ACG: Progress on Maintenance of Certification Rules

Maintenance of certification (MOC) is a touchy issue for the profession of gastroenterology. Outgoing president of the American College of Gastroenterology (ACG) Stephen Hanauer, MD, has assured members that the organization is confident it has reached an agreement with the American Board of Internal Medicine (ABIM) that will "put on hold some of the more burdensome aspects of the 'maintenance' process."

The key points of the pending agreement, Hanauer said in his farewell speech at the ACG's Annual Scientific Meeting in Honolulu, are aimed at making the MOC focused on competencies and "less intrusive and less expensive."

The goals are "to end the high stakes every 10-year exam" and "to eliminate the closed-book assessments" gastroenterologists must pass, a testing method that Hanauer said does not reflect the way medicine is practiced today, "the realities of medicine in the digital age."

The ACG favors oversight of continuing medical education (CME) providers and tracking of CME participation as a "reasonable alternative pathway" to the 10-year exam. The group also likes the idea of "individualized self-assessment pathways" that allow physicians to test and if necessary improve their skills and knowledge.

Online educational platforms are available through the ACG and other organizations and are effective tools, he said. Open-book tests, evaluated by groups like the ACG, rather than knowledge-based, closed-book exams would be more useful and efficient. Those would be taken in addition to activities that physicians are already doing, he said, such as CME, programmed readings and participation in quality initiatives.

The ACG has asked the ABIM to give clinicians credits for participating in learning activities such as hands-on training or sessions in simulation labs where they can assess their technical skills in essential procedures like colonoscopy and endoscopy.

Quality improvement programs, properly certified, could in turn rule on which of these learning activities meets standards. As for further board certification for sub-specialists, the ACG is opposed.

"In summary, we have encouraged the ABIM to consider offering multiple testing formats that could range from a large open-book style exam" or to sending individual of small question sets the physicians regularly, Hanauer said.

Such a shift in focus of the MOC process would give clinicians credit for participating in activities that are part of the "lifetime learning" experience, with "less of an emphasis on 'busy work'," he concluded.