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Medscape November 4, 2014
Physicians in focus groups agreed that the maintenance of certification (MOC) process is unnecessarily complex and is "of little benefit to physicians, patients, or society," according to a study published online November 3 in JAMA Internal Medicine.
The issue has long been debated among those who see it as a way for physicians to prove they are keeping up with their field, those who see it as a necessary evil and part of being a physician, and those who are upset, as a June 2014 Medscape article points out, about factors including the fees, which can range from $1300 to $2800 and about stricter requirements implemented in 2014.
In the current study, researchers gathered physicians in groups of three to five to talk about what needs to be fixed.
David Cook, MD, from the Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, and colleagues asked 11 focus groups to identify the primary areas of concern and to suggest changes to a process widely considered necessary in some form. They recruited 50 board-certified family medicine and internal medicine physicians.
The researchers asked physicians these questions: What are the barriers and enabling features associated with current MOC activities? And how can these activities be changed to more effectively accomplish the intended purposes of MOC?
As currently implemented, MOC involves four parts: professional standing (maintenance of active licensure), lifelong learning (physicians complete self-assessment and self-study modules), cognitive expertise (a multiple-choice exam), and practice performance (physicians complete a quality-improvement project).
Practice Performance Draws Most Frustration
Nearly all participants named practice performance as the most difficult and frustrating section. They said the projects require time-consuming, low-learning activities such as paperwork and data extraction. They suggested those tasks be delegated elsewhere.
Some participants also said they did not have the training or the skills to lead a quality improvement project.
One common concern was that physicians feel they must manipulate their practices to fulfill MOC requirements, rather than using what they learn from actual practice to earn credit. Researchers suggest that MOC topics and credits should emerge from natural workflow.
"Ideally, real patients (as contrasted with case-based questions or scenarios) would provide both the trigger for learning and the evidence that learning has occurred and has been translated into practice," they write.
Physicians also cite a lack of cohesiveness in the four parts that leads to redundant tasks and extra time. The lifelong learning part should prepare physicians for the cognitive expertise part and provide skills for the practice performance part, they say.
"While certifying boards cannot escape their ultimate accountability to societal needs and priorities, it seems unlikely that current tensions will resolve until physicians' needs have been adequately acknowledged and addressed and the misalignments between purposes and processes have been corrected," the authors conclude.
A coauthor reports receiving royalties from Mosby-Elsevier and, during the initial phases of conceptualization and analysis, serving as chief medical officer of the American Board of Internal Medicine. The other authors have disclosed no relevant financial relationships.
JAMA Intern Med. Published online November 3, 2014. Full text