A recent post on KevinMD put forward “the case for eliminating recertification by the ABIM,” in which the author expressed a number of concerns about the relevancy, time commitment and cost of maintaining certification. I have good news for the author: His concerns have already been addressed by ABIM over the last several years.
Allow me to share my case for ABIM’s Maintenance of Certification (MOC) program.
Like the author of the original post, I am also a gastroenterologist. I have been in community practice for 24 years. I wholeheartedly agree that medicine changes rapidly, necessitating more frequent and continuous approaches to assessing our knowledge currency. That’s why, in 2022, ABIM introduced the Longitudinal Knowledge Assessment (LKA), through which physicians test their medical knowledge on an ongoing basis and receive regular feedback on their performance.
I’m participating in both the internal medicine and gastroenterology LKAs, and can tell you it’s really been a great experience so far. The user interface is clean and easy to use, and, like many of my colleagues who have expressed their opinions publicly, I find I’m actually enjoying taking questions. Some have even gone so far as to say it’s fun.
As a more formative assessment designed to more closely align with how we practice, physicians aren’t expected to spend a lot of time studying. The LKA tests a physician on “walking around knowledge,” on average, participants spend less than two minutes per question, or about four hours a year for each discipline they are maintaining. Given how much I’ve been learning through the LKA, that seems like a reasonable amount of time to me, especially when weighed against the number of clinical hours in a year and the immeasurable impact on my patients.
Physicians participating in the LKA get immediate feedback if their answer is right or wrong, along with a rationale and references.
Personally, I have found that this allows me to incorporate anything I learn immediately into practice, which has been beneficial to me and my patients. After answering enough questions, we receive quarterly progress reports with more detailed information, including how we are doing compared to our peers and relative to the passing score. This allows me to understand what areas I may need to brush up on and to keep track of my progress.
ABIM recognizes that the LKA isn’t for everyone, and that’s why the traditional, 10-year MOC exam remains an option. And cardiologists can also choose the ABIM/ACC Collaborative Maintenance Pathway if that works better for them.
Why have MOC at all?
The author argues that there is an absence of compelling evidence that maintaining certification leads to improved patient outcomes. He also suggests that without MOC, physicians would be free to create their own personalized development and learning plans.
With regard to evidence, there is a substantial body of research that supports how ABIM’s MOC programs lead to better patient outcomes. To name just two examples: physicians with higher clinical knowledge scores on an MOC assessment were less likely to prescribe dangerous opioids like Oxycontin for back pain than those who scored lower. And patients are significantly less likely to face death, an emergency department visit or hospitalization for conditions at high risk for diagnostic errors when treated by a board-certified physician who scores higher on diagnostic questions on an ABIM MOC exam.
I disagree, however, that physicians left to their own devices would be informed enough about their knowledge gaps to identify the right learning opportunities accurately. We are all aware of the Dunning-Kruger effect, where people wrongly overestimate their knowledge or ability in a specific area. For example, who among us believes we are below-average drivers? Of course, there are below-average drivers on the road, but no one reading this thinks it’s them — it’s everyone else!
That’s why a rigorous process to assess and affirm medical knowledge through an independent, third-party organization like ABIM is critical for physicians and the patients they serve. It’s through this process that they can know and demonstrate their knowledge is current, and if knowledge gaps are identified, they can take steps to address them and improve.
Being a board-certified physician is not about self-declared expertise. It’s expertise that has been tested and validated by a community of peers and differentiates physicians who have demonstrated that knowledge from those who haven’t. Does it take time and energy to maintain certification? Yes, but making sure I remain current and confident in my medical knowledge is well worth that time and energy.
It makes me a better doctor.
I genuinely appreciate the ongoing conversation about the evolution of MOC. ABIM didn’t always get it right, but the organization has learned from that and listened to the community. In 2015, an American Gastroenterological Association MOC Task Force that I served on recommended lifelong learning and accountability, which is the embodiment of programs like the LKA. That study, among others, shows the value and utility of MOC, which I believe can create a stronger and more knowledgeable community of physicians practicing at the top of their field in service of patients everywhere.
Rajeev Jain is a gastroenterologist and chair, board of directors, American Board of Internal Medicine.
