Major MOC changes coming in September; full roll-out slated for 2019

The Maintenance of Certification (MOC) process that plastic surgeons have observed in one form or another through the past 22 years will undergo significant changes beginning in September, with a full slate of modifications to be launched in April 2019. The changes were approved during the Nov. 15 meeting of the American Board of Medical Specialties and representatives from its 24 member boards.

ABPS Executive Director Keith Brandt, MD, St. Louis, calls the impending changes revolutionary and unprecedented for plastic surgery.

"We're moving to individualized assessment of the diplomate while enhancing the learning component," he says. "The exam can be taken literally anywhere, anytime, without travel, because it will be online. No more testing centers!

"In addition, we're cutting total fees by 15 percent and moving to a single, annual payment – rather than all the ala carte fees," he continues. "We'll also, gradually, get rid of the high stakes, 10-year exam and replace it with smaller mini-assessments."

The past incarnation of MOC required plastic surgeons to undergo reexamination every 10 years. On top of that, physicians were required to travel to a testing center and undergo security processes, which many reportedly found "childish," Dr. Brandt says. In addition, plastic surgeons had to pay to take the exam, while also losing money through both travel expenses and significant time spent away from their practices. The coming changes will ease those burdens, Dr. Brandt says.

"We've renovated every component of MOC and made it better for the diplomate," he says.

Familiar modules

The four testing modules will remain unchanged (comprehensive, cosmetic, craniofacial and hand), but the exam itself will be based on "longitudinal learning" that will occur regularly over the 10-year cycle.

Through longitudinal learning, participants should better retain information when repeatedly exposed to the material over time, Dr. Brandt says. The new format will allow the individual diplomate to identify knowledge gaps, with subsequent education and reinforcement installed via targeted "clone" questions presented later to that plastic surgeon. The "mini-assessments" will be available throughout each April – the month during which diplomates can take the exam, Dr. Brandt says.

"It will consist of 30 questions in a resource-enriched format," he explains. "You'll answer the question; go to the rationale; and then answer the question again. If knowledge gaps are identified, you'll receive clone questions in August that reinforce the areas of weakness identified in April.

"For instance, if in April you take the craniofacial module and don't do well in cleft lip, in August we'll send you five more questions in cleft lip," he adds. "That's the reinforcement process – exposing you to the materials again, to hammer it home so you actually learn the material. In addition, the exam will supply links within the rationales – to videos and courses, to other educational materials in PSEN, to PRS articles and to educational materials from other societies. The best part is, if you perform well enough on the longitudinal assessment, then you'll be exempt from the 10-year exam."

Two other major alterations to MOC entail the move from Prometric testing centers to online testing and increased availability.

"Diplomates will be able to take the exam at home – in their pajamas if they choose – and they can access it as many times as they like. They'll have the entire month of April to complete it."

The new look MOC, in Parts I through IV, involve the following criteria and features:

Professionalism

• Twice in the 10-year cycle
• Required in Year 3
• Required either in Year 7, 8 or 9

Self-Assessment
Longitudinal assessment

• Answer 30 questions per year
• Four modules
  The diplomate answers a question and then is sent to the rationale, regardless of whether the answer is correct; then he or she is required to read the rationale (as they don't know if they have achieved the right answer). Regardless of how they've answered on first try, the examinee will be asked to answer a second time to document learning
• Scoring will be based on the first answer
• Knowledge gaps will be identified based on the first answer
• If the diplomate scores satisfactorily on the longitudinal assessment, he or she will be exempt from the Part III high-stakes exam

Assessment of Knowledge, Judgment and Skills

• The 10-year exam will still be used for diplomates who fail to participate in the longitudinal assessment or who perform poorly
• A study guide is no longer necessary (study guide has become the exam rationales)
• The exam is entirely online (no testing centers)
• The diplomate reads the question and gives an initial response; the diplomate reads the rationale; the diplomate must re-enter the answer
• The test is available for 30 days in April; an unlimited number of logins will be permitted

Practice Improvement

• Twice per 10-year cycle (Year 3, and either Year 7, 8 or 9)
• Multispecialty Practice Portfolio Project participation is accepted
• Quality-improvement articles, individual quality-improvement projects and participation in PROFILE®, GRAFT,® TOPS® and the National Breast Implant Registry® will be accepted

The longitudinal assessment program will allow improved individualization of the assessment experience, and it will also eliminate the pre-exam time, effort and money that diplomates previously had to invest ahead of taking the 10-year exam, Dr. Brandt says.

"Other savings will be realized, as well," he notes. "Diplomates will no longer need to study ahead of time, because everything is in the exam. That time away from the office is eliminated, because they can do this in the evening, the middle of the night or during lunch – and it's accessible on any computer. This isn't mobile yet, but we'll monitor diplomate interest in a mobile application.

"Either way, this new program eliminates the huge barriers of time away from the office, cost and inconvenience," he adds. "The ABPS, which in the past had observed the same process for decades, is now leaping ahead into the digital world and providing all the conveniences that our diplomates expect in the 21st century."