1. American Board of Surgery MAINTENANCE OF CERTIFICATION© G. Rainey Williams Surgical Symposium Oklahoma City September 30, 2005

2. Allergy and Immunology Anesthesiology Colon & Rectal Surgery Dermatology Emergency Medicine Family Practice Internal Medicine Medical Genetics Neurological Surgery Nuclear Medicine Obstetrics & Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology Pathology Pediatrics Physical Medicine and Rehabilitation Plastic Surgery Preventive Medicine Psychiatry & Neurology Radiology Surgery Thoracic Surgery Urology MOC is an initiative of the American Board of Specialties (ABMS) and its 24 member boards: The American Board of Surgery

3. What is Maintenance of Certification©(MOC)? • A process designed to document that diplomates of ABMS boards are maintaining the necessary competencies to provide quality patient care. • Intended to provide more continuous evaluation of physician performance than q 10 year “snapshots”. • Developed by the ABMS and its 24 member boards in a collaborative effort with a spectrum of medical and surgical specialties and other organizations involved in health care quality. The American Board of Surgery

4. Board Certification and Quality Care • The board movement was founded in 1917 out of concern for quality care • Certifying boards set standards for quality • There is evidence of a need for continued monitoring and promotion of quality … • “To Err is Human,” IOM, 2000 • 44,000-98,000 Americans die yearly due to preventable errors • “Bridging the Quality Chasm,” IOM, 2001 • Health care system fails to translate knowledge into practice The American Board of Surgery

5. History of MOC • 1973: ABMS establishes a recertification policy for the continued evaluation of competence; 1976 – ABS adopts time limited certif • 1999: ABMS defines the General Competencies of a physician. • 2002: The four components of MOC are established to evaluate these competencies. • 2003: ABMS and member boards formally commit to evolve their recertification programs into MOC. • 2005: The American Board of Surgery begins MOC upon certification or recertification. The American Board of Surgery

6. Physician General Competencies • Medical Knowledge • Patient Care • Interpersonal and Communication Skills • Professionalism • Practice-based Learning and Improvement • Systems-based Practice The American Board of Surgery

7. Four Components of MOC • Professional Standing • Lifelong Learning and Self-Assessment • Cognitive Expertise • Practice Performance Assessment The American Board of Surgery

8. Four Components of MOC1. Professional Standing • Full and unrestricted medical license • To be verified every three years following certification or recertification • Reference letters from chief of surgery and chair of credentials committee • To be submitted every three years following certification or recertification The American Board of Surgery

9. Four Components of MOC2. Lifelong Learning andSelf-Assessment • Yearly CME of 50 hours, 30 in Category I • Documentation of CME completion to be submitted every three years after certification or recertification • Self-assessment • To be documented every three years after certification or recertification • May be included in postgraduate CME or may be independent efforts so long as CME attached The American Board of Surgery

10. Continuing Medical Education (CME) • Traditional passive lecture format of minimal impact in changing practice • Adult learning more effective if interactive • Learning at home via web potentially available for wide variety of subjects – more convenient, cheaper • Specialty societies need to develop material that is targeted to needs/focus of practitioner • ACCME has not yet accommodated to change in methods of learning; no specific classification of self-assessment activities The American Board of Surgery

11. Self Assessment • Comprehensive self assessment in GS currently available only via SESAP • Ability of practitioner to self assess accurately currently very limited • ACS has recently added Surgical Index to online tools and is considering adding Selected Readings in Surgery • ACCME has not yet addressed self assessment as distinct from CME • Online learning coupled with self assessment offer possibility of more effective continuing education. The American Board of Surgery

12. Self Assessment • Goal of evolving continuing education/self-assesment is to develop activities which are most compatible with usual learning routines of surgeon • Classical lecture format CME is only one method of meeting requirements, and probably not the most effective or efficient • Flexibility in meeting CME/self-assessment requirements will be the hallmark of new program. The American Board of Surgery

13. Four Components of MOC3. Cognitive Expertise • Secure recertification examination • To be taken every 10 years after certification or recertification (unchanged) • While not presently planned, more effective outcome measures might eventually eliminate need for cognitive examination. The American Board of Surgery

14. Four Components of MOC4. Practice Performance Assessment • Intent is to use outcome measures where available:NSQIP, TRACS, UNOS Registry, Cancer databases • If national registry unavailable, participation in local/regional quality programs may apply • If none of the above, will require outcomes reporting by individual surgeon for 3-4 principal outcomes for 3-4 procedures • ABMS currently developing assessment tools in two areas: communication skills and patient safety. If effective, will be included in Part IV in future The American Board of Surgery

15. Potential Benefits of MOC for Diplomates • Improvement in actual and perceived quality of care • More relevant and focussed self-assessment • Acceptance by state boards for relicensure • Unitary measurement of practice performance • Will reduce duplicate quality assessments • Potentially useful in pay for performance • ? effect on malpractice costs The American Board of Surgery

16. Conclusion MOC is an evolving program which is targeted at more continuous measure of physician performance and more comprehensive assessment of multiple competencies. At present it is little different from traditional recertification, but it will change continuously as more effective measures become available. The American Board of Surgery