge passing standard and minimally on how to use the feedback to change skills that were important to their individual practices. Second, the resource burden of content development, distribution and scoring weighed heavy on planners. Finally, the quiz as a self-assessment reinforces learning only as an individual exercise instead of promoting a learning community with the opportunity to receive feedback from peers5.
The flexibility of the new model, which now offers a self-assessment mechanism menu, gives educational planners the freedom to provide interactive education; however, we realized that simply presenting the menu of options to them was perceived as overwhelming. Instead, we encouraged teams to pilot interactive methods aimed at creating a learning community and mutual feedback6.
Through testing with multiple educational planning teams, we piloted multiple self-assessment mechanisms. We learned a collaborative approach with the planners to incorporating process change was more successful than an authoritative speech on best practice7. To facilitate co-creation, we designed a series of self-assessment decision points to guide the implementation strategy discussion (See Table 1). This provided the planning team an opportunity to work with us to identify the best fit for the learner, the educational format and the planning team itself.
For example, the case discussion is a seamless mechanism for learners to share with each other how they would approach a case at various stages. Logistically, this mechanism is ideal for a smaller group; it would be challenging for one group leader to judge a hundred physicians’ active participation in the conversation. Case discussions is a good fit for the discussion of new strategies; it would be a poor fit when the education is designed for learners to demonstrate a strategy or skill.
Reduce Process Variability and Administrative Obstacles
Another consequence to opening the ABP MOC Part 2 floodgates was our own CME team’s confusion regarding process and data management needs across the different self-assessment mechanisms. To increase process replicability/efficiency and data reliability/validity, our team utilized process mapping. A process map is a visual tool that defines who is responsible for what standard in a process and how the success of the process can be determined8. Every member of our CME team contributed to our process map creation. In addition to role clarity, the exercise identified opportunities to eliminate duplication and reduce administrative obstacles. For example, our first step was to identify the self-assessment mechanisms that seemed to be most valued by our educational partners. We developed one process map for each self-assessment type we planned to support, reviewed them for accuracy after a couple of months of usage and scheduled each to be re-reviewed annually (See Figure 1). By approaching ABP MOC Part 2 integration as a structural analysis of process flow, our team was able to add value with minimal additional work (See Table 2).
MOC Part 2 allows CME partners to add value by emphasizing self-assessment and feedback through educational design. To eliminate integration barriers and increase impact, it is important to create a visual process map that outlines who is responsible and roles.