What is New In MOC? Anne Roberts, M.D. UCSD Medical Center

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1 What is New In MOC? Anne Roberts, M.D. UCSD Medical Center

2 American Board of Radiology Responsible for certifying candidates in Radiology Specialties Board Examinations MOC Quality of Radiologists ABR ACR American College of Radiology Political Arm of Radiology Standards of Practice Appropriateness Criteria Practice Accreditation Education aspects AIRP, Education Center, Radiology Leadership Institute Quality of Practice

4 ABR Mission The mission of the ABR is to serve patients, the public, and the medical profession by certifying that its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill, understanding, and performance essential to the safe and competent practice of diagnostic radiology, radiation oncology and medical physics

5 Core Examination ABR Exam After 36 months of radiology residency Covers all of diagnostic radiology Comprehensive, categorical exam Candidates must pass all categories Exams are given in June and November Exams are given in Chicago or Tucson exam centers

6 What Are the Categories? Organ Systems Modalities MSK, Thoracic, GI, Urinary, Neuro, Pediatrics, Cardiac, Reproductive/Endocrine, Mammography, Vascular CT, MRI, RF/Fluoro, Nuclear Radiology, Interventional, Ultrasound Fundamentals Physics, Safety

7 Modality and Organ Systems CT 0 IR MR NM/Molec ular Breast Cardiac GI MSK Neuro Pediatrics Thoracic Repro / Endocrine Urinary Vascular Rad/Fluor o US Physics Safety Q#

8 Core Exam: Content Image rich (unlike previous written exam) Approximately 40% fact retrieval (like previous written) Approximately 60% higher level (like previous oral) Differential diagnosis Management Mostly multiple choice questions

9 Exam Goals: Core Overarching goal: to protect the public by determining that individual candidates have attained competence in basic diagnostic radiology Specific goal: to create examinations that are relevant to current radiologic practice Specific goal: to make a reliable pass/fail decision about candidate performance in each category Reliability requires 60 questions/category Emphasis on unique importance of physics content = 136 questions

10 Core Exam Physics Practical, image based More questions than other categories Physicist included on each of the itemwriting committees

11 Physics content Core Exam Review Focus on practical applications Physics resource: rsna.org/education/physics.cfm Not intended to be the sole resource Diagnostic content Core study guide on ABR Website Category blueprint (estimated frequency of topics) Practice exam

12 ABR Chicago Test Center Used for Core and Certifying Exams Used for MOC exams

13 Tucson Test Center & Office Used for Core and Certifying Exams Used for MOC exams

14 Certifying Exam Given 15 months after finishing residency First exam just given - October 2015 Five parts (but questions will appear in random order) Non interpretive Skills Essentials Clinical Practice Areas (3 self-selected CPAs) Things every practicing physician should know Things every practicing radiologist should know Things this particular practicing radiologist should know

15 Clinical Practice Areas (CPA) Twelve categories Organ system: MSK, Cardiac, Thoracic, GI, Urinary, Neuro, Pediatrics, Breast Technology: US, VIR, Nuclear Radiology General Candidates can choose any combination of CPAs Level 1: fundamental Level 2: advanced Candidates selecting a CPA more than once will receive a higher proportion of level 2 items

16 Clinical Practice Areas (CPA) Emulates clinical practice Will include normals and variants Will include important findings outside chosen area Appropriateness, clinical vignettes, management decisions Item types Familiar: MCQs, extended matching Unfamiliar: Structured reporting, script concordance testing

17 Certifying Exam: Practicalities 300 items 5 hour exam (one half-day) Exam centers: Chicago, Tucson Exams offered October/March

18 Certifying Exam: Goals To confirm candidate has acquired and maintained necessary skills to practice independently Dual role Final ABR Certification Exam First exam of practice-based learning (MOC)

19 Certifying Exam Resources Non-interpretive skills and essentials Study guides are posted on theabr.org Clinical practice modules Study guides at theabr.org CME, SAMs Practice-based learning Society produced educational modules

20 What is Maintenance of Certification (MOC)? A process designed to document that physician specialists, certified by one of the Member Boards of ABMS, maintain the necessary competencies to provide quality patient care MOC is a continuous process

21 Who Has to Participate in MOC? All Radiology diplomates that took their initial board exams in 2002 or later All holders of other time-limited certificates CAQ neuro, IR, pediatrics Nuclear radiology Radiation oncology Medical physics Life time certificate holders that want to participate

22 MOC Process Continued learning, continued improvement, continued practice improvement Valid License CME SAMs Practice Improvement activities

23 Life Time Certificate Holders Enrollment in MOC Initially, apprehension about enrolling, participating What are benefits? Concerns: exams, fees, requirements Want no exams, but if have to, exams should be: Free Taken from home Tailored precisely to my practice Automatically passed Don t understand Part IV Myths and misconceptions

24 Myths and misconceptions Loss of lifetime certificate NO! Once you re in MOC, you can t get out Your MOC exam results are shared with institution, credentialers, etc. I won t ever need MOC to practice likely wrong because of: P4P, TJC, credentialers, public reporting of MOC status, pressure from practice groups, MOL, etc. Not a myth: Pressure mounting, as TLC diplomates are near to becoming the majority Progress is made one funeral at a time

26 MOC Components Part I: Professional Standing State Medical Licensure Part II: Lifelong Learning and Self-Assessment Category 1 CME and Self Assessment Modules (SAMs) 75 CME, every 3 years, 25 of which need to be SAM CMEs Part III: Cognitive Expertise Proctored, secure exam Part IV: Practice Performance Practice Quality Improvement (PQI)

28 Self-Assessment CME (SA-CME) Options SAMs (Self-Assessment Modules) Primarily in-person (live) Category 1 CME activities that count as SA-CME Society offered SAMs count as SA-CME Enduring Category 1 CME activities Enduring activities include: print, audio, video, DVDs, archived webinars, podcasts, monographs, journal CME

29 Sources of SA-CME In-person (live) SAMs ACR Case In Point (.25 SA-CME credits each) Journal CME through RSNA, ARRS, ACR, SIR, ASNR, etc. Other accredited CME providers offering enduring Category 1 CME activities

35 Part IV: Practice Performance Demonstrate what we do, not just what we know, strive to improve OK, but how do I do this??

47 MOC Participation 10 Year System Continuous Certification Part 1: Valid licensure Part 2: 25 CME and 2 SAMS Part 3: Exam Q 10 years Part 4: 3 projects q 10 years Part 1: Valid licensure Part 2: 25 CME/8 SA-CME Part 3: Exam q 10 years Part 4: 1 project q 3 years

48 Continuous Certification the basics It is not an MOC replacement It does modify the frequency of MOC participation evaluation Major MOC requirements are unchanged Fees are unchanged All ABR certificate issued 2012 and beyond no longer have valid through date All MOC participants are participating in continuous certification requirements

Advantages of Continuous Certification The number of CME and self-assessment CME credits (SA-CME) counted per year is unlimited You may take the MOC exam at any time, as long as the

49 Advantages of Continuous Certification The number of CME and self-assessment CME credits (SA-CME) counted per year is unlimited You may take the MOC exam at any time, as long as the previous MOC exam was passed no more than 10 years ago Built-in catch-up period of one year still certified Aligns reporting more closely with CMS, TJC, credentialing and state licensing boards

53 Optional program which provides administrator online access for MOC data entry on myabr More facile MOC compliance diplomate still required to log-in at least 1 time per year Required to be eligible for Whole Practice MOC Fee Discount Currently available to all interested groups/practices 140 groups enrolled, 4000 diplomates

55 ABR Website Need to have your personal data page set up Will have all of the information of where you stand Will have more webpages that will allow for putting in the PQI project Go to theabr.org and there are instructions on how to register

58 MOC ABR ABIM Part I: Licensure Part II: CME Self-Assessment Part III: MOC Examination Valid License ALL AMA Category 1 Live SAM Modules (ABR Diplomate chooses) Clinical content based on practice (ABR Diplomate chooses) Valid License Diplomate must use ABIM Modules for Self- Assessment ABIM specified IM content regardless of practice

MOC ABR ABIM PART IV: Quality Improvement (PQI) (1) Diplomate-designed Projects (2) Society-designed Projects (3) Department & Institutional Projects (ABR Diplomate chooses) Complex point system with

59 MOC ABR ABIM PART IV: Quality Improvement (PQI) (1) Diplomate-designed Projects (2) Society-designed Projects (3) Department & Institutional Projects (ABR Diplomate chooses) Complex point system with points coming from various ABIM-specified content areas (PIMs) Process Validation Online Tools DR, RO, MP Advisory Committees Diplomate surveys Team Tracker: Group Administrator data entry Board developed None

60 MOC Help Desk or (520)

Improving Diagnostic Imaging

Improving Diagnostic Imaging February 2018 Brent Wagner, MD (President-Elect) Brent.Wagner@towerhealth.org Disclosure: Volunteer, American Board of Radiology Important Note All of the information being