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  • 1. Russell G. Postier, MD, FACSRussell G. Postier, MD, FACS  This presenter will not discuss any commercial productThis presenter will not discuss any commercial product or service. Nor will the presentation include discussionor service. Nor will the presentation include discussion of any off-label and/or investigational use of anyof any off-label and/or investigational use of any products or services. This presenter will not use anyproducts or services. This presenter will not use any trade names in his presentation. The presenter does nottrade names in his presentation. The presenter does not have any relationship with the commercial supporters ofhave any relationship with the commercial supporters of this program.this program.  The sponsoring unit will not include discussion of anyThe sponsoring unit will not include discussion of any commercial product or service, nor will they discuss anycommercial product or service, nor will they discuss any off-label and/or investigational use of any product oroff-label and/or investigational use of any product or service. Trade names will not be used.service. Trade names will not be used.
  • 2. The American Board of SurgeryThe American Board of Surgery MOC: What it Means for the Rural SurgeonMOC: What it Means for the Rural Surgeon Rural Surgery SymposiumRural Surgery Symposium Grand Forks, North DakotaGrand Forks, North Dakota September 17,l 2007September 17,l 2007
  • 3. MAINTENANCE OFMAINTENANCE OF CERTIFICATIONCERTIFICATION The American Board of SurgeryThe American Board of Surgery
  • 4. The American Board of SurgeryThe American Board of Surgery  Orthopaedic SurgeryOrthopaedic Surgery  OtolaryngologyOtolaryngology  PathologyPathology  PediatricsPediatrics  Physical Medicine andPhysical Medicine and RehabilitationRehabilitation  Plastic SurgeryPlastic Surgery  Preventive MedicinePreventive Medicine  Psychiatry & NeurologyPsychiatry & Neurology  RadiologyRadiology  SurgerySurgery  Thoracic SurgeryThoracic Surgery  UrologyUrology MOC is an initiative ofMOC is an initiative of the American Board of Medicalthe American Board of Medical SpecialtiesSpecialties ((ABMSABMS)) and its 24and its 24 member boards:member boards:  Allergy and ImmunologyAllergy and Immunology  AnesthesiologyAnesthesiology  Colon & Rectal SurgeryColon & Rectal Surgery  DermatologyDermatology  Emergency MedicineEmergency Medicine  Family PracticeFamily Practice  Internal MedicineInternal Medicine  Medical GeneticsMedical Genetics  Neurological SurgeryNeurological Surgery  Nuclear MedicineNuclear Medicine  Obstetrics & GynecologyObstetrics & Gynecology  OphthalmologyOphthalmology
  • 5. The American Board of SurgeryThe American Board of Surgery What is Maintenance ofWhat is Maintenance of Certification?Certification?  A program of continuous learning and improvementA program of continuous learning and improvement that goes beyond the 10-year recertificationthat goes beyond the 10-year recertification “snapshot”“snapshot”  Designed to document that diplomates areDesigned to document that diplomates are maintainingmaintaining the necessary competencies to provide quality carethe necessary competencies to provide quality care  Created by the ABMS and its 24 member boards in aCreated by the ABMS and its 24 member boards in a collaborative effort with other organizations involvedcollaborative effort with other organizations involved in health care qualityin health care quality
  • 6. The American Board of SurgeryThe American Board of Surgery Why MOC?Why MOC?  The new “gold standard” of physician certificationThe new “gold standard” of physician certification  Upholds the meaning of board certification as a standard ofUpholds the meaning of board certification as a standard of qualityquality  Demonstrates to patients and peers a diplomate’sDemonstrates to patients and peers a diplomate’s commitment to continual practice improvement and lifelongcommitment to continual practice improvement and lifelong learninglearning  Allows diplomates to take a proactive position in the healthAllows diplomates to take a proactive position in the health care quality debate, using surgeon-developed metrics andcare quality debate, using surgeon-developed metrics and reportingreporting methodsmethods
  • 7. The American Board of SurgeryThe American Board of Surgery MOC is supported by:MOC is supported by:  Federation of State Medical Boards of the U.S. (FSMB)Federation of State Medical Boards of the U.S. (FSMB)  The Joint CommissionThe Joint Commission  American Hospital Association (AHA)American Hospital Association (AHA)  American Medical Association (AMA)American Medical Association (AMA)  National Board of Medical Examiners (NBME)National Board of Medical Examiners (NBME)  Accreditation Council for Graduate Medical Education (ACGME)Accreditation Council for Graduate Medical Education (ACGME)  Association of American Medical Colleges (AAMC)Association of American Medical Colleges (AAMC)  Council of Medical Specialty Societies (CMSS)Council of Medical Specialty Societies (CMSS)  Educational Commission for Foreign Medical Graduates (ECFMG)Educational Commission for Foreign Medical Graduates (ECFMG)
  • 8. The American Board of SurgeryThe American Board of Surgery Board Certification andBoard Certification and Quality CareQuality Care  The board movement began in 1917 to set standards forThe board movement began in 1917 to set standards for quality carequality care  There is evidence of a need for continued monitoring and promotion of qualityThere is evidence of a need for continued monitoring and promotion of quality …… – ““To Err is Human,” IOM, 2000To 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, 2001Bridging the Quality Chasm,” IOM, 2001  Health care system fails to translate knowledge into practiceHealth care system fails to translate knowledge into practice – Harvard Medical School Study, Annals of Internal Med., Feb.Harvard Medical School Study, Annals of Internal Med., Feb. ’05’05  Doctors who have been in practice for more years tend to possess lessDoctors who have been in practice for more years tend to possess less factual knowledge and are less likely to adhere to appropriate standardsfactual knowledge and are less likely to adhere to appropriate standards of careof care
  • 9. The American Board of SurgeryThe American Board of Surgery Physician CompetenciesPhysician Competencies  Medical KnowledgeMedical Knowledge  Patient CarePatient Care  Interpersonal and Communication SkillsInterpersonal and Communication Skills  ProfessionalismProfessionalism  Practice-based Learning and ImprovementPractice-based Learning and Improvement  Systems-based PracticeSystems-based Practice The ABMS and ACGME have defined six general competencies as the foundation for physicians’ training and practice during their professional lifetime:
  • 10. The American Board of SurgeryThe American Board of Surgery Four Components of MOCFour Components of MOC To assess physicianTo assess physician competencies on a continual basiscompetencies on a continual basis 1.1. Professional StandingProfessional Standing 2.2. Lifelong Learning andLifelong Learning and Self-AssessmentSelf-Assessment 3.3. Cognitive ExpertiseCognitive Expertise 4.4. Evaluation of PerformanceEvaluation of Performance in Practicein Practice
  • 11. The American Board of SurgeryThe American Board of Surgery American Board of SurgeryAmerican Board of Surgery MOC ProgramMOC Program  The following slides give an overview of the ABS MOCThe following slides give an overview of the ABS MOC Program as it is initially being implementedProgram as it is initially being implemented  The program will evolve as new learning and assessmentThe program will evolve as new learning and assessment methods become availablemethods become available  MOC requirements run in three-year cycles, beginning theMOC requirements run in three-year cycles, beginning the July 1 following certification or recertificationJuly 1 following certification or recertification  The ABS intends for MOC to be as flexible as possible toThe ABS intends for MOC to be as flexible as possible to allow diplomates to satisfy its requirements in ways mostallow diplomates to satisfy its requirements in ways most compatible with their practice environmentcompatible with their practice environment
  • 12. The American Board of SurgeryThe American Board of Surgery Four Components of MOCFour Components of MOC 1. Professional Standing1. Professional Standing ABS Requirements:ABS Requirements:  Full and unrestricted medical licenseFull and unrestricted medical license – To be verifiedTo be verified every three yearsevery three years  Reference letters from chief of surgeryReference letters from chief of surgery and chair of credentials committeeand chair of credentials committee – From the institution where most work is performedFrom the institution where most work is performed – To be submittedTo be submitted every three yearsevery three years
  • 13. The American Board of SurgeryThe American Board of Surgery Four Components of MOCFour Components of MOC 2. Lifelong Learning and2. Lifelong Learning and Self-AssessmentSelf-Assessment ABS Requirements:ABS Requirements:  Continuing medical education (CME):Continuing medical education (CME): 30 hours Category I, 50 hours overall30 hours Category I, 50 hours overall annuallyannually – Documentation of CME completion to be submittedDocumentation of CME completion to be submitted everyevery three yearsthree years  Self-assessment evaluationSelf-assessment evaluation – To be completedTo be completed every three yearsevery three years in conjunction with CMEin conjunction with CME
  • 14. The American Board of SurgeryThe American Board of Surgery CME & Self-Assessment ResourcesCME & Self-Assessment Resources  ACS has addedACS has added Selected Readings in SurgerySelected Readings in Surgery andand Surgical IndexSurgical Index to its educational toolsto its educational tools  JACSJACS now offers self-assessment related to selected articlesnow offers self-assessment related to selected articles  The ABS is encouraging the development of additionalThe ABS is encouraging the development of additional resources by specialty surgical organizationsresources by specialty surgical organizations  The ABS is compiling a list of CME and self-assessmentThe ABS is compiling a list of CME and self-assessment resources for MOC on its website,resources for MOC on its website, www.absurgery.orgwww.absurgery.org
  • 15. The American Board of SurgeryThe American Board of Surgery Four Components of MOCFour Components of MOC 3. Cognitive Expertise3. Cognitive Expertise ABS Requirement:ABS Requirement:  Secure examinationSecure examination – May be taken startingMay be taken starting three years priorthree years prior toto certificate expiration (unchanged)certificate expiration (unchanged) – All MOC requirements must be fulfilled up toAll MOC requirements must be fulfilled up to that point to be admissible to the examinationthat point to be admissible to the examination
  • 16. The American Board of SurgeryThe American Board of Surgery Four Components of MOCFour Components of MOC 4. Evaluation of Performance4. Evaluation of Performance in Practicein Practice ABS Requirements:ABS Requirements:  Participation in a national, regional or localParticipation in a national, regional or local outcomes databaseoutcomes database or quality assessment processor quality assessment process −− verifiedverified every three yearsevery three years  PeriodicPeriodic patient communication skills assessmentpatient communication skills assessment also to bealso to be required – not yet finalizedrequired – not yet finalized 2006 Surgery Recertification Examination: 51%2006 Surgery Recertification Examination: 51% of applicants said they were participating inof applicants said they were participating in outcomes studies. These individuals also had aoutcomes studies. These individuals also had a lower exam failure ratelower exam failure rate..
  • 17. The American Board of SurgeryThe American Board of Surgery Fulfilling the Performance inFulfilling the Performance in Practice RequirementPractice Requirement  Participation in SCIP, NSQIP, NTDB, UNOS, STS database,Participation in SCIP, NSQIP, NTDB, UNOS, STS database, SAGES database, burn registries, and bariatric surgerySAGES database, burn registries, and bariatric surgery databases would meet this requirementdatabases would meet this requirement  Participation in CMS’ Physician Quality Reporting InitiativeParticipation in CMS’ Physician Quality Reporting Initiative (PQRI) or the ACS case log system would also meet this(PQRI) or the ACS case log system would also meet this requirementrequirement  The ABS is investigating other national, regional, or hospital-The ABS is investigating other national, regional, or hospital- specific data systems, and is soliciting diplomates’ inputspecific data systems, and is soliciting diplomates’ input via e-mail atvia e-mail at mocpart4@absurgery.orgmocpart4@absurgery.org  The ABMS is developing an assessment tool for patientThe ABMS is developing an assessment tool for patient communication skills that will likely be used in futurecommunication skills that will likely be used in future
  • 18. The American Board of SurgeryThe American Board of Surgery MOC Requirements TimelineMOC Requirements Timeline MOC Year = July 1 to June 30, starting July 1 following certification or recertification MOCMOC YearYear MOC RequirementMOC Requirement 00 Year of certification or recertificationYear of certification or recertification 11 Yearly CMEYearly CME 22 Yearly CMEYearly CME 33 Yearly CME + self-assessmentYearly CME + self-assessment Reference letters and evidence of CME/self-assessmentReference letters and evidence of CME/self-assessment submitted; license status and participation in practicesubmitted; license status and participation in practice assessment verified.assessment verified. 44 Same as Year 1Same as Year 1 55 Same as Year 2Same as Year 2 66 Same as Year 3Same as Year 3 77 Same as Year 1Same as Year 1 88 Same as Year 2Same as Year 2 99 Same as Year 3Same as Year 3 88 -- 1010 Secure examinationSecure examination
  • 19. The American Board of SurgeryThe American Board of Surgery Requirements forRequirements for Multiple Certificate HoldersMultiple Certificate Holders  Parts 1, 2 and 4Parts 1, 2 and 4 of MOC –of MOC – professionalprofessional standing, lifelong learning/self-assessment andstanding, lifelong learning/self-assessment and performance in practiceperformance in practice – performed in– performed in compliance with one certificate may be creditedcompliance with one certificate may be credited to any other ABS or ABMS certificatesto any other ABS or ABMS certificates  Part 3Part 3 –– cognitive expertise (securecognitive expertise (secure examination)examination) –– must be fulfilled in all disciplines for whichmust be fulfilled in all disciplines for which diplomate holds a certificatediplomate holds a certificate
  • 20. The American Board of SurgeryThe American Board of Surgery Benefits of MOC for DiplomatesBenefits of MOC for Diplomates  Improved learning and self-assessment opportunitiesImproved learning and self-assessment opportunities  Relevant measures of practice performanceRelevant measures of practice performance  Will reduce multiple and/or redundant qualityWill reduce multiple and/or redundant quality assessmentsassessments  Responds to public’s concerns regarding health careResponds to public’s concerns regarding health care quality and patient safetyquality and patient safety  Overall improved patient careOverall improved patient care A system of continual self-assessment and practiceA system of continual self-assessment and practice improvement:improvement:
  • 21. The American Board of SurgeryThe American Board of Surgery ConclusionConclusion MOC will provide a moreMOC will provide a more comprehensive, continuouscomprehensive, continuous assessment of the rural physician’sassessment of the rural physician’s competencies and allow diplomatescompetencies and allow diplomates to assume a proactive role in theto assume a proactive role in the quest for safe, quality care.quest for safe, quality care.

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