1. In 1973, the American Board of Medical Specialties (ABMS) recommended to its member boards that periodic recertification become an integral part of all national medical specialty certification programs. With the constructive intent of maintaining and advancing the standards of practice of thoracic surgery in the United States, the ABTS concluded in 1974 that its Diplomats should recertify. The first time limited certificates of the ABTS were issued in 1976. In September 1979, the ABMS approved the recertification proposal of the ABTS. In April 1983, the ABTS determined that recertification should include: 1. evidence of attendance at appropriate continuing medical education functions; 2. a practice review; and 3.completion of the Self-Education/Self-Assessment in Thoracic Surgery (SESATS). Diplomates certified in 1976 or after must recertify within ten years of the date of the original certification in order to maintain this status. Should CCP’s Recertify Every 10 years?

2. All certified Perfusionists must recertify annually. Recertification is designed to en­sure that Certified Clinical Perfusionists, through continuing education and clinical activity, continue to meet standards and possess current and adequate knowledge in the field. Recertification contains two components: 1. Clinical activity (reported every year) 2. Professional activity (reported every third year) American Board of Cardiovascular Perfusion

3. Board certification is not required of U.S. physicians in order to practice their chosen specialty. However, it has become the gold standard for demonstrating expertise and commitment in their field to patients, providers, insurance companies, and quality organizations across the nation. 4 It is important that students be expected to retain a certain volume of information, foundational material (anatomy, biochem, pharm, etc.), and be tested on their mastery of those subjects. But critical thinking is ultimately the skill that allows mastery of a profession. Are students learning how to think critically? A - Yes, if students perform well on standardized tests. B - No, schools just teach students to fill in the bubbles. C - Sometimes, but not often enough. D - All of the above.

4. The one-size-fits-all examination, which requires many hours of preparation and the review of volumes of material, much of which may be irrelevant to one’s daily practice, is often central to standardized certification testing. If you fail the examination, you fail to become certified. With the emphasis on reducing medical mistakes and sticking with current clinical guidelines, an exam based on factual recall goes against this trend. Watson vs. the world on Jeopardy Watson may indeed "have all the answers" but it has no intuition, no wisdom borne of experience, no little hairs on the back of its neck to suggest that it lacks a crucial piece of information. Indeed, like any computer, its output is simply based on a highly sophisticated set of processes and calculations performed on its input. As with all computers, "garbage in, garbage out" still applies. You leave out one crucial piece of information (and the computer has no way of knowing whether you have or not) and you will likely get the wrong answer. Humans, with our ability to reason and intuit, can often surmise that we are missing that crucial piece of information and act accordingly. Watson is just an information machine......it cannot reason. That is a specialty that all professionals acquire during years of practice.

5. In 2000, the 24 Member Boards of ABMS agreed to evolve their recertification programs to one of continuous professional development – ABMS Maintenance of Certification ® (ABMS MOC®). MOC assures that the physician is committed to lifelong learning and competency in a specialty and/or subspecialty by requiring ongoing measurement of six core competencies: (1) patient care; (2) interpersonal and communication skills; (3) medical knowledge; (4) practice-based learning; (5) systems-based practice; and, (6) professionalism, which are measured using a four-part process. 5 Under MOC, the “every 10-year” snapshot of professionalism, participation in continuing medical education, and medical expertise that are part of current recertification will become a more continuous process. MOC adds the assessment of practice performance to these measures and represents a philosophical change as well as a requirement change. The focus of these assessments is for improvement rather than judgment. The extent to which MOC succeeds will reflect surgeons' ability to improve the quality of care through voluntary efforts.

6. Definition of competence in medicine as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individuals and communities being served. 7 For physicians, and other health professionals like Perfusionists - there needs to be accountability in showing that they are, in fact, specialists and are up to date on changes in their medical profession Considerations for many medical professionals in maintaining Board certification:  Time – study, preparation, vacation? from work and family,.  Cost – Exam costs, travel, away from work, preparation materials, courses  Results accountability – Impact on employment, personal ego, peer valuation

7. Who cares about up-to-date certifications - beyond savvy patients? Health insurers and hospitals. Doctors who are recertified might be paid more by Medicare under federal health-care reform. The healthcare reform bills passed in March 2010 state that participation in MOC by physicians can fulfill the requirements of the Physician Quality Reporting Initiative (PQRI), a reporting system by the Centers for Medicare and Medicaid Services (CMS) which provides an incentive payment to physicians who report quality data for professional services provided to Medicare beneficiaries, set to begin in 2011. 6

8. Perfusionists should re-certify Board credentials (as Physicians do) to ensure they meet nationally recognized standards for education, knowledge, experience and skills to provide high quality care in a specific medical specialty. A process is necessary to foster the habits of career centered learning. As specially trained clinicians, it is important to demonstrate a rigorous commitment to achieving quality clinical outcomes for patients in a responsive, patient-focused setting.

9. 1. “What Board Certification Means”, by American Board of Medical Specialties, http://www.abms.org/About_Board_Certification/means.aspx 2.“Considering Recertification”, by Jeffrey M. Drazen and Debra F. Weinstein, New England Journal of Medicine, Vol. 362, No. 10, May 19, 2010, p. 946; “Maintenance of Certification: Diagnostic Radiology”, the American Board of Radiology, http://theabr.org/moc/moc_faq_who.html 3.“Doctors Face Board Specialty „Expiration Dates ‟ ”, by Mariynn Marchione, Huffington Post, April 5, 2010, http://www.huffingtonpost.com/2010/04/07/doctors- face-board-specia_n_528351.html 4.“What Board Certification Means”, by American Board of Medical Specialties, http://www.abms.org/About_Board_Certification/means.aspx (Accessed 4/22/10) 5.“ABMS Maintenance of Certification®”, American Board of Medical Specialties, http://www.abms.org/Maintenance_of_Certification/ABMS_MOC.aspx 6.“ABMS MOC Included in Health Care Bill as Option to Assess Physician Quality”, American Board of Medical Specialties, March 23, 2010, https://www.abms.org/News_and_Events/Media_Newsroom/Releases/release_ABMSM OCInHlthcareBill_03232010.aspx https://www.abms.org/News_and_Events/Media_Newsroom/Releases/release_ABMSM OCInHlthcareBill_03232010.aspx 7.Assessment in Medical Education, N Engl J Med 2007;356:387-96.Copyright © 2007 Massachusetts Medical Society.