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Objective: To quantitatively assess radiologists' preferences for Maintenance of Certification (MOC) and Continuing Certification (CC) using a survey of attitudes and perceptions.Methods: A questionnaire that assessed attitudes and perceptions and included a discrete choice or trade-off task was developed by ACR staff in conjunction with an independent market research agency and the Survey Subcommittee of the ACR Task Force on Certification in Radiology. The trade-off exercise was integrated into this methodology to better understand the underlying utilities or preferences of the components of MOC-CC among respondents and to better enable specific recommendations on how to optimize the current program. The survey was administered via e-mail to 17,305 ACR members. The demographic and practice characteristics of the 1,994 (11.5%) respondents were similar to the ACR radiologist membership and correspond to a normal distribution. At a 95% confidence level, with a margin of error 2.1%, we believe that the respondent population fairly reflects the actual population.Results: Similar proportions judged the existing program as excellent or very good (36%), or fair or poor (35%), with 27% neutral. MOC-CC was perceived more often as excellent or very good by those who were grandfathered yet still participating in MOC, were in academic practice, were in an urban setting, were older, or had a role with the ABR. In contrast, MOC-CC was more often judged as fair or poor by those who were not grandfathered, were in private practice, were in a rural setting, or were younger. The current MOC-CC program is not well regarded by diplomates, with few showing preference or acceptability. The program's reception is most sensitive to the following attributes: absence or presence of a practice quality improvement requirement, Online Longitudinal Assessment content including or excluding general radiology in addition to one's specialty and inclusion or exclusion of self-assessment as part of the CME.Conclusion: ACR members diverged in their attitudes toward MOC, with differences among specific demographic and practice characteristics. The current package of features of MOC-CC was widely viewed as unsatisfactory, and a more optimal feature set arose from a simulation exercise. [ABSTRACT FROM AUTHOR]

Healthcare certification organizations carefully balance a commitment to bring value to their membership through programs that support lifelong learning and professional growth, while protecting the public by ensuring competent certified practitioners. These certifying bodies are challenged with remaining current with their maintenance of certification programs while keeping pace with the growing breadth of knowledge, industry standards and guidelines, innovative advances, and rapid technological gains in testing and assessment. Within the context of process innovation, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) evaluated the current landscape of Longitudinal Assessment (LA) as a potential strategy for the assessment of core knowledge as part of their Continued Professional Certification Program for Certified Registered Nurse Anesthetists. This manuscript details the evaluation of LA using a Logic Model as the tool to scaffold inquiry, a review of LA literature, an environmental scan of current LA programs with identification of LA program elements available, and the results of a LA feasibility study. The findings substantiate that continued professional certification which incorporates a LA strategy can augment lifelong learning, but is not an assessment strategy that can be implemented without thoughtful planning, customization and continuous maintenance. • Longitudinal Assessment (LA) is an evaluation strategy being trialed and implemented for recertification of practitioners. • LA is a process that uses modern technology to administer shorter assessments of specific content with immediate feedback. • The NBCRNA evaluated the utility of LA as a potential strategy for their Continued Professional Certification Program. • The considerations to develop, implement, evaluate, and maintain a LA program for the recertification is detailed here. [ABSTRACT FROM AUTHOR]

Changes to the American Board of Internal Medicine's Maintenance of Certification Program: Preserving Core Assessment Values As Maintenance of Certification (MoC) for practicing physicians has evolved into more continuous programs, controversy has arisen over how physicians should self-regulate their profession and serve the public trust in doing so. As a result, the American Board of Internal Medicine (ABIM) has focused on making substantial changes to its MoC program by inviting physician members of the internal medicine community to play critical roles in shaping the program's processes through innovation. Much of the recent focus has been on changing the high-stakes assessment to one that is more relevant and authentic to practice, less burdensome and anxiety provoking for physicians, and more continuous over the course of their career. However, at the same time, ABIM has been careful to preserve the core values of integrity and fairness that are central to testing programs especially when making consequential decisions about test-takers in order to ensure that public expectations are met. This paper lays out the case for a continuous certification program with consequences and the story of how substantial changes were made using an evidence-based approach involving the physician community. [ABSTRACT FROM AUTHOR]

Certification is often viewed to promote lifelong professional development. Industry accreditation agencies include standards for the Maintenance of Certification (MOC) that emphasize the measurement or promotion of continued competency throughout an individual's professional career. In 2013, NBCOT partnered with BreakAway Games to create the NBCOT Navigator®, a virtual continuing competency assessment platform that uses gaming technologies to present a variety of assessment tools that allow certificates to demonstrate their knowledge in specific practice areas. This article is an overview of our team's effort in conceiving, developing, and employing the NBCOT Navigator. The article contains a summary of recent user experiences as well as a description of outreach visits with key stakeholder groups. Generalized recommendations for future design and development of advanced technology-enabled MOC tools are postulated based upon our experiences. [ABSTRACT FROM AUTHOR]

Objective: To assess the factors that may influence physicians' desire to retire through an analysis of data collected through the American Academy of Pediatrics (AAP) State Pediatrician Workforce Survey.Study Design: An electronic survey was sent to retired and nonretired US pediatricians who held AAP membership. The respondents were asked about the importance of 12 factors that would influence or had influenced their decision to retire. The physicians who were not yet retired also were asked: "If you could afford to today, would you retire from medicine?"Results: The survey was completed by 8867 pediatricians. Among the nonretired respondents, 27% reported that they would retire today if it were affordable. Increasing regulation of medicine, decreasing clinical autonomy, and insufficient reimbursement were rated as very important factors by >50% of these pediatricians. Among retired pediatricians, 26.9% identified the effort to keep up with clinical advances and changes in practice as a very important factor in their decision to retire. Younger physicians were significantly more likely to rate maintenance of certification requirements, insufficient reimbursement, lack of professional satisfaction, and family responsibilities as very important factors. Rural pediatricians were more interested in retiring than those working in academic settings. There were no sex differences.Conclusions: Twenty-seven percent of pediatricians in practice today would retire today if it were affordable. Identifying and addressing the important factors that influence a pediatrician's desire to retire can potentially reduce the retirement rate of pediatricians and thus increase access to care for children. [ABSTRACT FROM AUTHOR]

The Institute of Medicine estimated that by 2030, from 10.1 to 14.4 million Americans aged 65 years or older will have mental health or substance use disorders. This article reviews the history and current status of training, certification, and practice in geriatric psychiatry against the backdrop of this "silver tsunami." The American Board of Psychiatry and Neurology (ABPN) administered the first subspecialty examination in geriatric psychiatry in 1991, and through 2015 3,329 certificates were awarded. The Accreditation Council for Graduate Medical Education approved the training requirements in 1993. After a surge in programs and fellows, the numbers appear to have stabilized at about 57 programs and 60-65 trainees per year with fewer than half of the positions filled each year. The majority of graduates seeks and obtains ABPN certification, and the majority of those who were fellowship trained have maintained certification. Despite the unprecedented demand for mental health services for older adults, it must be acknowledged that not enough geriatric psychiatrists can be prepared to meet the needs of an aging U.S.Population: Strategies for addressing the shortage are discussed, including undertaking subspecialty training in the fourth year of psychiatry training, increasing the time devoted to the care of older adults in undergraduate and graduate medical education, and developing alternative training pathways such as mini-fellowships. It is not clear whether more favorable Medicare reimbursement rates for those certified in geriatric psychiatry would increase the numbers seeking fellowship training. [ABSTRACT FROM AUTHOR]

Given that maintaining compliance with Maintenance of Certification is necessary for maintaining licensure to practice as a radiologist and provide quality patient care, it is important for radiology residents to practice fulfilling each part of the program during their training not only to prepare for success after graduation but also to adequately learn best practices from the beginning of their professional careers. This article discusses ways to implement continuous certification (called Continuous Residency Certification) as an educational model within the residency training program. [ABSTRACT FROM AUTHOR]

Background The Performance Improvement (PI) CME format improves physician performance in other specialties but data are lacking in dermatology. Objective We sought to assess the impact of a PI CME activity on physician practice patterns for patients with psoriasis, which was developed, implemented, and evaluated by the American Academy of Dermatology (AAD), in part to assist dermatologists in fulfilling Part IV of their Maintenance of Certification requirements. Methods In this PI CME activity, participants: (1) self-audited patient charts, which met inclusion criteria in stage A, and reflected on their results, benchmarked against peers; (2) reviewed educational materials in stage B and developed an improvement plan; and (3) self-audited a different set of patient charts following the plan's implementation. Aggregate stage A and C data were analyzed using χ 2 tests. Results We found a statistically significant improvement in the advisement of patients with psoriasis regarding their increased risk for cardiovascular disease, to contact their primary care provider for cardiovascular risk assessment, and in shared decision making regarding the treatment plan. We also found an overall statistically significant improvement in history taking per the guidelines. Limitations Learner chart selection bias, self-reporting of chart data, and lack of a control group are limitations. Conclusions The AAD psoriasis PI CME activity demonstrated significantly improved dermatologists' documentation of patient's history, counseling of patients for lifestyle behaviors, and shared decision making. [ABSTRACT FROM AUTHOR]

Radiologists in the United States are required to complete the Practice Quality Improvement (PQI) program as part of their Maintenance of Certification by the ABR. The Institute for Healthcare Improvement’s (IHI) Model for Improvement (MFI) offers an alternative to the 3-phase approach currently advocated by the ABR. The MFI implicitly assumes that many interventions will need to be tested and refined for any meaningful project, and provides a project management approach that enables rapid assessment and improvement of performance. By collecting data continuously, rather than simply before and after interventions, more interventions can be tested simultaneously and projects can progress more rapidly. In this article, we describe the ABR’s 3-phase approach, and introduce the MFI and how it can be employed to affect positive changes. Using a radiology case study, we demonstrate how one can utilize the MFI to enable rapid quality improvement. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Completing a systems-based practice project, equivalent to a practice quality improvement project (PQI), is a residency requirement by the Accreditation Council for Graduate Medical Education and an American Board of Radiology milestone. The aim of this study was to assess the residents' perspectives on quality improvement projects in radiology. Materials and Methods: Survey data were collected from 154 trainee members of the Association of University Radiologists to evaluate the residents' views on PQI. Results: Most residents were aware of the requirement of completing a PQI project and had faculty mentors for their projects. Residents who thought it was difficult to find a mentor were more likely to start their project later in residency (P < .0001). Publication rates were low overall, and lack of time was considered the greatest obstacle. Having dedicated time for a PQI project was associated with increased likelihood of publishing or presenting the data (P = .0091). Residents who rated the five surveyed PQI steps (coming up with an idea, finding a mentor, designing a project, finding resources, and finding time) as difficult steps were more likely to not have initiated a PQI project (P < .0001 for the first four and P = .0046 for time). Conclusion: We present five practical areas of improvement to make PQI a valuable learning experience: 1) Increasing awareness of PQI and providing ideas for projects, 2) encouraging faculty mentorship and publication, 3) educating residents about project design and implementation, 4) providing resources such as books and funds, and 5) allowing dedicated time. [Copyright &y& Elsevier]

Abstract: Background/Purpose: Quality improvement (QI) is critical to enhancing patient care. It is necessary to prioritize which QI initiatives are relevant to one’s institution and practice, as implementation is resource-intensive. We have developed and implemented a streamlined process to identify QI opportunities in our practice. Methods: We designed a web-based Pediatric and Infant Case Log and Outcomes (PICaLO) instrument using Research Electronic Data Capture (REDCap™) to record all surgical procedures for our practice. At the time of operation, a surgeon completes a case report form. An administrative assistant enters the data in PICaLO within 5–7days. Outcomes such as complications, deaths, and “occurrences” (readmissions, reoperations, transfers to ICU, ER visit, additional clinic visits) are recorded at the time of encounter, during M & M Conferences, and during follow-up clinic visits. Variables were chosen and defined based on national standards from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), and Patient Based Learning Log. Occurrences are queried for potential QI initiatives. Results: In 2012, 3597 patients were entered, totaling 5177 procedures. There were 220 complications, 278 occurrences, and 16 deaths. Specific QI opportunities were identified and put into place. Conclusion: Data on procedures and outcomes can be collected effectively in a pediatric surgery practice to delineate pertinent QI initiatives. PICaLO is recognized by the American Board of Surgery as a mechanism to meet Maintenance of Certification 4 criteria. [Copyright &y& Elsevier]

In 2007, the ABR established and implemented Maintenance of Certification as a way to ensure radiologists'' licensure and competency and to promote lifelong learning. Maintenance of Certification was instated for all radiologists receiving diagnostic radiology certificates starting in 2002. The 4 components of Maintenance of Certification are (1) Evidence of Professional Standing, (2) Lifelong Learning and Self-Assessment, (3) Cognitive Expertise, and (4) Practice Quality Improvement (PQI). Creating a PQI program involves establishing basic goals that, when met, will best benefit a department''s needs. Developing a PQI system that promotes quality improvement will benefit the individuals involved, the department, and the institution. Much good can come from these projects: improved patient safety, increased efficiency and throughput with resultant cost savings, improved outcomes, and revenue generation. In addition, these efforts ensure that faculty members and trainees understand the importance of quality efforts in daily practice. This article reflects the author''s experience setting up a PQI program for the radiology department of a large urban teaching hospital. Six steps are suggested to guide the creation of an effective PQI program. [Copyright &y& Elsevier]

The practice of medicine is becoming increasingly complex with regard to its economic and academic aspects. In a climate of increasing cutbacks and reduced reimbursements, health care providers are being held more accountable for proving that the services they render are top quality and worthy of the cost of the care provided. Furthermore, patient safety is currently in the public eye and a driving force behind the Pay for Performance initiative. Therefore, quality assurance programs and practice quality improvement systems have been developed to promote patient safety, improve current practice patterns, and help practitioners maintain their board certification. This article very briefly describes one simple example of a radiation safety quality assurance program. [ABSTRACT FROM AUTHOR]

Radiologists who are chronologically advanced (or mature, as the authors prefer to call them) are faced with many special issues, obstacles, and opportunities. These are in many ways unique and different from the circumstances involving those who are recently out of training or in midcareer. The authors discuss some of these circumstances. They look at the challenges facing mature radiologists through the prism of considerable personal experience, and they hope to offer some insight and suggestions as to how one might respond to these issues. [Copyright &y& Elsevier]

Background: High-volume and fellowship-trained surgeons have superior outcomes. However, in gynecology, a large proportion of cases are performed by low-volume surgeons. Simulation has been shown to be useful in assessing surgical skill and may be a useful tool in hospital credentialing and maintenance of privileges.Objective: To determine the correlation between a surgical case volume and fellowship training with performance on simulated procedural tasks.Study Design: A total of 108 obstetricians and gynecologists with laparoscopic privileges at 2 academic institutions completed a pre-test survey and performed 3 tasks on the LapSim laparoscopic virtual reality simulator. The pre-test survey inquired about the monthly laparoscopic case volume and prior training. Simulations included a basic skills task (peg transfer) followed by a procedural task (salpingectomy) of 2 difficulty levels (low and moderate). Spearman correlation and Wilcoxon tests were used to determine correlations between the survey responses and performance metrics.Results: Participants included 67 generalists (62%) and 41 fellowship-trained specialists (38%). There was an observed weak correlation among surgical volume (more than 6 cases per month), time to completion, and the amount of blood loss when performing the low-difficulty level salpingectomy (r=-0.32, P=.0007 and r=-0.29, P=.002, respectively). The economy of movement (instrument path length) was correlated to high surgical volume (r=-0.35, P=.0002). Compared with generalists, surgeons with fellowship training performed tasks faster (410.8 seconds [interquartile range, 309.7-595.2]) vs 530.2 seconds (interquartile range, 406.2-605.0; P=.0009), more efficiently at 6.1 m (interquartile range, 4.8-7.3) vs 8.1 m (interquartile range, 5.8-10.7; P=.0003), and with less blood loss at 21.7 mL (interquartile range, 11.8-37.7) vs 42.9 mL (interquartile range, 18.1-70.6; P=.002). Regarding the case volume and fellowship background, there was no difference in ovarian diathermy damage. In addition, there was no difference among most performance parameters for the peg transfer task and the moderate-difficulty salpingectomy procedure.Conclusion: Surgical experience obtained through higher case volume and fellowship training correlate with higher performance scores during simulated procedural tasks. In a previous study, we found a similar correlation with simulated basic skills tasks. The current study is a continuation of an ongoing quality initiative to establish a summative assessment of laparoscopic surgical skills using virtual reality simulator for the maintenance of credentials among obstetrical and gynecologic surgeons. Future studies will compare the performance metrics from laparoscopic procedures performed on virtual reality simulator with the performance in the operating room and clinical outcomes. [ABSTRACT FROM AUTHOR]

This review is a summary of a presentation at the 2005 Intersociety Conference on training for the future of radiology. Certification by all 24 boards of the American Board of Medical Specialties, including the American Board of Radiology (ABR), has changed significantly. All primary and subspecialty certificates issued by the ABR are currently limited to 10 years, and diplomates of the board must maintain their certification by completing the ABR’s maintenance of certification (MOC) program. The program consists of 4 components (professional standing, lifelong learning and self-assessment, cognitive expertise, and practice performance) and 6 competencies (medical knowledge, patient care, interpersonal skill, professionalism, practice-based learning and self-improvement, and systems-based practice) that are the key elements to be incorporated within the concepts of continuous quality improvement. The result, over time, is intended to have a major impact in the quality of patient care in terms of outcomes and best practices. How adults learn in the environment of expanding knowledge and the electronic distribution of content is a substantive question requiring research, data, and change. We must seize the opportunity to explore adult learning and the process of MOC. Time-limited certification and MOC can become catalysts for future training requirements, for the design of training pathways, and for certification methodologies. Shaping the future is a noble task requiring leadership, vision, patience throughout change, and creativity. [Copyright &y& Elsevier]

The process of continuing medical education is a part of every radiologist’s and radiation oncologist’s professional growth, development and lifelong learning. This process aids the physician in keeping current with new techniques, procedures, and information. Continuing medical education is required for maintenance of certification. There is also a continuing medical education component and recommendations within the accreditation programs of the American College of Radiology (ACR). The ACR is accredited to sponsor educational activities and award credit hours. It sponsors educational meetings as well as enduring materials. Each activity undergoes a complex, time-consuming development process and is reviewed by the ACR’s Committee on Accreditation for Continuing Medical Education. Traditional lecture based activities have not been effective with regards to improving physician performance and patient care outcomes, which are the ultimate goals of continuing medical education. The most effective educational activities are self-directed, interactive, often Web-based and available at the practice site and are timed when the information is most needed for a real life patient encounter. The ACR supports the radiology and radiation oncology community in their efforts at lifelong learning and is developing new and innovative educational programs and tools to accomplish this goal. [Copyright &y& Elsevier]

Maintenance of certification (MOC) recognizes that in addition to medical knowledge, several essential elements involved in delivering quality care must be developed and maintained throughout one’s career. The MOC process is designed to facilitate and document the professional development of each American Board of Radiology (ABR) diplomate through its focus on the essential elements of quality care in diagnostic radiology, its subspecialties, radiation oncology, and radiologic physics. The initial elements of the ABR’s MOC program have been developed in accord with guidelines of the American Board of Medical Specialties. Further details will be developed as the process evolves. [Copyright &y& Elsevier]

Lifelong learning is critical to radiology and the method by which, as professionals, we have kept up to date on new knowledge and developments. The American Board of Medical Specialists and the American Board of Radiology, along with other professional societies such as the Council of Medical Specialty Societies and the ACR, identified a need and an opportunity to serve the public and our profession through the Maintenance of Certification (MOC) initiative. These issues of lifelong learning, public concern, and MOC—and their interrelationship—are discussed. Lifelong learning is defined as a continuation of medical education with an ongoing process of professional development along with self-assessment, which enables physicians to maintain the requisite knowledge, skills, and professional standards.Continuing professional development can be grouped into three categories: formal, nonformal, and informal learning. Examples from the author’s career illustrate key points. Future technologies and scientific discoveries affect radiology and make the commitment to lifelong learning even more critical. The challenge will be the maintenance of specialty certification and its components and competencies, along with the attainment of knowledge and the skills necessary in our unique practices for quality patient care in the evolving health care environment. These are important challenges to our boards, professional societies, specialty societies, institutions, and practicing community. It is critical to participate actively in these organizations and processes to continue development of the MOC initiative, because it is beneficial to patients, applicable to practicing physicians, and credible to public interests. [Copyright &y& Elsevier]

Since 2006, after completing a cognitive certifying or recertifying examination, dermatologists are automatically enrolled into Maintenance of Certification (MOC) and can access a personalized electronic table (at www.abderm.org) that presents the requirements over the 10-year cycle. On this web site, diplomates can also pay the annual fee and attest to completion of the various components. Clicking on hyperlinks in the table launches explanations of the requirements. A hyperlink below the table takes the reader to the various resources approved for completion of the MOC requirements. There is a login tab in the upper left corner with a login help feature below. Clicking on the MOC tab will bring up the table. The timeline is specific to the individual. [Copyright &y& Elsevier]

Participation in Maintenance of Certification is a reality for the majority of board-certified physicians in the United States. It consists of 4 parts that focus the attention of participants on knowledge assessment, practice performance, communication skills, and patient safety. This continuing medical education article reviews the development and possible future of the program, data regarding Maintenance of Certification, what is currently not known about Maintenance of Certification, and how to navigate the requirements for dermatologists. [Copyright &y& Elsevier]