During the MOC debate that JAMA sponsored, I was asked what I would do if “I were king” of MOC.
As an internist, I believe in first making a diagnosis, then prescribing a treatment. So I have spent time diagnosing my needs as an internist.
When I passed my boards I showed knowledge competency. But medicine changes over time. We have major advances and changes since I took my boards.
Some examples follow:
- calcium channel blockers
- ace inhibitors
- ARBs
- many new antibiotics
- home oxygen
- the field of electrophysiology (both diagnostic and therapeutic)
- imaging advances
- ulcers are usually an infectious disease
- HIV
- growing antibiotic resistance
- a dizzying array of targeted chemotherapies
- biologics for treating many rheumatic diseases
- the rise of C. diff
Given that medicine continues to progress, I should work hard to remain updated. So my diagnosis is that an internist needs to learn and show proficiency in understanding and using important new knowledge.
Neither the current MOC secure exam or routine CME satisfy treating my diagnosis.
I believe we need targeted education and testing of that education. In my ideal world, we would have groups of practicing clinicians (each subspecialty needs its own group) who would receive recommendations of topics that MOC should include. Practicing clinicians (this does not exclude academicians who spend a significant amount of time as clinicians and clinical educators) would rate the importance of the topics and produce a list of those topics that internists (or hospitalists or endocrinologists or pulmonologists etc.) should learn at this time.
Then the test would focus on demonstrating satisfactory knowledge of that list.
Obviously this would be a very different test than the current secure exam that resembles the initial certification examination. Courses would likely develop to teach these topics. These courses would provide both MOC preparation and CME credit.
I would expect the panels to reject some important advances. As an internist, I do not give chemotherapy. If I have a patient who has a possible complication from chemotherapy, I pull out my smart phone, tablet or computer and do my research. If I were a panelist, I would reject needing to know the side effects of every new chemotherapeutic agent.
That is just an example of how I believe we could help internists have better knowledge, with the assumption that better knowledge will lead to better diagnostic skills and therapeutic decision-making.
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.
