1. MAINTENANCE OF CERTIFICATION © G. Rainey Williams Surgical Symposium Oklahoma City September 30, 2005 American Board of Surgery

2. The American Board of Surgery Allergy and Immunology Allergy and Immunology Anesthesiology Anesthesiology Colon & Rectal Surgery Colon & Rectal Surgery Dermatology Dermatology Emergency Medicine Emergency Medicine Family Practice Family Practice Internal Medicine Internal Medicine Medical Genetics Medical Genetics Neurological Surgery Neurological Surgery Nuclear Medicine Nuclear Medicine Obstetrics & Gynecology Obstetrics & Gynecology Ophthalmology Ophthalmology Orthopaedic Surgery Otolaryngology Pathology Pediatrics Physical Medicine and Rehabilitation Plastic Surgery Preventive Medicine Psychiatry & Neurology Radiology Surgery Thoracic Surgery Urology MOC is an initiative of the American Board of Specialties (ABMS) and its 24 member boards:

3. The American Board of Surgery What is Maintenance of Certification © (MOC)? A process designed to document that diplomates of ABMS boards are maintaining the necessary competencies to provide quality patient care. A process designed to document that diplomates of ABMS boards are maintaining the necessary competencies to provide quality patient care. Intended to provide more continuous evaluation of physician performance than q 10 year “snapshots”. Intended to provide more continuous evaluation of physician performance than q 10 year “snapshots”. Developed by the ABMS and its 24 member boards in a collaborative effort with a spectrum of medical and surgical specialties and other organizations involved in health care quality. Developed by the ABMS and its 24 member boards in a collaborative effort with a spectrum of medical and surgical specialties and other organizations involved in health care quality.

4. The American Board of Surgery Board Certification and Quality Care The board movement was founded in 1917 out of concern for quality care The board movement was founded in 1917 out of concern for quality care Certifying boards set standards for quality Certifying boards set standards for quality There is evidence of a need for continued monitoring and promotion of quality … There is evidence of a need for continued monitoring and promotion of quality …  “To Err is Human,” IOM, 2000 44,000-98,000 Americans die yearly due to preventable errors44,000-98,000 Americans die yearly due to preventable errors  “Bridging the Quality Chasm,” IOM, 2001 Health care system fails to translate knowledge into practiceHealth care system fails to translate knowledge into practice

5. The American Board of Surgery 1973: ABMS establishes a recertification policy for the continued evaluation of competence; 1976 – ABS adopts time limited certif 1973: ABMS establishes a recertification policy for the continued evaluation of competence; 1976 – ABS adopts time limited certif 1999: ABMS defines the General Competencies of a physician. 1999: ABMS defines the General Competencies of a physician. 2002: The four components of MOC are established to evaluate these competencies. 2002: The four components of MOC are established to evaluate these competencies. 2003: ABMS and member boards formally commit to evolve their recertification programs into MOC. 2003: ABMS and member boards formally commit to evolve their recertification programs into MOC. 2005: The American Board of Surgery begins MOC upon certification or recertification. 2005: The American Board of Surgery begins MOC upon certification or recertification. History of MOC

6. The American Board of Surgery Physician General Competencies Medical Knowledge Medical Knowledge Patient Care Patient Care Interpersonal and Communication Skills Interpersonal and Communication Skills Professionalism Professionalism Practice-based Learning and Improvement Practice-based Learning and Improvement Systems-based Practice Systems-based Practice

7. The American Board of Surgery Four Components of MOC 1.Professional Standing 2.Lifelong Learning and Self-Assessment 3.Cognitive Expertise 4.Practice Performance Assessment

8. The American Board of Surgery Four Components of MOC 1. Professional Standing Full and unrestricted medical license Full and unrestricted medical license  To be verified every three years following certification or recertification Reference letters from chief of surgery and chair of credentials committee Reference letters from chief of surgery and chair of credentials committee  To be submitted every three years following certification or recertification

9. The American Board of Surgery Four Components of MOC 2. Lifelong Learning and Self-Assessment Yearly CME of 50 hours, 30 in Category I Yearly CME of 50 hours, 30 in Category I  Documentation of CME completion to be submitted every three years after certification or recertification Self-assessment Self-assessment  To be documented every three years after certification or recertification  May be included in postgraduate CME or may be independent efforts so long as CME attached

10. The American Board of Surgery Continuing Medical Education (CME) Traditional passive lecture format of minimal impact in changing practice Traditional passive lecture format of minimal impact in changing practice Adult learning more effective if interactive Adult learning more effective if interactive Learning at home via web potentially available for wide variety of subjects – more convenient, cheaper Learning at home via web potentially available for wide variety of subjects – more convenient, cheaper Specialty societies need to develop material that is targeted to needs/focus of practitioner Specialty societies need to develop material that is targeted to needs/focus of practitioner ACCME has not yet accommodated to change in methods of learning; no specific classification of self- assessment activities ACCME has not yet accommodated to change in methods of learning; no specific classification of self- assessment activities

11. The American Board of Surgery Self Assessment Comprehensive self assessment in GS currently available only via SESAP Comprehensive self assessment in GS currently available only via SESAP Ability of practitioner to self assess accurately currently very limited Ability of practitioner to self assess accurately currently very limited ACS has recently added Surgical Index to online tools and is considering adding Selected Readings in Surgery ACS has recently added Surgical Index to online tools and is considering adding Selected Readings in Surgery ACCME has not yet addressed self assessment as distinct from CME ACCME has not yet addressed self assessment as distinct from CME Online learning coupled with self assessment offer possibility of more effective continuing education. Online learning coupled with self assessment offer possibility of more effective continuing education.

12. The American Board of Surgery Self Assessment Goal of evolving continuing education/self-assesment is to develop activities which are most compatible with usual learning routines of surgeon Goal of evolving continuing education/self-assesment is to develop activities which are most compatible with usual learning routines of surgeon Classical lecture format CME is only one method of meeting requirements, and probably not the most effective or efficient Classical lecture format CME is only one method of meeting requirements, and probably not the most effective or efficient Flexibility in meeting CME/self-assessment requirements will be the hallmark of new program. Flexibility in meeting CME/self-assessment requirements will be the hallmark of new program.

13. The American Board of Surgery Four Components of MOC 3. Cognitive Expertise Secure recertification examination Secure recertification examination  To be taken every 10 years after certification or recertification (unchanged)  While not presently planned, more effective outcome measures might eventually eliminate need for cognitive examination.

14. The American Board of Surgery Four Components of MOC 4. Practice Performance Assessment Intent is to use outcome measures where available: NSQIP, TRACS, UNOS Registry, Cancer databases Intent is to use outcome measures where available: NSQIP, TRACS, UNOS Registry, Cancer databases If national registry unavailable, participation in local/regional quality programs may apply If national registry unavailable, participation in local/regional quality programs may apply If none of the above, will require outcomes reporting by individual surgeon for 3-4 principal outcomes for 3-4 procedures If none of the above, will require outcomes reporting by individual surgeon for 3-4 principal outcomes for 3-4 procedures ABMS currently developing assessment tools in two areas: communication skills and patient safety. If effective, will be included in Part IV in future ABMS currently developing assessment tools in two areas: communication skills and patient safety. If effective, will be included in Part IV in future

15. The American Board of Surgery Potential Benefits of MOC for Diplomates Improvement in actual and perceived quality of care Improvement in actual and perceived quality of care More relevant and focussed self-assessment More relevant and focussed self-assessment Acceptance by state boards for relicensure Acceptance by state boards for relicensure Unitary measurement of practice performance Unitary measurement of practice performance Will reduce duplicate quality assessments Will reduce duplicate quality assessments Potentially useful in pay for performance Potentially useful in pay for performance ? effect on malpractice costs ? effect on malpractice costs

16. The American Board of Surgery Conclusion MOC is an evolving program which is targeted at more continuous measure of physician performance and more comprehensive assessment of multiple competencies. At present it is little different from traditional recertification, but it will change continuously as more effective measures become available.