Ensuring Physicians' Competence — Is Maintenance of Certification the Answer?

Iglehart, John K.; Baron, Robert B.

doi:10.1056/nejmhpr1211043

Cited by 91 publications

(81 citation statements)

References 19 publications

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“…Traditionally, board certification has been the primary method for physicians to demonstrate their competence; recently, with the creation of the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) Part IV activities, it has been used to demonstrate commitment to quality improvement (QI) [3–5]. Although board certification has some proven value, the value of MOC Part IV activities is less clear [6–10]. …”

Section: Introductionmentioning

confidence: 99%

Primary care physicians’ perceptions of practice improvement as a professional responsibility: a cross-sectional study

Stephenson

Wittich

Pacyna

et al. 2018

Medical Education Online

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Continuous quality improvement is a component of professionalism. Maintenance of Certification (MOC) is a mechanism in the USA for physicians to keep current with medical knowledge and contribute to practice improvement. Little is known about primary care physicians’ perceptions of the practice improvement (Part IV) components of MOC. We aimed to determine primary care physicians’ perceptions of their professional responsibility to participate in Part IV MOC. This was a cross-sectional study of primary care physicians using the American Medical Association Masterfile. We developed a nine-item survey, designed from expert consensus and literature to determine views on Part IV MOC as a professional responsibility. We surveyed 1500 randomly selected primary care physicians via mail from November 2014 to May 2015. The response rate was 42% (627 of 1,500): 47% (273 of 585) were family practitioners and 49% (289 of 585) were internists. Factor analysis revealed a two-factor survey, with five items pertaining to positive views of MOC Part IV and four items pertaining to negative views. Internists were more likely to view MOC Part IV as time consuming (82.0% vs. 70.3%, P = .001), expensive (50.9% vs. 38.8%, P = .004), and not relevant to practice (39.1% vs. 23.8%, P < .001). Family medicine practitioners were more likely to view MOC Part IV as improving patient care (64.5% vs. 48.8%, P < .001) and maintaining professional responsibility (48.7% vs. 32.5%, P < .001). Regardless of specialty, most physicians viewed MOC Part IV as time intensive, not beneficial for career advancement, and not a professional responsibility. Family medicine practitioners demonstrated more positive views of MOC Part IV. The difference between family medicine practitioners and internists could be related to the ABIM MOC controversy. Future changes to practice improvement requirements could focus on limiting time requirements and on clinical relevance.Abbreviations: ABIM: American Board of Internal Medicine; AMA: American Medical Association; CQI: continuous quality improvement; IRB: institutional review board; MOC: Maintenance of Certification; QI: quality improvement

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Section: Introductionmentioning

confidence: 99%

Primary care physicians’ perceptions of practice improvement as a professional responsibility: a cross-sectional study

Stephenson

Wittich

Pacyna

et al. 2018

Medical Education Online

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“…86 Others see these programs as an important element of the professional duty to maintain competence. 78 Still others fear that failure to self-regulate in this way invites more burdensome external regulation. 78 Which view will prevail is unclear at this point.…”

Section: Self-regulationmentioning

confidence: 99%

“…78 Still others fear that failure to self-regulate in this way invites more burdensome external regulation. 78 Which view will prevail is unclear at this point. 87 What is apparent, however, is that sensible debate will be difficult as long as a dearth of evidence regarding the effect of MOC programs on physician performance remains.…”

Section: Self-regulationmentioning

confidence: 99%

“…[74][75][76] The rapid pace of change in clinical and scientific knowledge has led medical boards to shift from basic one-time certification requirements to maintenance of certification (MOC) requirements that seek to ensure provider competence throughout a physician's practice career. 78,81 MOC requirements often include periodic examinations and other practice assessments and participation in qualityimprovement projects.…”

Section: Self-regulationmentioning

confidence: 99%

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Legal and Policy Interventions to Improve Patient Safety

2016

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“…1 While this is an appropriate goal, there is little empirical evidence that board certification or the new Maintenance of Certification (MOC) process assures this. 2 The American Board of Family Medicine (ABFM) was the first medical board to require recertification for its members. It has focused on competency-based assessments.…”

mentioning

confidence: 99%