Maintenance of certification in U.S. otolaryngologists: an update.

Many of us perceive board certification as passing the written and oral exams given by the American Board of Otolaryngology (ABOto). The certification process actually begins when a resident enters training. The resident must register with the ABOto so we can track his/her progress. Annually, the program director completes a form indicating the progress the resident is making and assuring that the resident receives credit for that year of training. At the residency completion, the program director must then sign the resident's application to take the examination, affirming that the resident is medically and professionally qualified.

In the past, once a candidate passed the exams and became certified by the ABOto, no further examinations or assessments were required to maintain certification. In 2002, based upon direction from the American Board of Medical Specialties (ABMS), the ABOto began issuing only time-limited certificates that expire in 10 years and must be renewed. All diplomates with time-limited certificates must participate in Maintenance of Certification (MOC), a program being developed by each of the member boards of the ABMS. Diplomates who hold timeless certificates and participate in MOC can do so without jeopardizing their timeless certificates.

The stimulus for this change is the increasing national focus on healthcare quality. The ABMS and its member boards, along with the state medical-licensing boards, are responsible for the assessment that individual physicians are practicing modern, quality medicine. After careful deliberation, the ABMS developed and mandated that all member boards develop specialty-specific MOC programs.

Each MOC program consists of four parts:

I. Professional standing

II. Continuing education/self-assessment

III. Cognitive examination

IV. Performance in practice

The current status of each of these components is as follows:

I. Professional standing

* All participants must have current valid ABOto certificates.

* All participants must have unrestricted medical licenses in all states in which they practice.

* All participants must have privileges at a hospital or ambulatory surgery center. Those who do not must certify the privileges were not lost due to an adverse action.

II. Continuing education/self-assessment

* Previously, each participant was required to complete 100 hours of CME every two years and report the number of hours in an annual report. Sixty percent of the hours were required to be in otolaryngology. However, the ABOto has applied to the ABMS to change the CME requirement to one in which the participant must meet his/her state licensure CME requirement.

* Each participant must periodically participate in Interact-based self-assessment modules. The ABOto is in the process of developing a prototype self-assessment module that should be available in 2007. More modules will be developed in a variety of areas to serve the wide diversity of practice focuses in otolaryngology. There is no pass/fail on the modules; they are to be used to identify areas of weakness that can serve as a guide for a self-study program.

III. Cognitive examination

* At the end of the 10-year MOC cycle, the participant will be required to take and pass a computer-based exam that is clinically oriented. Because there is such a wide diversity of practice focuses in otolaryngology, the ABOto exam will consist of two modules. The first is a core module that includes material that all otolaryngologists should know such as patient safety, antibiotics, anesthetics, etc. The second module will be selected by the participant based on his/her practice focus. Passing the examination will renew the primary certificate and not imply special expertise in a given area of otolaryngology.

The specialty modules will include:

General             Pediatric Otolaryngology
Head and Neck       Facial Plastic and
                     Reconstructive
Otology/Audiology   Rhinology
Laryngology         Allergy

Diplomates who are subcertified in Neurotology or Sleep Medicine will take those respective modules, which will renew their primary as well as their subspecialty certificate.

IV. Performance in practice

* This part of MOC is probably the most important because it will measure the actual practice of medicine. This is a very difficult concept, and there are no good metrics available at this time. However, all ABMS boards are working on developing this part. It is likely that Part IV will be useful also in the evaluation processes that are being mandated by insurers, Medicare/Medicaid, and state licensing boards. This part of MOC may also fulfill requirements for developing Pay-for-Performance programs. The ABOto's plan is to develop a process that is minimally intrusive, accurate, and cost-effective.

Maintenance of Certification applies to all diplomates certified in 2002 and thereafter, including subspecialty certificate holders. In addition, the directors of the American Board of Otolaryngology have voluntarily agreed to participate in MOC. The state licensing boards are in the process of developing a Maintenance of Licensure program that parallels MOC. It is felt that the states will require participation in their MOL program to maintain a state license. However, the state licensing boards have indicated that participation in the ABMS MOC program will fulfill their MOL requirements.

When we were in medical school and residency, our performance was reviewed regularly in the form of tests, rotation evaluations, and other mechanisms. Ultimately, we passed the ABOto examination and became certified but without any subsequent formal evaluation to help assure ourselves and the public that we were staying current on the latest medical knowledge. The vast majority of certified otolaryngologists provide excellent care. However, the national movement to improve the quality of healthcare mandates a program to ensure we remain up-to-date, the reason for MOC. The thrust of the MOC program is a continuous quality improvement program. It is not intended to be punitive but a stimulus for all to remain current in our practices. Our patients deserve no less.

Jesus E. Medina, MD

President

American Board of Otolaryngology

Robert H. Miller, MD, MBA

Executive Director

American Board of Otolaryngology