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Home > Medical Professionals > Education and Training Resources > Maintenance of Certification

Maintenance Of Certification

In 2006 all member of Boards of the American Board of Medical Specialties entered a new era, that of “Maintenance of Certification”. This process is a further evolution in the process of Board certification.

When Board certification in Surgery was first established more than 60 years ago, certificates were for unlimited duration. About 30 years ago, the ABMS began to adopt a policy of time limited certification and in the mid 1970’s this was applied to all certificates issued by the American Board of Surgery. Time limited certificates were valid for a 10 year period and renewal included a written examination.

Most recently the ABMS and its member Boards have taken the next step to add value to the certification process, “Maintenance of Certification”. This process will be required of all certificates issued after 2005 (including those certificates issued in the “recertification" process). It is therefore of utmost importance that all physicians holding any certificate issued by the American Board of Surgery, familiarize themselves with and participate in this process. The following is the first in a series of articles designed to explain this process.

In contrast to the “recertification” process, which required  intermittent involvement every 7-10 years, Maintenance of Certification is an ongoing process of continuous improvement with  participation by the Diplomate throughout his or her professional career. This process requires the Diplomate demonstrate a program of ongoing learning, professional assessment and self improvement. It also requires documentation by the Diplomate that he/she has maintained the expertise expected within his/her specialty.

While this process, may be seen by some as merely additional regulatory requirements heaped on what seems to be never ending bureaucracy, it is in reality an initiative to demonstrate to our patients the high degree of professionalism which should be associated with Board Certification. In fact, the components of Maintenance of Certification (“MOC”) are already part of the ongoing professional life of most diplomates. Taken in that context, the Maintenance of Certification Process is a patient centered initiative which speaks to the highest ideals of Medicine and Surgery. It places Diplomates squarely on the side of improving patient care and is an opportunity for us as surgeons to address the concerns the American public has about the maintenance of quality in our Health Care System. Done correctly, MOC will strengthen the value of Board certification within our medical care system. 
 
There are 4 components to Maintenance of Certification (“MOC”):     

1) Demonstration of Current Professional Standing
2) Demonstration of Lifelong Learning and Self Assessment
3) Demonstration of Cognitive Expertise
4) Evaluation and Improvement of Performance in Practice

To maintain Board certification, each Diplomate will need to address these components in an ongoing fashion throughout their period of certification. For holders of Multiple ABS certificates, Parts 1, 2, and 4 of MOC performed for one certificate may be credited toward other certificates. However demonstration of Cognitive Knowledge in an area of Certification (i.e. secure examination) will be required separately for each area of l certification.. Professional Surgical Organizations such as the American College of Surgeons, the Society for Vascular Surgery and the American Board of Surgery are working to define mechanisms by which each diplomate may address the requirements of “MOC”. In the area of Vascular Surgery recertification, the Vascular Surgery Board of the American Board of Surgery (VSB-ABS) is working with the Society of Vascular Surgery and other Vascular Professional Societies to identify mechanisms for Certified Vascular Surgeons to meet the requirements of MOC. This process is ongoing, and will be explored in subsequent articles.

Documentation of MOC runs in cycles of 3 years (Parts I, II and IV), culminating in a secure written examination to test knowledge Part III) every 7-10 years. MOC takes effect as of July 1, 2005 upon certification or recertification, so surgeons who certified or recertified in vascular surgery in the fall of 2005 are also affected.This means that those certificate holders will need to present data to the VSB-ABS documenting their (three year) involvement in MOC for the first time in 2009.

An illustrative 10 year timeline for a diplomate issued a certificate in 2006 is presented as an example.

Part I MOC: Documentation of Professional Standing – required every three (3) years
This will include evidence that the Diplomate holds an unrestricted License to Practice Medicine in one of the 50 United States and has privileges to practice Surgery within the Scope of his/her Specialty certificate in a licensed Hospital within the United States. This requires a letter of attestation to the diplomate's status by the Chief of Surgery and the Chair of The Credentials Committee for the Hospital in question.

Part II MOC: Documentation of Lifelong Learning and Self Assessment - required every three (3) years
Documentation of 50 CME credits per year (at least 30 must be category 1) for each of three years (i.e., 150 CME credits per period, minimum of 90 category 1). Those who hold multiple ABS certificates (i.e. ABS- Surgery and ABS Vascular Surgery) the CME credits can be used for both certificates (i.e. 150 not 300 CME credits will be required).

In addition to CME credits the diplomate will need to demonstrate evidence of self assessment though tools such as SESAP, or assessment tools developed through courses or journals. Some current options will be discussed in later articles. A vascular correlate to SESAP is being developed by the Society for Vascular Surgery as one of several options for use. Vascular surgeons will be expected to demonstrate some self assessment relative to their practice of Vascular Surgery, although the VSB has not defined this in a restrictive fashion at this time. At this point in time a self assessment tool such as SESAP, which contains material relevant to Vascular Surgery, is considered adequate self assessment.
 
Part III MOC:  Cognitive Knowledge and Experience –
This must be demonstrated once every TEN (10) years.
This will be unchanged from the current practice and will consist of a written test (the recertification examination) as administered by the VSB-ABS. Once a diplomate is enrolled in MOC, all MOC requirements must be satisfied up to the time of the application for recertification for a diplomate to apply and be admissible to the secure examination (Part 3). This means that Diplomates will need to begin MOC well in advance of applying for their written examination! A separate examination will be required for each certificate.

Part IV MOC- Practice Performance and Improvement –
Verification required every three (3) years. Diplomates will be required to demonstrate their involvement in one or more programs which focus on the analysis of their practice performance. This requirement is meant to include a quantitative assessment of performance parameters and ultimately involve development of a plan for practice performance improvement. This area of MOC is currently a subject of active discussion by the ABS, ACS and various professional Societies including the SVS. While it is unclear at this time what will qualify for demonstration of Practice Performance Evaluation and Improvement, it will be more than the traditional “M&M” participation. Some examples which might apply include participation in Quality Outcome projects such as National Surgical Quality Improvement Project (NSQIP), Surgical Care Improvement Project (SCIP) and practice databases such as those being developed through the ACS web portal and the SVS carotid database. A more detailed discussion of PART IV MOC and the opportunities it presents will be undertaken in a subsequent article.

Maintenance of Certification (“MOC”) is a mandate of the American Board of Medical Specialties and is here to stay. In ay ways, much of the MOC process is merely documentation of what surgeons currently do as part of their day to day professional development While it adds another layer of work to what has become an increasing set of requirements for the practice of our profession, it does indeed serve a noble purpose. Properly undertaken, MOC will improve the performance of all Diplomates, provide our patients with more knowledgeable and current surgeons and emphasize the importance which Board Certified Surgeons accord to optimal patient care. Your professional Organizations, including the SVS and the VSB-ABS are actively engaged in developing mechanisms to help you, the practicing Surgeon, address this new requirement.

For further information on MOC, visit the American Board of Surgery web site at: http://home.absurgery.org/default.jsp?exam-moc

MOC Timeline