Slide Massachusetts Society of Pathologists Home Rectal Examination

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					  Rebecca L. Johnson, MD
      Chair, Pathology &
         Clinical Labs
   Berkshire Health Systems
President, American Board of
           Pathology
     MOC
 MAINTENANCE OF
  CERTIFICATION -
WHY SHOULD I CARE?
          History of Board Certification

   1908 Derrick Vail, MD

   Presidential address to the American Academy
    of Ophthalmology & Otolaryngology

   ―I hope to see the time….let him then be
    permitted and licensed to practice
    ophthalmology.‖
      American Board Of Ophthalmology


   Am. Ophthalmologic Society, AMA, Academy
    of Ophthalmology
   1915—Defined requirements
   1917—ABO established
                    Early Boards

   1924—Am Board of Otolaryngology
   1930—Am Board of Obstetrics & Gynecology
   1932—Am Board of Derm & Syphilology
   1933—Am Board of Pediatrics
   1934—Psychiatry & Neurology, Radiology, Orthopedic
    Surgery
   1935—Colon & Rectal Surgery, Urology
   1936—Internal Medicine, PATHOLOGY
                 Advisory Board
              For Medical Specialties

   Est. 1933
   Uniformity in MD certification
   Increase public awareness
   Education, training, and certification
            Advisory Board
         For Medical Specialties


 Four first specialty boards
 AHA, AAMC, FSMB, AMA Council
  on Med Ed & Hospitals, NBME
 1970 - American Board of Medical
  Specialties (ABMS)
                   ABMS Purpose

   Discuss common issues
   Advise Boards
   Coordinate work
   Jurisdiction over policies as delegated
   Autonomy of any Board
   Stimulate improvements in med ed
                         ABMS

   24 Boards
     37 Primary specialties
     94 Subspecialties

   2005 ~89% licensed US MDs
   Evanston, IL
   Kevin Weiss, MD, EVP
   www.abms.org
                    ABMS MISSION

   Improve quality of medical care
       Professional and educational standards for
        certification


   Assurance to the public
       Certification has meaning and required components
               ABMS & Member Boards

   Assess
       Education, Training, Licensure, Ethical and
        professional requirements
   Initial examination
     Construction-fair, objective
     Psychometrically reliable and valid

     Assess knowledge & clinical skills
          Limits of Board Certification

   Assesses only medical knowledge
   Snapshot
SOLUTION?
   Recertification
   Time limited certification
   Maintenance of Certification (MOC)
       Evolution from Certification to MOC
1936                        1969               2006    2016



  Unlimited Certification

                            Time-Limited

                            Re-Certification     MOC
              ABMS


 1993 Member Boards agree to
 Recertification

 1997/98  ABPath Voluntary
 Recertification
                 1998 ABMS
          Task Force on Competency
   Mission statement—Diplomates are competent
   Define competence
   Research and assessment, validation
   Template to assess competence
   Peer review of certification
   Collaborative methods of assessment
                GOALS


             MOC Relevant
•Accountability for competence
•Accountability for practice quality
•Reshape Continuing Medical Education

         MOC is Essential; Tied to:
•Hospital Credentialing
•Maintenance of Licensure
•Pay for Performance
         Three Trends Make MOC Relevant

   Public wants accountability for performance
       Purchaser decision about quality
   Quality can be measured
       Patient’s perceptions and health status
       Guideline adherence and achieving outcomes
   Quality can be improved
       Health care results from system
       Change system processes improves care
    Relevance of MOC For A Composite
        Measure of Physician Quality

   Customers
     Healthcare purchasers & patients
     Health plans, medical staffs, group practices

   Competitors
     National Committee for Quality Assessment
     Center for Medicare and Medicaid Services
     Doctor Quality web sites

   Collaborators
     JCAHO
     State Medical Boards/FSMB
Changing View of Professionalism


 Autonomy         Collaboration
 Authority        Evidence
 Assertion        Measurement

 Control          Transparency
            Accountability
   Develop evidence of achieving best
    results for patient care

   Communicate results regularly and
    widely to those to whom
    accountability is owed

Profession                Public
            ABMS & ACGME
          Lifetime Competencies
   MEDICAL KNOWLEDGE
   PATIENT CARE
   INTERPERSONAL & COMMUNICATION
    SKILLS
   PROFESSIONALISM
   PRACTICE BASED LEARNING &
    IMPROVEMENT
   SYSTEMS BASED PRACTICE
   MOC – A Composite Measure of
     Competence and Quality

                              Safe
                             Timely
                            Efficient
                            Effective
                           Equitable
                        Patient Centered



Competencies            IOM Quality
                           Aims
                     Evolution of MOC
1936--Certification              2006 - Maintenance of Certification
Training                           Certification after training
 Competence/Practice               Milestone evidence of competence
 Examination                        I.      Professional standing
                                     II.     Lifelong learning & self-
1998 Voluntary Recertification              assessment

 CME                                III.   Cognitive expertise

 License & privileges               IV.     Practice performance &
                                            improvement
 Examination (optional)
                                    Can apply to all certificates
                                    Single credential
                                     o      Board Certification
                                     o      Maintenance of License
                                     o      Hospital Privileges
                                     o      Public accountability
           American Board of Pathology

   1936 Michigan
   Primary Certification
       AP/CP, AP, CP
   Subspecialty certification
     10
     ACGME approved fellowship

   Change in training requirements
        AMERICAN BOARD OF
           PATHOLOGY

   PRIMARY CERTIFICATION
     ANATOMIC & CLINICAL PATHOLOGY
     ANATOMIC PATHOLOGY

     CLINICAL PATHOLOGY
       AMERICAN BOARD OF
    PATHOLOGY- SUBSPECIALTY
   Blood Banking/Transfusion Medicine
   Chemical Pathology
   Cytopathology
   Dermatopathology*
   Forensic Pathology
   Hematology
   Medical Microbiology
   Molecular Genetic Pathology*
   Neuropathology
   Pediatric Pathology
            ABP Cooperating Societies

   ACLPS
   ADASP
   AMA Pathology Section Council
   APC
   ASCP
   ASIP
   CAP
   USCAP
         Maintenance of Certification

   ABMS initiative
   All 24 specialty boards
   2006 -Time-limited (10 year) primary and
    subspecialty certificates
   Participation in MOC process required
   Completed within 8-10 years
           ABMS Boards
           Recertification

1970   Family Medicine       7
1976   Surgery               10
       Thoracic Surgery      10
1980   Emergency Medicine    10
1985   Urology               10
1986   OB/GYN                6
       Orthopedic Surgery    10
2006   PATHOLOGY             10
             MOC Components

I.     Professional Standing
II.    Lifelong Learning & Self-
       Assessment
III.   Cognitive Expertise (the EXAM!)
IV.    Evaluation of Performance in
       Practice
                        Part I
                Professional Standing

   Maintenance of a full and unrestricted license in at least
    one U.S. jurisdiction, territory, or Canada

   Documentation of medical staff membership and
    privileges or, if not applicable, scope of practice

   Documentation of licensure and medical staff
    privileges at 4th and 8th year
              Part II
Life Long Learning- Self-Assessment

   70 Category 1 CME credits / 2 year cycle
   20 CME credits / 2 yr cycle must be SAMs
   80% CME related to individual’s practice
   Updated electronic record of activities every 2 years
   A fellowship fulfills Part II requirements for 2 year
    period
   Incomplete fellowships prorated
                Part II
Life Long Learning and Self-Assessment
 Content   specifications
   Important  advancements, key concepts
   Basis for CME and self-assessment
   Prep for MOC exam.
   Direct MOC test question development
   Practical ―need to know‖ information,
    used in daily practice, required for
    competence
   Cover all disciplines of pathology
                  Part II
    Life Long Learning-Self-Assessment

   AP and CP Content Committees’ ―Content
    Outlines‖ on line, updated annually
   Fundamental information for daily practice;
    important, validated new knowledge
   Outlines are not templates for exam or
    endorsements of authors
  Self-Assessment Modules (SAMs)

 Elements of SAMs
       Educational product
       Self-administered exam
       Minimum performance level
       Feedback

 SAM requirement for 2006-09 period waived
  because of insufficient offerings
 Certificates issued by societies should reflect regular
  CME versus CME / SAM
       Part III--Cognitive Expertise

 Examination is mandatory
 ―Secure‖ and closed book

 At least once per year

 Taken 8-10 years after initial certification

 Potential 3 year period of qualification
          Part III - Cognitive Expertise

   Modular exams related to practice
   Exams will include:
     Fundamental knowledge
     Current practice-related knowledge

     Emphasis on information new to field

     Practice environment knowledge
                   Part III
              Cognitive Expertise

   AP/CP certified individuals may chose to
    maintain their certification in AP/CP, AP
    only or CP only

   Individuals with subspecialty certification
    may choose to maintain only their
    subspecialty certification
                    Part III
               Cognitive Expertise
MOC exam:
     ―tailor‖ exam to practice by selecting modules.

     Menu of multiple modules

     At least one general module of AP or CP must
      be selected by AP/CP examinees
       Part III - Cognitive Expertise
               MOC EXAM


   6 modules of 25 questions (150 total questions)

   80% practical (virtual microscopy, case-based
    questions etc); 20% written

   Modules graded as one exam
           AP/CP MOC Exam


Option 1       +      + 4 add. =        6
                      total
                      + 3 add. =        6
Option 2       +
                      total


Option 3       +
                      + 3 add. = 6
                      total


     CP              General module
     AP              Specialty module
AP only MOC Exam            CP only MOC Exam


   +                                  +
   or                                 or

   or                                 or
                                                     3
   or                                 or             max

   or                                 or
   or                                 or

 6 total                                   6 total

            CP     General module
            AP     Specialty module
                     Modules
                Clinical Pathology


General CP I, II, III, IV   Hematology I, II
Blood Bank I, II            Immunopathology
Blood Bank-Coagulation      Microbiology I, II
Coagulation                 Chemistry I, II
                     Modules                  Revised 11/08

              Anatomic Pathology

Gen AP I,II               Breast
Gen Surg Path I,II        Cardiovascular
General Cytology I, II    Dermatology I, II
Cytology, Gyn             Endocrine
Cytology, Non Gyn         GI-Liver-Biliary
Bone-Soft Tissue          Autopsy
                                      Revised 11/08
                 Modules
        Anatomic Pathology cont’d


Genitourinary           Pediatric Pathology

Gynecologic             Pulmonary/Mediastinal

Head-Neck               Transplant pathology

Medical Renal           Forensic Pathology

Neuropathology
                                              Revised 11/08
              Common Modules*
       Anatomic and Clinical Pathology

 General Hemepath I             Flow Cytometry
   (Lymph node-Spleen)

 General Hemepath II            Molecular Pathology
   (Bone Marrow)

 Molecular-Cytogenetics         Lab Man / Informatics


* May be used to fulfill AP or CP specialty
modules
        Part III—Exam & MOC Myths

   High stakes—Low failure rate
   Irrelevant—Modular
   Not useful—Improves MK, Pt. Care
   Time consuming—Payoff- meet pt and
    regulatory expectations for quality,
    accountability, self-regulation
     Part IV. Evaluation of Performance in
                    Practice
   Demo to pts, public, profession
       Safe, effective, pt centered, timely, efficient,
        equitable health care
   Improve quality of PC
   CI of practice performance
   Evaluate
       Individual physician performance
    Part IV. Evaluation of Performance in
          Practice - ABMS Principles
   Phase-in; evaluate effectiveness; improve
   Reflect activities of diplomate
   Assessment based on
       EBM/guidelines
       Expert consensus
       Normative peer comparisons
    Part IV. Evaluation of Performance in
          Practice- ABMS Principles
   Compare diplomate to standards
     •   Baseline, plan to improve, measure
   Assess all 6 competencies during cycle
   Key disease or clinical processes
   Collaborative/shared databases
   Proven educational & assessment methods
   MOC for inactive and no PC MDs
     Part IV. Evaluation of Performance in
           Practice - ABMS Principles

   Provide feedback to improve PC, workflow,
    efficiency
   Not be duplicative-P4P
   Collaborate with specialty societies
   Begin assessment during residency
                   Part IV
            Performance in Practice

   Four personal attestations (4th and 8th year)
   Lab accreditation (4th and 8th year) except
    forensic labs
   Laboratory participation in inter-laboratory PI
    programs (2 yrs)
   Individual participation at least 1 laboratory PI-
    QA program/yr. (2 yrs)
                 Part IV
          Performance in Practice

   Society-sponsored programs or created by
    departments/institutions
   On-line application for Part IV programs
   Programs must be ABP-approved
Part IV. Evaluation of Performance in Practice

   Attestations as to:
     Interpersonal and communication skills

     Professionalism

     Ethics

     Effectiveness in systems-based practice
    Part IV. Evaluation of Performance in Practice –
          Interpersonal & Communication Skills

    4th year after certification and at application for exam


    Attestations from:
      ABP-certified pathologist

      Credentials Com or equivalent (e.g. CMO)

      Board-certified physician in another specialty

      Technologist or physician’s assistant (360)
Part IV. Evaluation of Performance in Practice
          Laboratory Accreditation

   Timeline: 8th-10th year with exam application

   Document accreditation status of laboratory
    Part IV. Evaluation of Performance in Practice
           Laboratory Improvement

   Every 2 years after certification

   Documentation to ABP of successful
    participation in inter-laboratory improvement
    and quality assurance programs relevant to the
    practice
    Part IV. Evaluation of Performance in Practice
Individual Improvement & QA Activity

   Every 2 years after certification
   Documents individual participation in at least
    one QA program/year relevant to professional
    activities, or
   Document use of appropriate protocols,
    outcome measures, & practice guidelines to
    improve practice
 Quality Improvement System
                                           Goal
 Quality Measure




                   Time
                                   Collect
                                 Performance
                                  Measures

Report to                  Analyze &     Change a
 Board,                    Compare       Practice
Payer, or                 Performance
                                         Process
Patients
Six Core Competencies In Medical Practice

 Medical knowledge
 Patient care

 Interpersonal and communication skills

 Professionalism

 Practice-based learning and improvement

 Systems-based practice
    Involvement of Specialty Societies in
                  MOC
   ABP --standard setting organization
   Cooperating Societies:
     CME
     Self-assessment tools
     Programs for evaluation of practice performance
     Verification of satisfactory performance
     Remedial education programs
     Content
            MOC Cost to Diplomates

   Fee for electronic database
      $50/year

   CME
   Self-assessment modules
   Cognitive exam
      Currently $2200
   Requirements For MOC Parts I-IV


Part I: Professional Standing

Part II: Life-Long Learning and Self-Assessment

Part III: Cognitive Expertise

Part IV: Evaluation of Performance in Practice
     Failure to meet MOC Requirements

   Must participate and demonstrate satisfactory
    performance in all 4 parts of MOC

   Performance below expectations requires an
    implementation plan to improve performance

   Failure to satisfy performance criteria results in
    loss of certification December 31st of 10 year
    anniversary of initial certification
                 Transition to MOC

   Holders of life-time certificates:
     Voluntary recertification
     Participate in MOC

     Original certificate NOT jeopardized

   Holders of time-limited certificates:
       Must participate in MOC
   Candidates for initial certification:
       Must participate in MOC after certification
  Voluntary
Recertification
  and MOC
             Voluntary Recertification


   1998 ABMS initiative
   Assessment of individual credentials
   Measure quality of professional practice
   Evaluate basic parameters of practice
             Voluntary Recertification

   Diplomates of ABP with non-time-limited
    certificate
   Recertification certificate dated January 1 of the
    year following completion of process
    Valid for 10 years
   Expiration--no effect on original certificate
     Voluntary Recertification Requirements


   Possess lifetime primary certificate
   Current valid, full, and unrestricted license to practice
    medicine or osteopathy in US, its territories, or Canada
   Provide a written statement attesting physically and
    mentally ability to practice pathology
Voluntary Recertification Requirements

   150 CME credits during the 3 years prior to
    application
      100/150 hours must be Category 1
      80/100 Category 1 hours must be directly related to
       practice


   Verify that primary laboratory or work environment
    is accredited
Voluntary Recertification Requirements


 Written statement documenting medical staff
  standing
 References from the head of the department or
  section chief and from chief of the medical staff
 Demonstrate membership in appropriate
  professional organizations
           Recertification Examination

   Optional secure examination

   Computer based, ABP test center

   May be mandatory if candidate does not fully
    meet the other requirements
        Voluntary Recertification vs MOC

   Requirements differ in degree
       CME
         VR – 150 hours in 3 years prior to application;
               100 Category 1
         MOC - 25 hours/yr, all Category 1 AND 1 SAM /yr for
               10 years
         80% of CME related to practice
        Voluntary Recertification vs MOC

   Practice evaluation
     VR – licensure, references, laboratory accreditation,
      medical staff standing, quality of practice assessed by
      references
     MOC – licensure, references, laboratory
      accreditation, inter-laboratory improvement and QA
      programs, individual improvement and QA
      programs
        Voluntary Recertification vs MOC

   Examination
     VR – voluntary, (now) secure, combined AP and CP
      questions
     MOC – mandatory, secure, closed-book exam,
      modular
        Voluntary Recertification vs MOC

   Consequences
     VR – failure to meet requirements or decision not to
      recertify subsequently has no effect on original
      certification status
     MOC – failure to meet requirements results in loss
      of certification
  MOC-Special Circumstance Physicians


 Not  in active practice
 Must complete MOC Parts I, II, III

 Will not need to complete Part IV
                MOC
         Unanswered Questions
 MOL

 Hospital Credentialling
 Health Plan Credentialling
AMERICAN BOARD OF
   PATHOLOGY
  <www.abpath.org>

				
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Description: Slide Massachusetts Society of Pathologists Home Rectal Examination