This document summarizes a presentation on the evolution of continuing medical education (CME) and new requirements for physician certification and licensure. It outlines two dominant trends driving changes - that education should be meaningful to patient care and an active, deliberate process. New models require measuring higher levels of outcomes like patient health. Requirements are increasingly defined by external bodies and include CME, MOC parts 1-4, OPPE/FPPE, and state medical licensure renewal. Physicians must navigate complex and changing requirements from multiple oversight groups to maintain certification and licensure.

1. The Evolution of Continuing Medical Education
Implications for Navigating New Requirements for Performance Evaluation and
Maintenance of Certification and Licensure
Tristan Gorrindo, MD
MGH Psychiatry
Grand Rounds
www.mghcme.org
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2. Disclosures
Dr. Gorrindo has no disclosures to report.
www.mghcme.org
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3. Learning objectives
• Examine the new constructs which are driving
changes in CME and Maintenance of
Certification
• Describe new requirements for CME and MOC
• Create a path for your own professional
development
www.mghcme.org
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4. Two Dominant Trends
1. Education should be
meaningful to patient
care
2. Education should be an
active and deliberate
process
www.mghcme.org
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5. Trend 1: Impact is measurable
Live
Lecture
Format
Performance
Improvement CME
Simulation
www.mghcme.org
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6. Trend 1: Levels of Educational Outcomes
Level 6:
Patient
Health
Level 5:
Performance
Chart Audits
Level 4: Competence
Clinical Simulation
Level 3b: Procedural
Knowledge
Level 3a: Declarative Knowledge
Interactive Webinars
Live Symposia
Level 2: Satisfaction
Level 1: Participation
Moore’s Model
www.mghcme.org
Source: Moore, J Cont Ed Health Prof, 29(1):1-15,2009
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7. Trend 2: Education is deliberate
A THREE Component Educational Program Design
Model
Needs and
Objectives
Educational
Intervention
Evaluation and
Assessment
Adapted from Moore, J Cont Ed Health Prof, 29(1):1-15,2009
www.mghcme.org
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8. Trend 2: Education is deliberate
• Tied to competencies
– As seen in UME and
GME
•
•
•
•
•
•
Patient Care
Knowledge
Communication
Professionalism
Practice-based learning
System-based practice
• Content requirements
are being defined
externally
www.mghcme.org
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9. Physician Requirements
Physicians / Groups:
Professional self-regulation
MGPO QI
Program
Hospital
Accreditation
Bodies
Protect patients
Dept / Group
Quality Efforts
Care Redesign
P4P Measures
Credentialing /
Re-Credentialing
Payer Credentialing
Privileging
Meaningful Use
Payers:
Attract and protect
consumers
OPPE / FPPE
ICD-10 / DSM
Board Exams (MOC III)
Maintenance of
Certification
(Part IV)
Specialty Boards:
Professional
self-regulation
Maintenance
of
Certification
(Part II)
Licensing
Requirements
Board of Registration in Medicine
Protect public from harm
www.mghcme.org
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10. Two Dominant Trends
1. Education should be meaningful to
patient care
2. Education should be an active and
deliberate process
Challenges for clinicians:
Complicated
Time of transition
www.mghcme.org
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11. The Post-graduate Puzzle
MOC-4
MOC-2
Education
MOC-3
& Assessment
MOL
MOC-1
OPPE &
FPPE
CME
www.mghcme.org
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12. The Post-graduate Puzzle
CME – Continuing Medical Education
(Credits)
MOC – Maintenance of Certification
MOL – Maintenance of Licensure
OPPE – Ongoing Professional Practice
Evaluation
FPPE – Focused Professional Practice
Evaluation
www.mghcme.org
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13. Dr. Seasoned
- Board certified in Adult
Psychiatry in 1989
- Holds a massachusetts
medical license
- Sees patients on the
inpatient unit
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14. Dr. MidCareer
- Board certified in adult in
1995 and child in 1997
- Valid state medical license
- Sees patients at MGH
Charlestown Health Center
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15. Dr. Junior
- Board certified in 2012 in
adult psychiatry and
addictions psychiatry in
2013
- Valid state medical
license
- Works in the West End
clinic
www.mghcme.org
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16. Dr. Behaves
- Licensed psychologist in
MA since 1999
- Conducts research in
addition to providing
clinical care
www.mghcme.org
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17. Definitions
CME
MOL
MOC
OPPE
www.mghcme.org
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18. Continuing Medical Education (CME) Credits
CME Credits
Category 1
Live
Enduring
PICME
Journal
Review
Papers &
Posters
Category 2
Teaching
Teaching
Self-study
Peersupervision
Consultation
with
education
Peer-review
Caseconference
Selfassessment
www.mghcme.org
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19. www.mghcme.org
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20. Massachusetts State Requirements
100 Credits Every 2 years
(“majority in area of practice”)
Category 1: > 40 hours
Risk Management: 10 hours (>4 Cat 1)
Pain & Opioid Education: 3 hours (Cat 1 or Cat 2)
End of Life: 2 hours (Cat 1 or Cat 2)
Board of Medicine Regulations: 2 hours (Cat 2)
Electronic Medical Record: Coming 2015
www.mghcme.org
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21. www.mghcme.org
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22. Maintenance of Certification (MOC)
Certification after
NO
Oct 1, 1994
Grandfathered out of
MOC process
MOC-1 Prof Standing
YES
MOC-2 Self-Asst & CME
Last Recert
Before 2012,
Then 10-year
MOC
OR
MOC-3 Cognitive Exam
Last Recert
2012 or later,
Then MOC-C
MOC-4 Perform in Pract
www.mghcme.org
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23. MOC 1
MOC-1 Professional Standing
- Continuously hold an active, full,
and unrestricted license to practice
medicine in at least one state
www.mghcme.org
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24. MOC-2
MOC-2 Self-Assessment & CME
• Self-Assessment Activities
– Quiz of your knowledge to identify further gaps
– Starting Jan 1 only approved products
– Only completion gets reported to board
• 30 specialty or subspecialty CME credits
(  MA state requirements)
www.mghcme.org
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25. MOC-2
MOC-2 Self-Assessment & CME
Year Certified or
Recertified
CME
Self-Assessment
2004
240
20
2005
270
40
2006
300
60
2007-2011
300
80
2012
MOC-C Program
PIP
MOC-C Program
www.mghcme.org
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26. MOC-3
MOC-3 Cognitive Exam
• Once every 10 years
• To sit, all MOC requirements
must be satisfied (audit 5%)
• 215 questions; Computeradministered via Pearson
VUE Centers
www.mghcme.org
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27. MOC-3
MOC-3 Cognitive Exam
• Combined Exams Available
– Addiction Psychiatry
Child and Adolescent Psychiatry
Forensic Psychiatry
Geriatric Psychiatry
– 100 additional questions per specialty
www.mghcme.org
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28. MOC-3
MOC-3 Cognitive Exam
DSM-5
• 2013 and 2014
–
•
2015 and 2016
–
•
Will continue to use DSM-IV-TR
Will use classifications and diagnostic criteria that have not
changed from DSM-IV-TR to DSM-5
2017+
–
Will use DSM-5 classifications and diagnostic criteria
www.mghcme.org
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29. MOC-4
MOC-4 Performance in Practice
Clinical Module
• 5 Patient charts
• 4 quality measures
• Re-measurement within
24 months of another 5
patients
• Starting Jan 1 only approved products
• Only Completion is reported to the ABPN
Feedback Module
• 5 peers and 5 patients
• Identify opportunities for
improvement
• Re-measurement: within
24 months
www.mghcme.org
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30. www.mghcme.org
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31. www.mghcme.org
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32. www.mghcme.org
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33. MOC-4
MOC-4 Performance in Practice
Year Certified or
Recertified
CME
Self-Assessment
PIP
2004
240
20
1
2005
270
40
1
2006
300
60
2
2007-2011
300
80
3
2012
MOC-C Program
MOC-C Program
MOC-C Program
www.mghcme.org
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34. Maintenance of Certification (MOC)
Certification after
NO
Oct 1, 1994
Grandfathered out of
MOC process
MOC-1 Prof Standing
YES
MOC-2 Self-Asst & CME
Last Recert
Before 2012,
Then 10-year
MOC
OR
MOC-3 Cognitive Exam
Last Recert
2012 or later,
Then MOC-C
MOC-4 Perform in Pract
www.mghcme.org
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35. Maintenance of Certification (MOC)
Certification after
NO
Oct 1, 1994
Grandfathered out of
MOC process
MOC-1 Prof Standing
YES
MOC-2 Self-Asst & CME
Last Recert
Before 2012,
Then 10-year
MOC
OR
MOC-3 Cognitive Exam
Last Recert
2012 or later,
Then MOC-C
MOC-4 Perform in Pract
www.mghcme.org
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36. Maintenance of Certification (MOC)
Certification after
NO
Oct 1, 1994
Grandfathered out of
MOC process
MOC-1 Prof Standing
YES
MOC-2 Self-Asst & CME
Last Recert
Before 2012,
Then 10-year
MOC
OR
MOC-3 Cognitive Exam
Last Recert
2012 or later,
Then MOC-C
MOC-4 Perform in Pract
www.mghcme.org
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37. C-MOC
Continuous Maintenance of Certification (C-MOC) Program.
- Beginning in 2012, Diplomates who certify or recertify are enrolled
into the C-MOC
Similarities to 10 year MOC
- Same requirements for MOC 1-4
- Other Diplomates certified prior to 2012, including lifetime
certificate holders, may elect to participate in the program through
their Physician Folio.
Differences from 10 year MOC
- Annual recording of progress required
- Annual fee to ABPN
www.mghcme.org
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38. C-MOC
www.mghcme.org
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39. www.mghcme.org
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40. Hospital
Education
• CME
– ( MA state requirements)
Joint Commission
• Ongoing Professional Practice Evaluation
– CSAT
Annual Trainings:
• Conflict of Interest, Fire Safety, etc
www.mghcme.org
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41. Hospital - OPPE
All Staff (n=410+)
Email
CSAT
De-Identified
Scored
Anonymously
Coral Reef
Fails onto
FPPE
Chart Review
Re-Identified
www.mghcme.org
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42. www.mghcme.org
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43. Professional Societies
• AACAP
– 1 hour of ethics
• APA
– Discounted malpractice
insurance
www.mghcme.org
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44. www.mghcme.org
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45. MA State
Requirements
Dr. Seasoned
(1989)
Dr. MidCareer
(1995 &1997)
Every 2 years:
100 credits
- 40 Cat 1
- 10 RM
- 3 EOL
- 2 Pain
- 2 State Regs
- ? EMR
Dr. Junior
(2012 & 2013)
Dr. Behaves
(1999)
MOC-SA
(Part 2)
MOCPIPa
(Part 4a)
MOC-PIPb
(Part 4b,c)
OPPE
Annual
40 by
recert date
24 credits
every
three
years
Every 2 years:
20 CE credits
MOC-Exam
(Part 3)
2015
(10 years
from last
adult & 8
years child)
Every 10
years
1 by recernt
in 2015
1 by
recernt in
2015
Annual
1 every
three years
1 every
three
years
Annual
Annual
www.mghcme.org
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46. Tristan’s Tips for staying on Target
Maximize your Cat 2 CME credits
Use a tool to track credits and activities
Sign up for reminder system
Expect change in process
Do activities in groups
Start early and review timelines
www.mghcme.org
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47. Resources
AMA CME Category 1 and Category 2
http://www.ama-assn.org/ama/pub/education-careers/continuing-medical-education/physicians-recognition-award-credit-system/full-textbooklet.page
Summary of state requirements:
http://www.acponline.org/education_recertification/cme/state_requirements/2012ama_requirements.pdf
Massachusetts State Requirements:
http://www.massmed.org/Continuing-Education-and-Events/Continuing-Medical-Education-Requirements-for-Physician-License-Renewal-inMassachusetts/#CME_Reporting_Cycle
ABPN MOC Program:
http://www.abpn.com/downloads/moc/moc_web_doc.pdf
ABPN Approved MOC-2 and MOC-4 Products:
http://www.abpn.com/moc_products.asp
www.mghcme.org
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48. Thank You
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