Give Feedback on ASCO's Proposed Alternate Pathway for MOC

Give Feedback on ASCO's Proposed Alternate Pathway for MOC

Julie Vose, MD, MBA, FASCO

@DrJulieVose
Sep 06, 2016

As you are aware, the American Board of Internal Medicine (ABIM) currently requires that physicians pass a comprehensive high-stakes oncology examination every 10 years to maintain certification. Many concerns were raised by diplomates as the maintenance of certification (MOC) process became increasingly cumbersome and complicated. As a result, the ABIM committed to developing a new process that included active engagement of the physician community in the redesign of alternate pathways for maintaining certification. Earlier this year, the ABIM communicated openness to the possibility of more frequent lower-stakes assessments, delivered by societies such as ASCO, as a potential alternate to the high-stakes 10-year examination.

ASCO convened an MOC Task Force, led by Dr. David Johnson. The Task Force was given the charge to develop a recertification process that is personalized, aligned with physicians’ practice and knowledge needs, and integrated into ongoing physician activities. The ASCO MOC Task Force proposal outlined below shifts the focus of the recertification process from one that is a 10-year assessment of comprehensive knowledge in oncology to one that focuses on continuous learning in oncology. ASCO is committed to delivering an alternate pathway for maintaining certification that is more meaningful and less burdensome.

As a member of this Task Force, I am sharing the proposal for an alternate pathway for maintaining certification, developed after considerable discussion and deliberation. ASCO has been working with the ABIM throughout this process and is impressed by the ABIM’s commitment to collaboration. Our communication with ABIM has been open, encouraging, and productive and has helped shape the proposal outlined here. As this plan is meant to address your needs, the proposal is presented for your input.

After reviewing this proposed alternate pathway, please email your feedback to ascou@asco.org with the subject line "MOC proposed plan." Thank you in advance for your thoughtful review and input!

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Comments

Sergio Giralt, MD

Sep, 12 2016 10:10 AM

The concept looks great and seems to be viable. It would be important to include some of the activities as part of our ASCO Membership fee

Total cost of recertification should not be more than what it is currently

S.Giralt MD

Shakun M. Malik, MD

Sep, 12 2016 10:12 AM

I appreciate ASCO's and ABIM's efforts to work on this together.

Although 5 years is better than 10, I suggest, consideration be given to have it every other year with less intensity.

All the licencing needs to be renewed every 2 years and this could be the same.

Thank you for your consideration. 

Haluk Tezcan, MD

Sep, 12 2016 10:13 AM

Overall the concept is very attractive and seems less cumbersome.  The section test item writing CME/MOC is not clear.  How CME/MOC eLearning activities are integrated (ease of access, cost) are important details.

 

 

Samit Hirawat, MD

Sep, 12 2016 10:16 AM

The proposal is very good. How will recertification be accomplished for physicians no longer in clinical practice - for example, those who are now doing drug development through Pharma?

Thank you

David J. Park, MD

Sep, 12 2016 10:35 AM

What is Test item writing MOC/CME?

It is more thoughtful than the current testing practice.  All the retakes should be free of charge.

I would like to see more details which I am sure will be available in the future

Gerald L. Messerschmidt, MD, FACP

Sep, 12 2016 10:36 AM

Julie etal

I like this.  I have just filled out a survey for ABIM where they were proposing a 2 and 5 year proctored exam!  This is superfulous. As an Internist, first, I will not be able to pass renal and ICU medicine anymore.  Just is not going to happen.  I never see these peopel.  Same in Oncology, the data and knowledge is so extensive and growing every day, that being about to answer every question about every cancer is very hard for many.  In academics, some specialize in only breast cancer.  How do they answer the questions about glio's, thyroid, sarcomas etc.

We can require some specific updates in all areas over time.  But most of us will be able to stay up-to-date in the areas where we see patients, teach fellows, etc.  This is the concentration MOC should have.  To punish people that fail with the 8 hr exam is rediculous.  We need a programs that identifies those having trouble and supports there learning.

 

Delong Liu, MD, PhD

Sep, 12 2016 10:37 AM

The proposal appears to be a better alternative. It should also give consideration to those who practice in a  super-specialized field, such as BM transplantation, leukemia, etc.

Rachid C. Baz, MD

Sep, 12 2016 10:45 AM

There should be a track for physician who have subspecialized within their field and if i read this correctly this seems to account for this. the cost should be contained and possibly covered (at least partially) by ASCO membership costs

Jordan Berlin, MD

Sep, 12 2016 11:20 AM

needs to take into account that not all of us see all of hematolgoy/oncology.  I don't need to keep up to date with adjuvant therapy of breast cancer because I will never treat that situation.  Let a specialist be a specialist, but anything that wrests control from ABIM is better than the current or their 2 and 5 year plans

Isan Chen, MD

Sep, 12 2016 11:46 AM

I have attended ASCO almost every year since my fellowship. Attending meetings from the most influencial specialty meeting should count toward MOC. We take several days off from our work to get the latest information and it should count.

Sanjay Goel, MD

Sep, 12 2016 12:14 PM

I like the new proposed format, with importance given to overall knowledge in oncology, sub specialized and MOC/CME eLearning. I would suggest to give the individual an option of opting for more points in the "topic specific knowledge" eg, GI, or GU, or breast etc, and this could range from 10-30, and therefore vice versa for the "core knowledge assessment", between 30 and 10. This gives the freedom to decide what works best for each one, a sub specialist may choose to do 30/10 or a general oncologist may choose 10/30. Also, regarding the MOC/CME, it wasn't clear, how frequently this is required.

 

David R. Spriggs, MD

Sep, 12 2016 12:28 PM

this would be a substantial improvement.   2 comments:  1) I would make explicit requirement of annual MOC activity of some kind as the medical education is best when continuous and not concentrated once overy 5 years; 2) I think that there could be some flexibility to allow up to 60 questions in a subspecialty (like GI cancer) with a proportionate decrease in the general oncology questions.  

Vinni Juneja, MD

Sep, 12 2016 12:40 PM

Having just took the Spring MOC exam, the above recommendations are a substantial improvement.  I agree with Dr Goel's comments about the flexibility in the # of points between core and topic so that subspecialists do not need to be onerously burdened with questions in general oncology that they will only see while cross covering or rounding in the hospital.  Additionally, who is coming up with the questions?   will this all be peer reviewed and peer issued question?  That would be most appropriate since it is part of the "other learning activities" requirement anyway that we write questions.  And I do think that we as a community are the best judges of each other's competence.

Francis A. Forte, MD

Sep, 12 2016 2:06 PM

are the exams open book , with time to research the answers ?

Iftekhar Khan, MD

Sep, 12 2016 4:20 PM

The goal of testing should be to evaluate for recent developments in the field of General oncology.  ASCO should develop and publish developments in the field every year.Testing should be based on these new developments.  In my opinion that test should be an open book similar to updates in oncology by ABIM.  The emphasis should be on learning and not memorizing.For sub specialists in oncology the approches mentioned above may be more prudent.

Glenn Jesus Shamdas, MD

Sep, 12 2016 6:55 PM

Testing material could simply be module format with 25-30 questions open book and questions with topics relevant to our daily practice (not esoteric questions).  Questions should be formulated by the medical oncology practice community (meaning us). The intent here is again to test yourself and learn by expanding on a particular topic. There is no need to put folks through a cumbersome and tedious test whose validity and rationale are highly dubious and purposeless.

Daniel Morganstern, MD

Sep, 12 2016 7:33 PM

Like the concept. Hoping with all the recent discussion in VALUE that this too Adds VALUE to asco membership rather than adding as much expense as the ABIM.

I think the unique position that ASCO has is to develop curiculum that is always up to date.  It is also important that the curiculum not be just based on the latest therapeutics but also contain key elements of basic diagnostics and biology that are skill sets/knowledge sets that need continual review and updating.

 

PLease move Forward!!!

Dan Morganstern

Michael B. Troner, MD, FASCO

Sep, 12 2016 9:41 PM

I'm ok with one broad test every 5 years and one sub specialty test every 5 years.  I would like to see you use the same type of approach as the current ASCO MOC questions which I enjoyed and found helpful.  You might want to stagger the test over the five years and just do 20 questions per year.

In terms of the 60 credits for CME and other such learning, I assume that this weill be credit for credit earned at ASCO and similar meetings. 

I do think the cost needs to be reasonable.  I like the idea of incuding the cost in our current dues (which are pretty high) and if there is an increase, keep it nominal. 

E. Gabriela Chiorean, MD

Sep, 13 2016 12:24 PM

I do like the idea of tailored testing based on physician's needs and specialty. The staggered approach is more feasible than an every 10 yrs approach.

Ulka N. Vaishampayan, MD

Sep, 13 2016 5:46 PM

This is a change for the better. Keep options open but keep it simple. It should be made clear and easy how i can pursue different paths to get to the required 100 points.

Apar Kishor Ganti, MD

Sep, 13 2016 11:22 PM

This is a better idea than the new 2- or 5-year proposal by ABIM. One suggestion would be to make the Core Knowledge Assessment and Topic Specific Assessment more flexible in terms of points needed e.g. a mandatory minimum of 10 points for each and then making up the remaining (to total 40) based on inidividual preferences.

Rachel A. Freedman, MD, MPH

Sep, 13 2016 11:37 PM

I love the idea of exams that focus on knowledge and learning as well as identifying deficits. So is this not the 'open book' exam proposed by the recent ABIM survey we took about 2 and 5 yr options? Not sure what 'low stakes' exactly means but it sounds good!

Patrick J. Donovan, MD, FACP

Sep, 14 2016 12:25 AM

Dr Vose,
I think this ASCO proposal is a good one and much better than the ABIM model.

Katherine Anne Thornton, MD

Sep, 15 2016 1:31 PM

Having just recently re-taken the internal medicine boards, I can't tell you how important this effort is.  I think the revised model is completely agreeable, and actually, would be slightly enjoyable, dare I say it!  While studying for the Medicine Boards, I went through, as part of MOC requirements and took all the oncology sections and found it a really helpful study for oncology SOC.  Being a sub-specialist, I never take care of breast, lung, kidney, etc, so was  great practice to take these modules.  The actual test itself, as it stands now, is just a way to test short term memory, not a true testament to knowledge base.  Thanks for the proposal.

Koyamangalath Krishnan, MD, FACP, FRCP

Sep, 17 2016 7:30 AM

Dr. Vose,

I applaud the significant efforts of ASCO'S TASK FORCE led by Dr. David Johnson.  I must admit that the alternate MOC format suggested by the ASCO is much more appealing than the more onerous ABIM MOC/recertification approach.  It takes into account the realities of practice and subspecialization in oncology these days.  i have one recommendation though- instead of making the process every 5 years, it may be more appealing for some of us to make it once a year or two and allow the accumulation of MOC points annually instead of every 5 yrs.  

Bruce Gordon Raphael, MD

Sep, 18 2016 10:54 AM

I also applaud the effort of ASCO. This formula allows for appropriate contribution of CME credits which is required by locally and exams on a 5 yr basis to maintain MOC status.

 

Sakeer Hussain, MD

Sep, 19 2016 2:40 PM

This looks more reasonable than ABIM maintainance of certification which is very complex and time consuming. Thank you ASCO for doing this.

Eleonor Quan, MD

Sep, 24 2016 1:29 PM

I carry the same opinion as most of my colleagues. Most of us are super busy in taking care of patients who are becoming more and more complicated to manage. To prepare to take an 8 hours MOC exam every 10 years is becoming an impossible goal for me. I have registered to take the test this fall but has not yet find the time to prepare for the test. The low stakes exam every 5 years sounds a friendly efficacious improvement to help maintain our certification. I still would need to know the final details but I am very confident that ABIM/ASCO are trying their best effort to make things better.

Nicole A. Shonka, MD

Sep, 27 2016 11:03 AM

I think this alternative pathway for MOC is less daunting, but more importantly, a better measurement of the need to be continuously learning. This seems much more widely applicable to those of us in academic and subspecialized practice, yet still salient for those in general community practice as well.

Robert Leon Robles, MD

Nov, 24 2016 12:30 PM

Intermittent testing never seemed like a good way to stay current, much less assess one's knowledge. I would propose including a system ACOG uses: periodically sending out (electronically or otherwise) a small packet of relevant articles with a test, perhaps quarterly.

Anthony David Hoffman, MD

Dec, 20 2016 8:49 AM

Anthony Hoffman MD

Eastchester Center for Cancer Care NY

Dear Colleagues,
We need an alternative to ABIM, at least we need to price other "vendors". Why does ABIM have a monopoly in how physicians are screened or tested for knowledge.

ASCO should make an effort to find alternatives to the status quo and not just perpetuate something that is expensive and not proven to ultimately provide benefit for our patients.

An alternative now exists. The National Board of Physicians and Surgeons

https://nbpas.org/

an alternative Board providing continuing board certification. The major difference is replacing onerous computer modules and repeated exams with ACCME accredited Continuing Medical Education.

The NBPAS fee is $169 for two year certification (i.e. $84.50 per year), irrespective of the number of specialty applications. This one fee covers two years and all your specialties.  This one fee covers two years and all your specialties. The fee will be adjusted up or down in future years, determined by expenses. Physicians in or within 2 years of training qualify for a reduced rate of $29 for a two year certification ($14.50/year). The application requires less than 15 minutes to complete.

Here are some of the NBPAS Board Members:
Paul Teirstein, M.D., President NBPAS, Chief of Cardiology, Scripps Clinic
John Anderson, M.D., Past President, Medicine and Science, American Diabetes Association, Frist Clinic, Nashville, TN
David John Driscoll, M.D., Professor of Pediatrics, Mayo Clinic College of Medicine
Daniel Einhorn, M.D., Immediate-Past President, American College of Endocrinology; Past President, American Association of Clinical Endocrinologists
Bernard Gersh, M.D., Professor of Medicine, Mayo Clinic College of Medicine
C. Michael Gibson, M.D., Professor of Medicine, Harvard Medical School

Paul G. Mathew, M.D., FAHS, Director of Continuing Medical Education, Brigham & Women's Hospital/Harvard Medical School, Department of Neurology

Jordan Metcalf, M.D., Professor and Research Director, Pulm. & Crit. Care,  Oklahoma University Health Sciences Center
J. Marc Pipas, M.D., Professor of Medicine, Dartmouth Medical School
Jeffrey Popma, M.D., Professor of Medicine, Harvard Medical School
Harry E. Sarles Jr., M.D., FACG, Immediate Past President for the American College of Gastroenterology

Hal Scherz, M.D., Chief of Urology- Scottish Rite Children's Hospital, Assoc Clinical Professor of Urology Emory University

Karen S. Sibert, M.D., Associate Professor of Anesthesiology, Cedars-Sinai Medical Center, Secretary, California Society of Anesthesiologists
Gregg W. Stone, M.D., Professor of Medicine, Columbia University College of Physicians and Surgeons
Eric Topol, M.D., Chief Academic Officer, Scripps Health; Director, Scripps Translational Science Institute
Bonnie Weiner, M.D., Professor of Medicine, University of Massachusetts Medical School
Mathew Williams, M.D., Chief, Division of Adult Cardiac Surgery, New York University Medical Center

Sincerely,

Anthony Hoffman MD

 

Julie Vose, MD, MBA, FASCO

Dec, 21 2016 5:02 PM

Dr. Hoffman,

Thank you for your response and for sharing information on the NBPAS alternative.  The charge of the ASCO MOC Task Force was to formulate a process for maintaining certification that was personalized, aligned with physicians’ practice and knowledge needs, and integrated into ongoing physician activities.  Task Force members engaged in in-depth discussion about the type of process that would address these elements.  The proposed plan that resulted from those discussions is what we have shared.

The ASCO proposal offers another potential alternative for those seeking to maintain certification.  Since ASCO is not, and does not seek to be, a certifying body, the proposed plan was shared with the ABIM. We believe that maintaining certification should be based on meaningful, peer-defined standards.  The proposal is still a work in progress with many details not yet worked out.  We have been in discussion with the ABIM to determine how this proposed plan might be shaped into a separate alternate pathway for maintaining certification.  This plan, once fully developed and approved, will be offered by ASCO on an ASCO-selected and supported platform.  In order for the ABIM to recognize that a Diplomate is maintaining certification through the ASCO alternate pathway, some type of attestation of successful completion will ultimately need to be submitted by ASCO to the ABIM.

ASCO’s goal is to support oncologists by understanding their needs and challenges, and then working to devise ways to mitigate the impediments that lead to a meaningful process for maintaining certification.  ASCO believes that maintaining certification is an important process for physicians and is also important to the public.  That is why ASCO is willing to fund and develop an alternate pathway for MOC.

Again, thank you for your response.  We are all working to define options for MOC that are truly meaningful.

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