ABIM Announces Plans for New Longitudinal Assessment Option for MOC

A self-paced pathway that could replace Knowledge Check-In

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The American Board of Internal Medicine (ABIM) has announced plans to develop a new self-paced longitudinal assessment for maintenance of certification (MOC) as an alternative option to the traditional every-10-years exam.

“With this new option, physicians will be able to answer a question and receive immediate feedback as to whether it was correct or not, along with the rationale, and links to educational material,” according to a statement from ABIM Board of Directors Chair Marianne M. Green, MD, and President and CEO Richard J. Baron, MD.

ABIM is currently seeking comments on the proposal at its website and has no

The American Board of Internal Medicine (ABIM) has announced plans to develop a new self-paced longitudinal assessment for maintenance of certification (MOC) as an alternative option to the traditional every-10-years exam.

“With this new option, physicians will be able to answer a question and receive immediate feedback as to whether it was correct or not, along with the rationale, and links to educational material,” according to a statement from ABIM Board of Directors Chair Marianne M. Green, MD, and President and CEO Richard J. Baron, MD.

ABIM is currently seeking comments on the proposal at its website and has no timeline for its implementation. The new option could possibly replace the every-two-years Knowledge Check-In (KCI) exam rolled out just last year.

“We see the development of the longitudinal assessment option as an ongoing collaboration with the internal medicine community, with many opportunities for feedback throughout the process. We’ve already had a strong initial response to the announcement, and will spend a lot of time reviewing what physicians have told us,” Baron told Kidney News.

The longitudinal assessment format would allow physicians to log on from anywhere and answer as few or as many questions as desired or as time permits, using whatever information resources they use when treating patients.

Addressing physician concerns

The new format would address some of the major concerns physicians have expressed about MOC, according to Jeffrey S. Berns, MD, FASN, chair of the ABIM nephrology board and a nephrologist at the Hospital of the University of Pennsylvania.

“A lot of physicians have been asking for something you can do at your own pace, you could do it on nights and weekends and without all the high security,” Berns said. “They want robust, formative feedback, with the questions linked to educational material, and a discussion as to why the right answer is right, and the wrong answers are wrong. That makes it a vehicle for ongoing learning, for self-assessment as well as assessment for maintenance of certification.”

The American Board of Anesthesiology has successfully pioneered this formative process by dropping its 10-year recertification test and replacing it with regular online tests and learning modules called the MOCA (Maintenance of Certification in Anesthesiology) Minute. Participants are required to answer 30 questions each quarter of the year at their own pace. The board reports that diplomates have been enthusiastic about the new approach.

Checking in with the Knowledge Check-In

ABIM said it hopes to announce more details about the development timeline later this fall. That leaves the KCI as the alternative to the 10-year exam for the foreseeable future. Nephrology and internal medicine were the first two ABIM specialties given the option last year, and it was rolled out in eight more specialties in 2019.

In addition to the two-year frequency, the KCI differs from the traditional 10-year test in other ways. Physicians can take the KCI either at a test center (in similar circumstances to the 10-year exam) or online from their home or workplace. The KCI is much shorter, with a time cutoff of three hours rather than all day. Failing the exam does not lead to loss of certification; physicians can try again two years later. Both tests are now open book, with UpToDate as the only reference permitted.

In the first year the KCI was offered, about twice as many nephrologists chose it over the 10-year exam. “Seven of eight people who took the KCI in nephrology said it was a fair assessment of knowledge in the discipline, and most of them were satisfied with the testing experience,” Baron said, adding that the KCI received the most positive ratings any ABIM test ever has.

New blueprint

He said the test benefited from the recent review of the “blueprint” used to map out which questions were the most relevant for inclusion on the test. “We set up an online tool and invited everybody who is board-certified in the discipline to rate the relevance of the questions, identify which conditions they treat and which they rarely see, and discuss what is important to know about a condition. The relevance ratings of test questions went up substantially after we did that review,” Baron said. More than 400 nephrologists participated.

One aim of the KCI was to lessen the pressure of the 10-year exam, but many test takers still view it as a high-stakes situation. And although it is a shorter exam, the two-year frequency actually adds up to more time-taking tests.

One test taker with a positive impression despite low expectations was Paul M. Palevsky, MD, FASN, chief of the renal section at the VA Pittsburgh Healthcare System and professor of medicine at the University of Pittsburgh School of Medicine.

“I have spoken to colleagues who have taken the 10-year recertification exams, and [without exception] they said that the questions were on minutiae that were clinically irrelevant. They said, ‘We don’t see the rare diseases that they are asking questions about.’ One of my colleagues texted me immediately after finishing the exam, asking if he still had a job if he didn’t pass because there was so much ridiculous material on the exam,” Palevsky said. “That is the sort of negative feedback that anyone who has followed discussions about the recertification process is well aware of.”

But Palevsky said that he found the KCI covered the “bread and butter topic areas in nephrology” in a reasonable way.

Open book

“Having the opportunity to use UpToDate was beneficial and reflects a reality of how people take care of patients,” Palevsky said. “If you are unsure of something, you can quickly look it up and see what the experts say. I would love to see ABIM allow a broader open book approach. It is quick to look things up if you are acquainted with UpToDate, [but] someone who doesn’t routinely use it might be at a bit of a disadvantage.”

Specialty societies offer resources such as self-assessment programs that they would like to see included among the approved sources, according to Jin Soo Kim, ASN senior director of education.

Kim said another potential test option ASN has been discussing with ABIM is the development of what ABIM calls “practice profiles,” or tests that are customized based on the focus of a physician’s practice, such as dialysis or transplantation.

ASN and ABIM surveyed nephrologists on their practice patterns earlier this year and are in the process of analyzing the results. The analysis will include Medicare data about practice patterns. “Creating practice profiles is a data-driven, expert-informed activity,” Baron said.

Berns said: “There could be two or three or four practice profiles so that every nephrologist can take a version of the assessment that reflects their practice more closely than a single-blueprint–based exam might. So it is modifying the blueprint—not changing the questions, but changing the fraction of the exam that is associated with different blueprint topics.”

Palevsky said of the KCI: “I would have preferred getting more granular feedback about the questions that were answered incorrectly. To turn the exam into a valuable learning experience, it would be nice to have feedback with information about the questions, and why the ABIM question-writers thought that their answers were the correct ones.”

ABIM has heard this request from enough physicians that the longitudinal assessment is designed to take this approach as part of an ongoing evolution.

“I think as an organization we have done a better job of listening to a very broad community,” Baron said. “We didn’t used to focus very much on connecting with those folks, but I think we have gotten better at hearing what they have to say and using it to change the program. The people who hold our certificates are expert clinicians, and we are getting better at using their expertise to make our program better.”

Diplomates can comment on the proposal at www.abim.org.

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