Getting Started with Maintenance of Certification: A Beginner's Guide

By Sarah Porter 

As the Accreditation Council for Continuing Medical Education (ACCME) expands collaboration with American Board of Medical Specialties (ABMS) member boards to simplify the integration of Maintenance of Certification (MOC), accredited providers have increased opportunities to demonstrate the value of their CME programs and meet the needs of physician learners. 

For those who are unfamiliar with or new to MOC, it’s helpful to first identify a few key terms and understand the framework in which it exists. 

  • ABMS: ABMS stands for the American Board of Medical Specialties, which is the organization overseeing the 24 Member Boards. 
  • MOC: MOC stands for Maintenance of Certification. 
  • CC: CC stands for Continuous Certification. This is a term utilized by certain ABMS Member Boards, such as the American Board of Pathology. CC is also utilized by the ABMS as in the “Continuous Certification Directory.” The term CC is essentially a re-branding of MOC. For example, the American Board of Pathology transitioned to utilizing Continuous Certification in 2018. As such, materials are now required to read, “Continuous Certification, formerly Maintenance of Certification.” For purposes of simplicity, this article will refer solely to MOC. 

What Is Maintenance of Certification (MOC)?

Physicians, once they are board certified by one of the 24 Member Boards of the American Board of Medical Specialties (ABMS), must maintain their medical specialty expertise by participating in the ABMS Program for MOC. According to the ABMS, “The MOC program provides physicians a structured approach for enhancing patient care and improving patient outcomes through focused assessment and improvement activities.”1 The ABMS Program for MOC involves ongoing measurement of six core competencies defined by ABMS and ACGME within a four-part framework.2 Per the ABMS, while the six core competencies and the four-part framework are consistent across all Member Boards, variation across specialties exists in terms of the specific activities used to measure the competencies. 

The six core ABMS/ACGME competencies that the ABMS Program MOC measures include the following, which ACCME accredited providers should already be familiar with in the context of Criterion 6 as these are often the same competencies upon which CME activities are designed and implemented. 

  • Practice-based Learning and Improvement
  • Patient Care and Procedural Skills
  • Systems-based Practice
  • Medical Knowledge
  • Interpersonal and Communication Skills
  • Professionalism 

Lastly, the four-part ABMS MOC Framework consists of the following components. MOC is focused on Part II and Part IV.

  • Part I: Professionalism and Professional Standing
  • Part II: Lifelong Learning and Self-Assessment
  • Part III: Assessment of Knowledge, Judgment and Skills
  • Part IV: Improvement in Medical Practice 

What Does MOC matter? What Is Its Value? 

As highlighted, board certified physicians must maintain their medical specialty expertise by participating in the ABMS Program for MOC. As such, accredited providers that offer MOC thus help physicians meet the requirements. Therefore, MOC is a potential value-add for an accredited provider’s CME program.

The ACCME plugs-in as it has established a collaboration with the ABMS “…to simplify and align the MOC process to better meet the needs of physicians and educators.”3 Specifically, the collaboration is related to Part II: Lifelong Learning and Self-Assessment, Part IV: Improvement in Medical Practice and patient safety.

The ACCME and the ABMS decided to collaborate regarding CME and MOC for several reasons. For one, the collaboration aims to expand the number and diversity of accredited CME activities that offer MOC and meet the needs of learners in a straightforward way, with a wider range of formats and activities. Further, the collaboration responds to the requests from both physicians and accredited CME providers and helps to streamline the process for registering CME activities while also removing barriers in technology and time.

There are currently six Member Boards participating in the ACCME/ABMS collaboration: 

  • American Board of Anesthesiology (ABA) MOCA
  • American Board of Internal Medicine (ABIM) MOC
  • American Board of Ophthalmology (ABO) MOC
  • American Board of Otolaryngology–Head and Neck Surgery (ABOHNS) MOC
  • American Board of Pathology (ABPath) Continuing Certification (CC)
  • American Board of Pediatrics (ABP) MOC 

The collaboration means that CME providers are no longer required to submit MOC applications for approval to the Member Boards that are collaborating with the ACCME. Instead, accredited CME providers are able to use the ACCME Program and Activity Reporting System (PARS) to register activities for these programs.

When registering activities in PARS for MOC, accredited providers must attest to compliance with the certifying board requirements, agree to collect the required individual learner completion data and submit it via PARS, agree to abide by certifying board and ACCME requirements for use of the data, agree to allow the ACCME to publish data about the activity on its website and agree to comply with requests for information about the activity if the activity is selected for an audit by the ACCME.4 

Per the ACCME, all accredited CME providers have the option — but are not required — to offer accredited CME that meets certifying board MOC program requirements. As stated on the ACCME website, “This includes state-accredited providers, providers directly accredited by the ACCME, and providers that have received Joint Accreditation for Interprofessional Continuing Education™.”5

How to Approach Implementation of MOC 

In order to effectively implement MOC, an accredited provider must first engage with the MOC requirements specific to the ABMS Member Board for which it is interested in offering MOC credit. Further, a provider should develop a clear plan for integrating MOC into its current CME program. The first step to developing such a plan, is for a provider to evaluate is current CME program against the MOC requirements for a specific Member Board to identify what programmatic and/or system changes would need to occur to integrate MOC. It is helpful to first identify both the needed resources and process and/or policy changes to implement MOC. 

However, before engaging with the requirements or evaluating resources, systems and processes, there are a few items to consider from the outset when tackling MOC. First of all, is MOC a need for the target audience? An organization should have a firm grasp on the benefit of MOC to the target audience. Implementation of MOC requires resource input, so its key to ensure that implementation of MOC is truly a significant benefit to the CME provider’s target audience. 

The second initial consideration, if MOC is a need for the target audience, is to determine which ABMS Member Boards collaborating with the ACCME are most applicable. In this case, it’s important to identify which board certification(s) the target audience holds. While some organizations have access to this data, other organizations might not have this data readily available. One suggestion is to implement a survey that might ask: 1) Are you board certified? If yes, which board; and 2) Do you need MOC credits to maintain your certification?

The third consideration to weigh from the get-go is: What stakeholders need to be involved in implementation of MOC? Typically, this will include an organization’s leadership, the CME Provider Unit and the physician target audience. 

After working through the initial considerations, an accredited provider is prepared to dive deeper into MOC. At this point, the first step is to obtain the Program Guide for the specific Member Board for which MOC is to be implemented. 

Each ABMS Member Board collaborating with the ACCME has its own Program Guide that outlines the specific requirements for MOC. While there are similarities across the Member Boards, there are also differences. Generally, the Program Guide outlines the “Requirements for all MOC Activities” specific to a particular Member Board. Each Program Guide also outlines specific requirements for different activity types (for example: Self-Assessment versus Improvement in Medical Practice). Lastly, the Program Guide includes information regarding MOC recognition, collection and reporting of participant data and other policies such as audit, if applicable. Each Program Guide is available for download on the ACCME Website, which also includes additional resources for each Member Board collaborating with the ACCME such as FAQs.

Each requirement outlined in the Program Guide may represent an impact on resources including both staff resources and IT resources as well as policies, procedures and processes, particularly as related to activity planning, activity assessment and collecting and reporting data. 

One method for systematically assessing the degree to which the requirements outlined in the Program Guide impact an accredited provider’s CME program is to put each requirement into a simple chart with two separate columns that read, “Change(s) to Current Process/Policy/Procedure” and “Notes/Questions/Next Steps.” This method provides a structured, yet simple, way to consider needed changes and areas of impact, if applicable. 

Beyond what is outlined in the Program Guide, it is also important to capture other outstanding questions, additional notes and the work required to obtain the necessary information and clarity prior to officially implementing MOC. 

Lessons Learned and Key Takeaways 

As is the case when implementing anything new, there will be some kinks and challenges. It’s important to be realistic about both the time needed and the additional resource input, particularly staff time, given the changes identified as necessary for MOC implementation. It’s also essential to ensure that there is both stakeholder investment and clarity regarding roles and responsibilities. One tip is to utilize team meetings to ensure everyone is on the same page and clear about their roles.  Another tip is to look at what is required for MOC activity registration in PARS before getting started as this can help to provide added clarity and context. Lastly, make it streamlined. Use templates and create processes wherever possible.

One final note: The Member Boards often provide updates to the Program Guide, so be sure to check periodically for an updated version and pay attention to announcements.

References/Resources

  1. https://www.abms.org/board-certification/steps-toward-initial-certification-and-moc/
  2. https://www.abms.org/board-certification/steps-toward-initial-certification-and-moc/
  3. http://www.accme.org/cme-support-moc
  4. http://www.accme.org/cme-support-moc
  5. http://www.accme.org/cme-support-moc
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