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    MOC reform: One year later

    This article reports the latest developments in the process of reform for the American Board of Pediatrics’ Maintenance of Certification (MOC) requirements, what transformations already have occurred, and what changes still lie ahead.


    A new exam format

    In May 2015, the ABP convened a conference to discuss converting the 10-year exam to one that is a complete departure from the existing format. The new testing concept is that pediatricians will be given questions on a regular ongoing basis, perhaps monthly via the Internet, and be allowed to research the topic before submitting their answers. In the view of the ABP, by changing to this format, pediatricians will utilize these questions either to gain new knowledge or reinforce present understanding. The idea was based on a pilot program developed by the American Board of Anesthesiology (ABA).

    More: How to make pediatrics great!

    In 2015, 1400 ABA members participated in a Maintenance of Certification Assessment (MOCA) pilot. Participants received 1 multiple choice question via e-mail once a week. Once accessed, they had a limited amount of time to answer. They received feedback immediately indicating whether the answer was correct and a brief discussion, including references. If answered incorrectly, they would receive follow-up questions on the same subject weeks or months later. The ABA has subsequently replaced its current system with a redesigned MOCA 2.0 program that went into effect in January of this year.

     According to a recent blog posted by ABP President and CEO David G Nichols, MD, provisional features of the ABP version of the MOCA exam will include the following (subject to change):

    •      Diplomates will establish a practice profile when registering for MOCA, so that the content can be weighted to suit the type of practice.
    •      Diplomates may receive 1 to 3 multiple choice questions per week.
    •      The amount of time allowed for the answer may vary depending on the complexity of the question.
    •      Online resources or books may be used, but because each question is timed, the diplomate will need to judge carefully whether to invest time in searching through a resource.
    •      A feedback page will pop up after submitting the answer.
    •      A randomization protocol will minimize the likelihood that any 2 diplomates receive the same questions during a given time period.
    •      Flexibility will allow diplomates to decide when to respond based on their schedule and time availability. Test security provisions may vary depending on whether the diplomate chooses to answer questions during the week they are delivered or wait to answer a batch of questions.
    •      If MOCA is ultimately adopted, the ABP will make pass/fail decisions based on the response patterns. Those who successfully participate will meet standards for Part 3 of Maintenance of Certification.

    An ABP MOCA pilot will be launched next year. Interested pediatricians should visit the ABP website (www.abp.org) to find out more about the program and consider participating in focus groups regarding the MOCA pilot.

    NEXT: Sample MOC Part 3 pilot exam question

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...


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      I just signed the Peds4MOCReform petition and have forwarded it to several of my Pediatric friends/colleagues. . . I have passed this thing three times - the last time in 2013, during perhaps the most trying/awful time of my professional life (and given my horrific experience as a public-servant-turned-medical whistle-blower back in the days of "Hillary's village" that's saying a lot). . . Responding to a request for feedback at the end of this last exam, I wrote the ABP's present/past Presidents - telling them my story (it took, I think, a considerable amount of courage to do that). I might as well have tossed the letter into a black hole. . . I've read about the new protocol - and I still think it's too much. I certainly recognize the need to stay current, and after passing the original exam, I am perfectly fine with regular CME and/or some form of low-pressure/open-book testing to be done at MY CONVENIENCE, but I am NOT FINE with the proctored test, or the practically useless/time-consuming "Part 4" activities (seriously, how many times can you do a "hand-washing" or "breast-feeding" module and not want to kill yourself?), or with answering the timed e-mails that the ABP now wants to hurl at me once a week (NO PRESSURE! and as if I don't have enough to do). It's just for the birds. . . I have decided that if the ABP continues down this road, as an older-but-not-quite-old-enough-to-be-grandfathered-in Pediatrician who has suffered mightily because of her ADD (only diagnosed as an adult/after training), I will be seriously considering legal action based on discrimination law (for instance, when I inquired about accommodations for my ADD during the last test, the ABP offered only extra time - completely MISSING the crux of the problem - which, to me is pretty sad given that Pediatrics is the medical specialty that is supposed to understand more than others that not all brains work/process/learn/TEST the same way). . . It's never been fair or right . . . OBTW, when I inquired about participating in the recent feedback sessions - the ABP's "schedule" could not accommodate the response. . . And/so enough is enough. The ABP needs come down out from its rarefied academic towers in Chapel Hill and start LISTENING to its diplomates on-the-ground and in-the-trenches . . . and give credence to voices that they have long/determindedly ignored. . . In point-of-fact, over the years, my Board certification in Pediatrics has meant absolutely NOTHING to a series of smug, self-important, way-over-paid hospital executives and/or lawyers (who do not have to re-pass their bar exams every ten years) who regard Pediatricians as "a dime a dozen" - lowly pawns on their chessboards of power and greed. . . they've done whatever they wanted with no checks or balances and the ABP looking the other way. It's WAY past the time that changed.
    • Dr. Vic Strasburger
      I agree with Mary and feel bad that she's not being treated fairly. Sure, the ABP is making changes -- under pressure -- and the changes they're making are INSUFFICIENT! MOC should be fun, educational, online, and CHEAP! The testing component could be a short quiz at the end of (an educational) module just to show you didn't click through it all at once. The idea that somehow the public and Congress DEMANDS MOC is ludicrous -- in 35 years, I've never been asked if I'm Board-certified (and only been asked once where I went to medical school -- Harvard, BTW). Time for the ABP to make substantive changes, not just window-dressing.


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