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The American Board of Radiology Maintenance of Certification

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  • 1. The American Board of Radiology Maintenance of Certification Update Presentor: Bhudatt R Paliwal, PhD Coauthors: William R. Hendee, PhD Stephen R Thomas, PhD June 17, 2004
  • 2. FIRST-CURVE: PRE-INDUSTRIAL (CRAFT) SECOND CURVE: POST-INFORMATION (SYSTEMS) 6 sigma ↑ ↑ 4 sigma (Information Age Culture) ↑ ↑ (Craft-age Culture) (Now) ↑ ↑ Performance Time → → → → -adapted from Ian Morrison, The Second Curve, Managing the Velocity of Change, 1996
  • 3. KEY ASSUMPTIONS AND BELIEFS PRE-INFORMATION POST-INFORMATION 1. Quality capability: 2 – 4 Sigma “satisfactory” 1. Quality capability: 5 – 6 Sigma essential 2. Organized around needs of providers 2. Designed around needs of those served, including those of all caregivers 3. Assumption: “1st , do no harm,” provider intentions impeccable 3. Assumption: Humans inherently fallible, harm occurs despite providers’ best intentions 4. Reality: Human error generates harm, threat of punishment as deterrent 4. Reality: System is “error tolerant,” i.e., accepts human error as inevitable, designs “error-proofing” 5. Quality capability conceived almost solely in terms of professional skills, with virtual blindness to importance of support systems 5. Understands that carefully designed quality infrastructure absolutely essential to reduce risk and optimize skills of professionals 6. Complexity makes it “easy to do things wrong, hard to do things right” (IOM) 6. Well-designed “latent workplace conditions” make it “easy to do things right, hard to do things wrong” Turnbull, JE Personal Mastery: The Key to Managing Tensions Around Patient Safety
  • 4. KEY ASSUMPTIONS AND BELIEFS PRE-INFORMATION POST-INFORMATION 1. System fragmented – patient “fends for her/himself” moving from “silo to silo” 1. System seamless – coordinates needs of complex patients, using case managers for those especially difficult 2. Medical record fragmented and idiosyncratic to particular “silo.” Individual caregivers work off entirely unconnected, often contradictory “scripts” 2. Medical record electronic – medical record instantly updated and available for all relevant caregivers: all caregivers read from precisely the “same script” 3. Billing/payment systems arcane, confusing, virtually impossible to understand 3. Coverage and co-payment clear, web-facilitated, and easy to navigate 4. Payment system blind to quality and value, rewards volume, even that generated by poor quality and error 4. Payment system fine-tuned to value, rewards superior performance as defined by value equation (V = Q/$) 5. Huge resources consumed in “reimbursing” inefficient systems, human error, litigation, and “cost-plus” models 5. Huge resources freed up for innovation and quality improvement, with “cost-plus, value-blind reimbursement” a distant memory 6. Health care as an isolated, quirky “high-tech, organizationally primitive” industry, a “throwback” to pre-18th century human organizational development 6. Health care as a vibrant participant in the best that learnings from the industrial/information revolution can offerTurnbull, JE Personal Mastery: The Key to Managing Tensions Around Patient Safety
  • 5. Health Care Must Become IOM 2001 AIMS TO CROSS THE CHASM Patient and Provide Safe Evidence-Based Patient-Centered Timely Efficient, Equitable JCAHO (www.jcaho.org) DIMENSIONS OF PERFORMANCE Patient Safe Efficacious, Appropriate Respectful, Caring, Continuous Available, Timely Efficient, Effective © WRH, MCW (April, 2004)
  • 6. …And changing culture? “Once people have created a particular way of understanding the world, they tend to hold to it quite tenaciously. One tentative axiom would thus be that culture changes about as fast as its most recalcitrant powerful members change.” -Alan Wilkins and Kerry Patterson in Ralph Kilmann, et al. Gaining Control of the Corporate Culture Or, as a pioneering 20th Century physicist once remarked, “Scientific progress moves forward, one funeral at a time.” © WRH, MCW (April, 2004)
  • 7. MAINTENANCE OF CERTIFICATION American Board of Radiology © WRH, MCW (April, 2004)
  • 8. History of MOC • 1936:1936: ABMS Advisory Board reference toABMS Advisory Board reference to “Reregistration at Stipulated Intervals”“Reregistration at Stipulated Intervals” • Early 1940’s:Early 1940’s: Open discussions regarding issuance ofOpen discussions regarding issuance of certificates valid for a stated period of time only.certificates valid for a stated period of time only. • 1973:1973: First formal policy regarding recertification wasFirst formal policy regarding recertification was adopted by the ABMS.adopted by the ABMS. • 1993:1993: ABMS reaffirmed its policy with all 24 memberABMS reaffirmed its policy with all 24 member boards required to establish a mechanism to recertifyboards required to establish a mechanism to recertify diplomats.diplomats. • March 2000:March 2000: Agreed that existing or planned programsAgreed that existing or planned programs of recertification would evolve into programs ofof recertification would evolve into programs of Maintenance of Certification (MOC).Maintenance of Certification (MOC). © WRH, MCW (April, 2004)
  • 9. ABMS: Four Components of MOC • Component 1: Professional StandingComponent 1: Professional Standing - Validity of the license to practice.- Validity of the license to practice. • Component 2:Component 2: Lifelong Learning and Self-Assessment.Lifelong Learning and Self-Assessment. - The requirement to keep current in the field.- The requirement to keep current in the field. • Component 3: Cognitive ExpertiseComponent 3: Cognitive Expertise - Examination process.- Examination process. • Component 4: Practice PerformanceComponent 4: Practice Performance - Assessment of patient care.- Assessment of patient care. © WRH, MCW (April, 2004)
  • 10. ABMS SIX COMPETENCIES OF MOC • Professionalism • Practice-Based Learning/Self Improvement • Practice Knowledge • Patient Care • Interpersonal/Communication Skills • System-Based Practice © WRH, MCW (April, 2004)
  • 11. ABR MOC Appendix 1 (Diagnostic Radiology) 1/04/04 Evaluation Criteria for the Four MOC Components According to the Six General Competencies MOC Components I. Professional Standing II. Lifelong Learning and Self-Assessment III. Cognitive Expertise IV. Practice * Performance Competencies 1. Professionalism Verification of valid non- restricted medical license Records of professional activities associated with Lifelong Learning & Self-Assessment TBD TBD 2. Practice- Based Learning and Self Improvement Documentation: special certificates, diplomas, licensure Minimum of 500 hours CME credit over 10 year cycle. Minimum of 250 hours Category 1 credits, at least 70% must be specialty specific or related areas Computer-based self- assessment and cognitive exams given over a 10-year period focused on essential core knowledge and practice. TBD 3. Practice Knowledge TBD. Documentation and completion of 500 hours CME credit. Minimum of 250 hours Cat 1, Personal assessment of performance and practice with education plan. Achieve a passing score on the ABR MOC cognitive exams TBD 4. Patient Care TBD. Documentation: New or review of techniques and protocol as part of Lifelong Learning & Self Assessment Achieve a passing score on the ABR MOC cognitive exams that includes a patient care component. TBD 5. Interpersonal and Communication Skills TBD Considering evaluation from patients and colleagues TBD TBD 6. Systems- based Practice TBD Utilization of continuous quality improvement principles related to analysis of practice based systems Achieve a passing score on the ABR MOC cognitive exam along with completion of self assessment and review of assigned materials TBD
  • 12. Radiology’s Perspective of MOC • 1998: Concerted efforts initiated by The ABR toward1998: Concerted efforts initiated by The ABR toward the development of its MOC process.the development of its MOC process. • Dec 2001: The ABR convened a meeting to engage eachDec 2001: The ABR convened a meeting to engage each of its sponsoring organizations in planning MOC.of its sponsoring organizations in planning MOC. • Jan 2004: ABR convened a wider meeting ofJan 2004: ABR convened a wider meeting of radiological organizations to discuss MOCradiological organizations to discuss MOC implementation.implementation. • The ABR is responsible for executing MOC inThe ABR is responsible for executing MOC in radiology.radiology. • Establishing mechanisms for life long learning will beEstablishing mechanisms for life long learning will be the responsibility of the other radiology societiesthe responsibility of the other radiology societies. © WRH, MCW (April, 2004)
  • 13. The ABR MOC Coordinating Committee MembersMembers • Radiologic Physics:Radiologic Physics: Stephen R. Thomas, PhD, ChairStephen R. Thomas, PhD, Chair • Diagnostic Radiology:Diagnostic Radiology: John Madewell, MD, MD Anderson CCJohn Madewell, MD, MD Anderson CC Gary Becker, MD, Miami CardGary Becker, MD, Miami Card &&Vas InstVas Inst Chris Merritt, MD, PhiladelphiaChris Merritt, MD, Philadelphia • Radiation Oncology:Radiation Oncology: Larry Kun, MD, St Jude’s Children’s, MemphisLarry Kun, MD, St Jude’s Children’s, Memphis Larry Davis, MD, Emory UniversityLarry Davis, MD, Emory University © WRH, MCW (April, 2004)
  • 14. Initiation of Time-Limited Certificates • Diagnostic Radiology 2002 • Radiation Oncology 1995 • Physics 2002 • CAQs – Pediatrics 1994 – Neuro 1995 – Vascular and Interventional 1994 – Special Comp Nuclear 1999 © WRH, MCW (April, 2004)
  • 15. MOC Component 1: Professional Standing Three Elements: • Letters of attestation • Documentation of licensure or other regulatory agency certification for practice components (where applicable) • Expertise based appointments or recognition © WRH, MCW (April, 2004)
  • 16. MOC Component 2: Life Long Learning and Self Assessment • Two Categories of CME (CEC) – Category 1: 250 credits over 10 year cycle – Category 2: 250 credits over 10 year cycle • Self-Directed Educational Project (Physics) – ____credits per project © WRH, MCW (April, 2004)
  • 17. Self Assessment:Self Assessment: • At specific time points, candidates will be required toAt specific time points, candidates will be required to perform a self-assessment a to their overall progress inperform a self-assessment a to their overall progress in completing the requirements of the MOC process.completing the requirements of the MOC process. • Self-assessment as a global process is intended to bringSelf-assessment as a global process is intended to bring all facets of essential professional development intoall facets of essential professional development into focus.focus. • The diplomates will evaluate their performance inThe diplomates will evaluate their performance in fulfilling the 4 components of MOC.fulfilling the 4 components of MOC. • Candidates will provide an assessment of the degree toCandidates will provide an assessment of the degree to which they have satisfied the requirements inwhich they have satisfied the requirements in correlation with their personal schedule for completioncorrelation with their personal schedule for completion and submission of their MOC application.and submission of their MOC application. MOC Component 2 (continued): Life Long Learning and Self Assessment © WRH, MCW (April, 2004)
  • 18. MOC Component 3: Cognitive Expertise • Expectation: That the individual 1.) maintains the fundamentalExpectation: That the individual 1.) maintains the fundamental core knowledge and 2.) remains up to date on evolvingcore knowledge and 2.) remains up to date on evolving technologies, protocols and applications.technologies, protocols and applications. • In Physics:In Physics: – Three modules for the examination to be completed over the 10-yearThree modules for the examination to be completed over the 10-year certification period.certification period. – Format: Web based; proctored; multiple choice; open book, newFormat: Web based; proctored; multiple choice; open book, new module available on an annual basis.module available on an annual basis. – Upon passing, a certificate of completion is issued that would beUpon passing, a certificate of completion is issued that would be submitted with the MOC application packet (web process).submitted with the MOC application packet (web process). – A candidate who fails an exam would have the opportunity to retakeA candidate who fails an exam would have the opportunity to retake the exam the next year.the exam the next year. © WRH, MCW (April, 2004)
  • 19. MOC Component 4: Assessment of Practice Performance • Expectation: That the individual hasExpectation: That the individual has maintained active, professional involvementmaintained active, professional involvement in the discipline.in the discipline. © WRH, MCW (April, 2004)
  • 20. “It’s not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” -Charles Darwin © WRH, MCW (April, 2004)
  • 21. • “You don’t have to (change), survival is not compulsory.” -W. Edwards Deming © WRH, MCW (April, 2004)

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