1. Maintenance of Certification
-MOC-
Conference of CAP State Pathology Presidents
Washington, D.C.
William F. Hickey, MD, FCAP
Chair, Education Committee of the CAP
June 29th, 2007

2. Maintenance of Certification (MOC) Requirements for Pathologists: What You Need to Know
Based on information from:
The American Board of Pathology
The CAP Education Committee
Presentation/Article by Dr. Eliz. Hammond
and the CAP Education Committee

3. Key MOC Questions Where do we currently stand?? What is MOC?
Where did it come from?
Who is responsible for MOC?
How will it be implemented?
What is the CAP doing about it?

4. Where do we currently stand??
Pathologists certified by the American Board of Pathology (ABP) prior to June 2006 have a “permanent” board certification that will neither expire nor will the ABP require that it be renewed *.
Voluntary recertification is available and will not change the status of your original certification.
Pathologists certified by the ABP in or after June 2006 will receive a time delimited certificate that must be renewed at least every ten (10) years, but can be renewed as soon as eight (8) years after certification.
*The catch: while the ABP does not require recertification, a number of states,
third party payers and some hospitals are requiring pathologists to recertify regardless of
the ABP’s guidelines.

5. What is MOC? ABMS Definition:
Maintenance of Certification (MOC) is the board certification program for assessment of continuing competence of physicians and encompasses a formal recertification process.

6. Components for Assessment
What is MOC?
Program Elements 6 4
Competencies
Components for Assessment

7. 6 4 What is MOC? Program Elements Competencies Medical Knowledge
Components
for Assessment
Medical Knowledge
Patient Care
Practice-based
Learning and
Improvement
Interpersonal and
Communication Skills
Professionalism
Systems-based
Practice

8. 4 6 What is MOC? Program Elements Components for Assessment
Competencies
Components
for Assessment
Professional standing
Commitment to lifelong
learning and involvement
in a periodic self-
assessment process
Cognitive expertise
Evaluation of performance
in practice

9. Where did MOC come from?
In March 1998, ABMS created a Task Force on Competence to “…develop and implement a system for certifying that physicians are competent.”
Focus of activities is on evaluation of physicians AFTER initial certification, resulting in the MOC concept

10. Where did MOC come from?
ABMS produced a description of the competent physician and six general competency categories against which physicians should be evaluated
They stipulated expectations of specialty boards and timeframe for compliance
They approved a statement of their commitment to the MOC program

11. Who is responsible for MOC?
As a member board of the ABMS, the ABP is responsible for developing the MOC program for pathologists
In 2006, primary/subspecialty certificates will be 10 years duration. MOC requirements must be completed by certificate expiration date.
Candidates may sit for re-certification beginning in eighth year of certificate, but must do so before their certificate expires or they will be deemed to be “not board certified”. (Exams given twice/year.)

12. How will it be implemented?
ABP will determine implementation
for each of the four components for
assessment of continuing competence.

13. How will it be implemented?
1. Professional Standing
Unrestricted license to practice medicine in the US/Canada
Medical staff membership and scope of hospital privileges in pathology
Peer attestations as to interpersonal and communication skills, professionalism, and effectiveness in a systems-based practice

14. How will it be implemented?
2. Lifelong Learning/Self Assessment
Learning content specifications focused on topics important for maintaining competence
Performance feedback to pathologist to direct ongoing CME
Participation mandatory; documentation provided directly to ABP biannually
Programs affordable and readily accessible
20 self-assessment modules (SAMs) must be completed every 2 years.

15. 70 Category 1 CME credits each 2 year reporting cycle and at least 20 must be from self-assessment modules
80% of CME must be directly related to individuals’ practice
Must maintain an electronic record of activities with ABP-updated every 2 years

16. Self-assessment Modules (SAMs)
Must be in a setting of CME – one module will
be equivalent to one hour of CME.
Must be a scored exam with a fix passing score
The score must be reported to the individual
A record of the examination and verification
of a passing score must be provided to the
ABP by the testing organization.
Failing scores on the SAMs are not reported
to the ABP and do not meet the requirement
for a SAM.

17. How will it be implemented?
3. Cognitive Expertise
Measured by performance on a secure exam
(i.e. closed book)
Modular exam relevant to individual practice
Knowledge fundamental to the field of pathology
Diplomates will be eligible to take the exam for
3 years
AP/CP diplomates can recertify in one or both
Tests will be geared to actual area of practice

18. Fall 2006:
The ABP requested that the Cooperating Societies each nominate four (4) of their members – two (2) in AP and two (2) in CP. From the four nominees the ABP will select two (2), and they will be incorporated into a committee charged with preparing the recertification examination on the “medical knowledge” component (i.e., the cognitive exam).
May 2007:
The ABP convened a committee composed of anatomic and clinical pathologists who were charged with identifying areas of emerging importance about which practicing pathologists should be aware.
Future:
The ABP will direct their test committees to develop questions for
the exam derived from the areas the Cooperating Societies are
offering educational programs and SAMs.

19. How will it be implemented?
4. Evaluation of Performance in Practice
Compliance with published practice and
report content guidelines
Consideration being given to:
Laboratory accreditation required
Inter- and intra-laboratory improvement
and quality assurance programs that are
approved by the ABP. Attestation of
participation required every 2 years.
(Use of accepted templates for complete reporting ??)

20. Candidates must provide attestations as to interpersonal and communication skills, professionalism, ethics, and effectiveness in systems-based practice
--4 references must be provided at beginning of year 4 and again when applying for exam:
1) ABP certified pathologist
2) Individual in senior administration
3) Physician in another specialty
4) Technologist or PA who works with diplomate

21. Why is MOC important to you?
All board-certified pathologists* will be required to demonstrate evidence of lifelong learning
You will have to acquire education addressing the six
competency categories
You will need a mechanism for tracking your
CME participation
Health care organizations may require similar evidence from ALL physicians, including pathologists
Patients want evidence of ongoing competence
* Certified after 2006
ABP is relying on CAP & others to provide programs of self-assessment & lifelong learning.
CAP members will need to demonstrate evidence of lifelong learning which may at some point require CME credits in specific competence categories.

22. What is the CAP doing? etc. Keeping members informed of MOC
Offering education in the emerging
areas targeted by the ABP
- Working with the ABP on tests
- Designing and offering SAMs
- Providing an electronic, on-line
tracking tool for CME & SAMs
Laboratory accreditation
etc.

23. Questions?

24. Finis

25. Appendix Slides

26. Competency Categories
Medical Knowledge
Patient Care
Practice-based Learning and
Improvement
Interpersonal and Communication Skills
Professionalism
Systems-based Practice

27. Medical Knowledge
Demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of their knowledge to pathology.
Anatomic Pathology
Clinical Pathology

28. Patient Care
Demonstrate a satisfactory level of diagnostic competence and provide appropriate and effective consultation in the context of pathology services.
Informed decision-making
Colleague and patient education
Information Technology use
Performance of procedures
Preventive health services

29. Interpersonal and Communication Skills
Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates.
Building Relationships
Communication
Teamwork
Empowerment

30. Professionalism
 Demonstrate a commitment to carrying out professional responsibilities, awareness of the fiscal aspects of our actions in practice, adherence to ethical principles, and sensitivity to a diverse patient population.
Leadership
Ethics
Respect for Diversity
Financial Responsibility

31. Practice-Based Learning and Improvement
Investigate and evaluate diagnostic and laboratory practices, appraise and assimilate scientific evidence, and improve laboratory practices and patient care.
Practice Analysis
Assimilation of External Data
Process and Outcome Improvement

32. Systems-Based Practice
Demonstrate an understanding of national, regional and local health care systems and an ability to utilize the resources of those systems in providing medical care.
Practice and System Integration
Medical Practice & Delivery Systems
Practice Economics

33. Identification of MOC Categories
Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, the patients’ families, and professional associates.
Demonstrate a satisfactory level of diagnostic competence and provide appropriate and effective consultation in the context of pathology services.

34. Identification of MOC Categories
Demonstrate ability to investigate and evaluate diagnostic and laboratory practices in your own lab, appraise and assimilate scientific evidence, and improve laboratory practices and patient care.
Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse patient population.

35. Identification of MOC Categories
Demonstrate understanding of and contribution to local, regional, and national health care systems, and support health care in system-based practice definition.
Demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to pathology.

36. The following slides were produced by the American Board of Pathology
and are available on their website
Under: MOC Presentation

38. Maintenance of Board Certification (MOC)
• Response to ABMS initiative
• ABP MOC program is part of an ABMS-wide MOC process involving all 24 specialty boards
• Beginning in 2006 ABP issued time-limited primary and subspecialty certificates of 10 years duration
• Participation in the MOC process is required for all diplomates certified after 2005 and must be completed no later than 10 years after initial certification

39. 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

40. Part I--Professional Standing
Maintenance of a full and unrestricted license
Restricted license leads to disqualification for MOC until restriction is removed
Diplomates must notify ABP of restriction within 60 days after its imposition
Documentation of medical staff membership and privileges or, if not applicable, diplomate must submit a description of their practice

41. Part II--Life Long Learning and Self-Assessment
70 Category 1 CME credits each 2 year reporting cycle and at least 20 must be from self-assessment modules
80% of CME must be directly related to individuals’ practice
Must maintain an electronic record of activities with ABP-updated every 2 years

42. Self-Assessment Programs
May address knowledge in a particular area or review of specific medical literature
Each program must include a self- administered examination
Diplomate must meet a minimum performance level
Feedback immediately after examination is preferred

43. Part II--Life Long Learning and Self-Assessment
Topic lists and references representing important advancements in diagnostic pathology will be published annually by the ABP
These will:
Serve as a template for CME and self-assessment
Assist pathologists to prepare for MOC exam
Direct MOC test question development
Focus on practical “need to know” information that is used in daily practice and required for competence
Cover all disciplines of pathology

44. Part III--Cognitive Expertise
MOC examination is mandatory
Closed book examination
Given at least once per year
Must be taken no later than 10 years after initial certification
May be taken as early as year 8
Potential 3 year period of qualification

45. Part III--Cognitive Expertise
Examinations as relevant as possible to individual practice settings
AP/CP certified individuals may chose to be examined (maintain their certification) in AP/CP, AP only or CP only
Individuals with subspecialty certification may choose to maintain only their subspecialty certification

46. Part III--Cognitive Expertise
Modular exams relevant to the individual practice settings (exact nature of modules is under development)
Exams will include:
Fundamental knowledge
Current clinically-valid practice-related knowledge
Emphasis on information new to field since last certification
Practice environment knowledge, such as regulations, CLIA standards, laboratory management, coding, etc.

47. Part IV--Performance in Practice
Candidates must provide attestations as to interpersonal and communication skills, professionalism, ethics, and effectiveness in systems-based practice
4 references must be provided at beginning of year 4 and again when applying for exam
ABP certified pathologist
Individual in senior administration
Physician in another specialty
Technologist or PA who works with diplomate

48. Part IV--Performance in Practice
Documentation of laboratory accreditation
Accrediting agency must be appropriate for the diplomate’s scope of practice
Laboratory participation in inter-laboratory improvement and QA programs approved by the ABP
Attestation of participation must be provided every 2 years

49. Part IV--Performance in Practice
Diplomate must participate in inter- and intra-laboratory improvement and QA activities and programs appropriate for their professional activities
Attestation of participation must be submitted to the ABP every 2 years

50. Part IV--Performance in Practice
Practice performance will be further assessed by documentation of use of appropriate protocols, outcome measurements, and practice guidelines
Evaluation of performance in practice will include assessment of the 6 ACGME-ABMS core competencies

51. SIX CORE COMPETENCIES IN MEDICAL PRACTICE
Medical knowledge
Patient care
Interpersonal and communication skills
Professionalism
Practice-based learning and improvement skills
Systems-based practice

52. MOC EVALUATION ACCORDING TO THE 6 CORE COMPETENCIES
Competencies Record Checklist Global Rating 360 Portfolio/Log Cognitive
Review of Performance Exam
Medical knowledge X X X X
Patient care X X X X
Interpersonal &
communication skills X X
Professionalism X X
Practice-based X X X X
learning and
Improvement skills
Systems-based practice X X X X X

53. 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

54. Transition to MOC Holders of non-time limited certificates:
Will retain voluntary recertification
Participation in MOC does not place original certificate in jeopardy
Holders of time-limited certificates:
Must participate in MOC
Candidates for initial certification:
Must participate in MOC after certification

55. Nature of Involvement of Cooperating Societies in MOC
Cooperating Societies will play an important role in:
Content development (ad hoc committees in AP and CP)
CME courses
Self-assessment tools
Programs for evaluation of practice performance
Assisting in verification of diplomates’ participation in performance improvement programs
? Remedial education programs