Association between Performance in a Maintenance of Certification Program and Disciplinary Actions against the Medical Licenses of Anesthesiologists

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In 2000, the American Board of Anesthesiology (Raleigh, North Carolina) began issuing time-limited certificates requiring renewal every 10 yr through a maintenance of certification program. This study investigated the association between performance in this program and disciplinary actions against medical licenses. Methods The incidence of postcertification prejudicial license actions was compared (1) between anesthesiologists certified between 1994 and 1999 (non–time-limited certificates not requiring maintenance of certification) and those certified between 2000 and 2005 (time-limited certificates requiring maintenance of certification); (2) within the non–time-limited cohort, between those who did and did not voluntarily participate in maintenance of certification; and (3) within the time-limited cohort, between those who did and did not complete maintenance of certification requirements within 10 yr. Results The cumulative incidence of license actions was 3.8% (587 of 15,486). The incidence did not significantly differ after time-limited certificates were introduced (hazard ratio = 1.15; 95% CI, 0.95 to 1.39; for non–time-limited cohort compared with time-limited cohort). In the non–time-limited cohort, 10% (n = 953) voluntarily participated in maintenance of certification. Maintenance of certification participation was associated with a lower incidence of license actions (hazard ratio = 0.60; 95% CI, 0.38 to 0.94). In the time-limited cohort, 90% (n = 5,329) completed maintenance of certification requirements within 10 yr of certificate issuance. Not completing maintenance of certification requirements (n = 588) was associated with a higher incidence of license actions (hazard ratio = 4.61; 95% CI, 3.27 to 6.51). Conclusions These findings suggest that meeting maintenance of certification requirements is associated with a lower likelihood of being disciplined by a state licensing agency. The introduction of time-limited certificates in 2000 was not associated with a significant change in the rate of license actions.

Maintenance of Certification: Reply

“…The objective of Zhou et al 2 was to establish the value of Maintenance of Certification in Anesthesiology. They used the rate of state medical board disciplinary actions as an outcome measure.…”

“…3 Nevertheless, the outcomes of the study are revealing. 2 One arm of the study compared the rate of disciplinary actions imposed on anesthesiologists who received initial certification between 1994 and 1999 (before required Maintenance of Certification in Anesthesiology) versus those certified during the 2000 to 2005 "Maintenance of Certification in Anesthesiology era." There was no difference.…”

“…We find the results of Zhou et al and Sun et al consistent and convincing: those physicians who are adult learners as defined by Malcolm Knowles are more likely to obey rules, seek continuing medical education opportunities, and be less likely to commit infractions resulting in state medical board discipline. 2,4,5 These adult learners actively seek the continuing education most useful and relevant to their work. But, as Zhou et al proved unequivocally, the introduction of Maintenance of Certification in Anesthesiology did not change the incidence of adverse medical board actions against anesthesiologists.…”

“…But, as Zhou et al proved unequivocally, the introduction of Maintenance of Certification in Anesthesiology did not change the incidence of adverse medical board actions against anesthesiologists. 2 Meanwhile, the medical profession grapples with finding meaningful programs and metrics with which to assess physician competency for Maintenance of Certification. We find evidence for this in the February 2, 2018 "Statement from the American Board of Medical Specialties and its Member Boards to Subspecialty and State Medical Societies about Maintenance of Certification."…”

Connecting Purpose and Performance: Rethinking the Purpose of Maintenance of Certification

“…Indeed, the ABA has published evidence showing that passing a periodic high-stakes examination has little utility in predicting which physicians have pronounced practice deficiencies that result in disciplinary actions against their medical license. 12 Second, the use of assessments and other MOC elements to "weed out" doctors largely squander the golden opportunity to use MOC assessments as formative tools to effect "learning to improve practice" as opposed to "learning to pass an examination." Significant advances in cognitive science over the last several decades clearly show that a given assessment can function effectively as either an assessment of learning (summative assessment) or an assessment for learning (formative assessment), but assessments that attempt to serve both purposes compromises the effectiveness of each.…”