Thanks to a new report from an independent commission created by the American Board of Medical Specialties (ABMS), many doctors – after years of complaints about the process of maintaining certification (MOC) – have finally been heard.
96 pages rough draft The Commission considers that the process has been sufficiently far removed from the system for the term "maintenance of certification" to be abandoned.
"A new term communicating the concept, intentions and expectations of future certification programs in progress should be adopted," the commission writes.
A survey of 34,000 doctors on behalf of the commission found in the report found that only 1 in 10 (12%) said they valued COMs, while 41% said that they did not. they did not like the program, and 41% had feelings. "
The report – the result of a process started in the fall of 2017, including 21 hours of public testimony – is open to comment until January 15, after which it will be presented to the ABMS board of directors, probably in February, announced a spokesman for ABMS.
Paul Teirstein, MD, one of the fiercest critics of the OMC, said that he was pleasantly surprised. "I think they have very well documented the real problems," said Teirstein, chairman of the National Council of Physicians and Surgeons (NBPAS), who created an alternative certification process. "What struck me in the first place was that they were very clear in agreeing that maintaining the certification had caused harm to the doctors," said Medscape Medical News Teirstein, Head of the Cardiology Department at the Scripps Clinic in San Diego, California.
But Teirstein said the NBPAS wants action. Four points comment At the Vision Commission, the NBPAS stated that it was seeking an immediate end to secure examinations and high stakes; immediately stop requiring quality initiative (IQ) / practice improvement (PI) components; maintenance of the components of continuing medical education and professionalism; and a reduction in fees to less than $ 100 per year, regardless of the number of certifications retained.
At the time of printing, more than 15,000 doctors had signed an agreement.
The vision commission co-chairs said the report's recommendations would not be binding on the 24 expert councils that make up the ABMS system. But Christopher Colenda, MD, MPH, and William Scanlon, PhD, said they believed boards would take them to heart.
"The ABMS boards of directors have been very committed and have expressed a sincere desire to improve the ongoing certification process so that it becomes a system demonstrating the commitment of the profession of professional self-regulation, providing a consistent and clear understanding of what continuous certification means, and establishing a meaningful, relevant and valuable program that meets the highest standards of quality patient care " said the two co-chairs in a statement to Medscape Medical News.
Warren Newton, MD, MPH, president of the American Board of Family Medicine (ABFM), said the ABFM was still working on its final response to the Vision Commission's report. "We agree with many details – especially the importance of a trainer element, the commitment of diplomats and consistency across the boards of directors," said Newton at Medscape Medical News.
"We are delighted that they have recognized the importance of making correlative decisions and improving quality, ensuring that doctors have the merit of what they already do." he said, adding, "We are confident that the report encourages us to continue on our path to evolve board certification."
The American Council of Internal Medicine (ABIM), which has been the subject of particularly violent complaints – and is the subject of a class action trial Alleging monopolistic practices, which was filed in December – said that he supported some aspects of the report, but not others. Richard Baron, MD, MACP, President and Chief Executive Officer of ABIM and the ABIM Foundation, however, did not specify any recommendations or conclusions that ABIM deems unacceptable or appropriate.
"We have made dozens of changes to our program over the past three or four years, all in consultation with a fairly broad community," Baron told Medscape Medical News.
All the MOC programs of the specialized councils "evolve", he declared, adding: "I think that we all pursue the same objective".
Longitudinal and non-periodic examinations
The commission made 15 recommendations to improve the MOC process. He added that he hoped that all suggestions would be taken into account by 2024. "Some of these recommendations are ambitious, but many of them can be addressed in the short term," he added. said the commission.
Key recommendations included a call for the completion of one-time reviews and a preference for ongoing longitudinal assessments that allow graduates to acquire and retain knowledge, identify gaps in knowledge and skills, and learn to progress. in the field. Ideally, diplomats should be hired every year, write the report's authors.
The report noted that the commission had heard a substantial objection to the summative review "all issues" of all decades, as the sole source of assessment of clinical competence. Instead, the exams should be formative and provide diplomats a way to learn, said the commission.
ABIM, for example, began in 2018 to allow diplomats to take shorter exams every two years. He called this initiative the registration of knowledge. Only general internists and nephrologists had this option in 2018; This year, eight more sub-specialties will be able to use knowledge registration and nine more will be added in 2020.
However, the committee said: "Diplomats have not found more frequent shorter assessments in a highly secure or remotely monitored environment (for example, ABIM recording of knowledge) as trainers, but rather more frequent in the case of high stakes assessments.
Baron d'ABIM defended the registration of knowledge, saying that any OMC offering the possibility of losing certification increased the stakes. "The stakes do not come from the evaluation process, but from the value of the title and the risk or not," he said.
The commission also recommended that the exams not be grouped in a four-part format, but rather multi-source and "based on the skills and competences required for optimal patient care in each specialty".
He also encouraged the ABMS Board of Directors to develop new standardized methods of assessing professionalism and to further raise awareness among medical societies, diplomats and other stakeholders, including the public, to ensure that current certification is current and meets multiple needs.
ABMS councils should also consider creating status categories other than simply "certified" or "uncertified," the commission said. This status should also be made public, as surveys, focus group data and public evidence indicate that the public considers certification to be important. Boards must have "clearly defined rehabilitation paths" so that graduates have the opportunity to retain their accreditation in case of potential loss.
Do not use MOC as a baton
The commission also touched on several areas that particularly annoyed doctors, including the fact that accreditation is often the only criterion used to provide references or privileges. In recommendation 8, the board stated that although the certificate has value, meaning and purpose in health care, the ABMS should indicate to hospitals and health care organizations that certification is in progress should not be the only criterion used in decisions regarding accreditation and privileges.
In addition, ABMS should encourage these organizations not to give up their credentials or privileges solely on the basis of certification status, the Commission said.
Many MOC critics have also said that the evidence is derisory as to whether certification improves patient care. The commission recommended that ABMS boards of directors facilitate independent research to determine the extent to which continuing certification helps clinicians provide safe and quality care to patients.
Research should also focus on what types of evaluations and professional development activities are most effective in helping diplomats retain their skills and knowledge.
Expenses not addressed
The commission did not directly address the cost of PC programs for physicians, although in its own survey, 58% of physicians said that costs were the primary concern. Fifty-two percent said the COM was heavy and 48% said it did not accurately measure their abilities as a clinician.
"We clearly heard the testimony of the public and the concerns of the survey of diplomats regarding the fee structure," said the co-chairs of the two commissions. But they said that they had solved the problem. The commission "specifically noted that boards of directors should have reasonable fee structures to continue their certification programs," Colenda and Scanlon told Medscape Medical News.
"However, recommending pricing structures or specific prices did not and should not have been part of the commission's work," they said.
They also heard concerns about what they termed "lack of value" and said that "it is believed that the changes recommended by the commission, associated with some of the changes already implemented by the Offices, will enhance the value of the process for all the different stakeholders ".
Teirstein, however, wants more responsibility. He alleges that ABMS member boards are monopolies and that they "can therefore charge whatever they want," he said. "And I lose my job if I do not have certification."
The NBPAS recommends the creation of an independent oversight committee to review the fees charged to physicians – much like the regulation of utilities.
Yet he applauds the commission. "I think they've documented the problems," he said, adding that they had also recommended positive steps to improve ongoing certification.
He hopes the ABMS boards will suspend some aspects of the OMC considered harmful or unnecessary for doctors "until new policies have been tested and found useful for Doctors and patients, or at least there is a general consensus of doctors on the fact that these new policies are useful for the doctor and helpful for patients, "Teirstein said.