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MS. McREYNOLDS is the Manager of Physician Excellence Programs at the American College of Obstetricians and Gynecologists.
DR. GILSTRAP is Director of Evaluation at the American Board of Obstetrics and Gynecology, Dallas, TX.
DR. BREKKEN is Assistant to the Executive Director at the American College of Obstetricians and Gynecologists.
MS. MARKHAM is Administrator of Maintenance of Certification at the American Board of Obstetrics and Gynecology.
The American Board of Obstetrics and Gynecology stopped issuing their usual certificates in 2008 and have switched to a "maintenance of certification" protocol that requires all ob/gyns to walk through a more demanding 6-year process involving CME offerings, a written examination, and chart reviews.
In 1930, the American Board of Obstetrics and Gynecology (ABOG) became the third medical specialty board incorporated in the United States, and it was a founding member of the American Board of Medical Specialists (ABMS). In 1986, ABOG began issuing 10-year time-limited certificates in obstetrics and gynecology. Prior to that time, ABOG issued lifetime certificates. The following year, 10-year time-limited certificates were also issued in the subspecialties of maternal-fetal medicine, reproductive endocrinology and infertility, and gynecologic oncology. In 2001, ABOG began issuing 6-year time-limited certificates. But in 2008, a major shift occurred in the board's approach to certification: In cooperation with the other 23 member Boards of ABMS, ABOG agreed to advance recertification into a system of Maintenance of Certification (MOC).
MOC was mandated by the ABMS in response to pressure from medical consumers, the government, and in part because of the report from the Institute of Medicine regarding medical errors. Although technical and surgical skills may increase over time, didactic information regarding quality improvement and best practices tends to decline over time. For example, although a physician may be very adroit in the performance of a laparoscopically-assisted hysterectomy or the removal of fibroids hysteroscopically, he or she may not be familiar with recent systematic reviews or meta-analyses regarding the effectiveness of various treatment modalities or practices, or with the pitfalls of basing clinical practice on results of studies that use inappropriate study design.
Although there has been a backlash of criticism from both individuals and editorialists that ABMS and the Boards (including ABOG), have moved too fast with this concept, MOC is here to stay for the foreseeable future. Moreover, our patients expect their physicians to remain current with the latest in safe quality care, and third-party payers are beginning to demand it. Important also is the fact that the Joint Commission, the Federation of State Medical Boards, the American Hospital Association, and several other medical associations support MOC. Finally, maintaining certification is one way of demonstrating professionalism (one of the six core competencies that we require of our residents) to both our patients and our colleagues.
What is MOC?
PART I. Professional Standing. Part I includes verification of medical licensure by ABOG and the Federation of State Medical Boards. Diplomates must hold an unrestricted medical license in all states in which they are licensed. There is no action or fee required of the Diplomate.
PART II. Lifelong Education. This component of MOC has been in place since 1998 and has been known as the Annual Board Certification or ABC process. It is now part of maintenance of certification as opposed to "recertification." As in the past, three sets of articles are available online during January, April, and July (hard copies will no longer be available). Each set will have approximately five articles each, with questions from each article, for obstetrics, gynecology, and office practice (total of 15 articles and 60 questions for each set or a total of 180 questions per year). One must answer at least 120 of the 180 questions and receive a passing grade of 70%. Upon successful completion of this process, 25 CME hours are awarded by the American College of Obstetricians and Gynecologists (ACOG). Ten additional CME hours (total 35) are awarded for answering all 180 questions (70% correct) for an additional fee. Part II must be accomplished each year of the 6-year cycle. Subspecialists must answer 60 questions from general obstetrics and gyn-ecology and all 90 questions from their subspecialty. All answers must be received no later than September 30 of each year. The fees for ABC are summarized in the ABOG bulletin and on the ABOG website ( http://www.abog.org/). A word of caution: Once the answers are submitted, they cannot be changed.
PART III: Cognitive Expertise – "The written examination." This component of ABC must be passed once in every 6-year cycle. The current plans are to give this exam for the first time in 2012 (the 5th year for those entering MOC in January 2008; the entering year counts as year 1) and twice in 2013 (the 6th year of the cycle). In the future, it is hoped that this test can be given several times a year and in many different locations. The content and make-up of the test is a "work in progress." Subspecialists will have questions in general ob/gyn and questions in their subspecialty.
PART IV: Practice Performance/Self-Assessment – "The Modules" or "The Road to Maintaining Excellence". This part of the MOC process is a joint project of the ABOG and ACOG. The goal of this combined effort is to help Diplomates and Fellows maintain the excellence they exhibited when they passed their original written and oral certification examinations. The program consists of a chart review based on diagnostic-specific modules for most of the topics. A few topics or modules require review of hospital or practice policies as opposed to a chart review. There are two phases to each module. Phase 1 consists of the chart or policy review. Phase 2 consists of a follow-up approximately 6 months after completion of Phase 1, asking if a physician's practice was changed or influenced by the module (no chart review is required for Phase 2). Modules in obstetrics, gynecology, office practice, and cross content subjects such as patient safety, communication, and ethics will be available to all Diplomates and Fellows without cost and will not be graded. If a Diplomate is not an ACOG Fellow, there is a fee payable upon registration for MOC. General obstetricians/gynecologists must complete 10 modules from any basic category or cross content during each 6-year cycle (2009 ABOG MOC Bulletin, not more than three modules per year) as long as there is sufficient patient volume to answer the "Practice Profile/Assessment" portion of each module. There are working groups of ABOG and ACOG members who continually develop new modules and review those currently available.
Subspecialties. Subspecialists must complete five modules from general obstetrics and gyn-ecology and five modules from their subspecialty (total of 10 per 6-year cycle).