– The American Board of Dermatology has thoroughly overhauled the Maintenance of Certification (MOC) process in response to pointed criticism from dermatologists, and the revised program has received rave reviews in pilot testing, Erik J. Stratman, MD, announced at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.

current president of the American Board of Dermatology (ABD) and Dr. Erik J. Stratman chairman of the department of dermatology at the Marshfield (Wisc.) Clinic. Bruce Jancin/MDedge News

Dr. Erik J. Stratman

“Especially if you look at the last 2 years, you’ll see that things in MOC are a lot simpler, they’re quicker, and they’re cheaper than what they’ve ever been before,” according to Dr. Stratman, current president of the American Board of Dermatology (ABD) and chairman of the department of dermatology at the Marshfield (Wisc.) Clinic.

The first version of MOC for dermatology started in 2006 and ran for a decade. Unhappiness abounded. Major changes were introduced during the 2016-2018 pilot program. A second pilot program starts in March 2019, with a full launch expected in 2020.

Dr. Stratman came to the Hawaii Dermatology Seminar to convey the message that dermatologists’ complaining about the first version of MOC “was listened to very intently,” and that the second-generation MOC addresses all four of their major complaints.

“It’s very, very rare that the first iteration of anything is perfect,” he observed.

He also bore a second message about the new MOC: “There are some very, very simple things that every one of us ought to be doing that make it so much easier, cheaper, and so much quicker.”

First off, he recommended logging into the ABD website and clicking on “My MOC” to see a personalized table that provides a snapshot of where the user stands in the MOC process. Of note, the “Patient Safety” component is soon going to be eliminated because the ABD has recognized that patient safety is already embedded in other elements of MOC. So there’s no point in wasting time trying to seek out Patient Safety credits. On the My MOC table, the dermatologist can click a box attesting that he or she possesses an unrestricted medical license and another box attesting to the total CME credits accrued for the year. It’s also possible to securely pay the $150 annual MOC fee electronically on that site.

Why the $150 per year? Traditionally, dermatologists with time-limited certification have had to take the dreaded high-stakes, standalone recertification exam once every 10 years at a cost of $1,500, plus the expense incurred in closing the practice and traveling to a test site. The ABD decided to lessen the financial blow by breaking that expense up into 10 yearly payments of $150 for MOC, with no additional charge for the 10-year exam. All the educational materials required to meet the MOC requirements are included in that $150 per year; dermatologists should not feel obligated to purchase any additional materials.

Also, the ABD is one of seven members of the American Board of Medical Specialties (ABMS) piloting a novel longitudinal method of physician assessment known as CertLink. Instead of taking an anxiety-producing, all-or-nothing recertification exam once every 10 years, CertLink, a web-based platform developed by ABMS, involves longitudinal assessment coupled with education on an ongoing basis.

“It’s something you can do at home or work at your own pace using a your desktop or mobile device,” Dr. Stratman explained.

Participating dermatologists will receive small batches of questions electronically, a total of 40-50 per year. Before submitting their answer, they rate the relevance of the question to their own practice and their confidence in their response. After they answer a question they receive immediate focused feedback and an evidence-based explanation as to why their answer was correct or incorrect. And if they have prospectively rated the question as high relevance and then gotten the answer wrong, they can expect that question to come back later in the process.

Dr. Stratman’s first big time-saving MOC tip was directed to the 98% of practicing dermatologists who are members of the American Academy of Dermatology. Go to the academy website, he urged, and sign up to participate in the academy’s CME transcript program. Then check the box that allows everything on that CME transcript to be auto-updated to the ABD My MOC table.

His second major tip, both a time- and money-saver, is to sign up on the AAD website for the self-assessment question of the week. The question, delivered electronically, typically involves a clinical scenario with a photo and perhaps a pathological finding, followed by a question as to the most likely diagnosis or the therapy of choice. Concise feedback is provided about the medical condition and why the right answer was right and the other answers were wrong. And each question that’s completed earns the dermatologist 1 point of ABD MOC self-assessment credit, regardless of whether the answer provided was right or wrong.

“I’d say this is incredibly important. It’s part of your member benefits. It doesn’t cost you any additional money beyond your AAD membership fee. And it’s a very easy way to get your ABD MOC self-assessment elements [a required 100 points every 3 years] met,” Dr. Stratman noted.

An AAD survey showed that the question of the week is the single most successful AAD educational activity ever, with nearly 300,000 total MOC credits claimed and more than 74,000 total CME credits awarded in the first year and a half of the program.

The survey also showed that dermatologists spent an average of 45 seconds from clicking on the question of the week to submitting an answer. That works out to a mere 22 minutes and 30 seconds per year in order to meet the MOC self-assessment elements, simply by participating in the question of the week.

“Not too shabby,” Dr. Stratman commented.

He is especially pleased by this work-time analysis because one of the four major criticisms repeatedly leveled at the ABD regarding the first iteration of MOC was that it’s too time-consuming.

Another major gripe was that MOC is too expensive. But now every MOC requirement can be completed at no additional cost beyond AAD membership and the MOC participation fee, the dermatologist noted.

The third major criticism of MOC was that traditional CME should be adequate to demonstrate proficiency. Not so, according to Dr. Stratman, who cited two Cochrane reviews that concluded traditional CME activities don’t change physician performance or improve health care outcomes, which are the stated purposes of MOC.

The fourth criticism digested by Dr. Stratman and his fellow board members was that MOC wasn’t relevant to clinical practice. So here, major changes have been made in the ABD-approved Practice Improvement activity component. And to accomplish this, the ABD turned to the specialty of ob.gyn.

“We came up with a concept we borrowed from ACOG [the American College of Obstetricians and Gynecologists]. When you talk to people from the ob.gyn. world, they’re like the one specialty that almost never complains about MOC. It makes you ask, what is it that’s so different that they like what they’re doing? Because we want to have diplomates that are very happy with their MOC as well. And it came down to ob.gyns. being asked to participate in very focused quality improvement projects, where they’re looking at 1 thing to be changed, not 35,” the dermatologist explained.

So now, once every 5 years, dermatologists pick from a menu of roughly 50 focused Practice Improvement modules that address every area of dermatology. Some examples include “contraceptive education prior to starting isotretinoin,” “the importance of completing a delayed patch test reading,” or “choosing a step in the skin biopsy pathway to assess in your office.” And no more than three questions are asked about one patient’s chart. “This is what the majority of people are doing, and they’re really finding it worthwhile, quick, and relevant,” Dr. Stratman said.

Indeed, during the 2-year pilot in 2016-2018, more than 6,000 ABD diplomates completed more than 7,500 Practice Improvement modules. And in anonymous surveys, participants gave the program enthusiastically positive reviews. About 98% reported that their focused Practice Improvement activity was relevant to their practice as a dermatologist, 20% reported a resultant improvement in the care they delivered, 21% indicated at least one patient experienced a better outcome as a result, and 97% said they would recommend these modules to a practice partner or other dermatologists, he noted.

One Hawaii audience member offered a personal testimonial: “I used to rail against the irrelevance of the process. But I took my first recertification exam and I give the ABD a lot of credit for listening to our bitching and moaning and then streamlining things and making everything more pertinent. A big thank you to you guys!”

More about CertLink: The questions will be of three types. There will be core questions about general dermatology and skin conditions that all dermatologists should recognize; concentration-based questions focused on whatever the participant considers areas of individual expertise, such as pediatric or cosmetic dermatology; and article-based questions. The article-based questions are based on input from the editors of the major dermatology journals as to what they consider to be the top five articles of the past year that should have the most influence on practice. The participant clicks on the article, reads it, and then launches the questions; the answers to which are embedded in the body of the article. The questions are answered on an unlimited time basis with the article in front of the participant.

“I think the article-based questions are going to be a very big deal because the purpose of MOC isn’t really about testing you, it’s about trying to keep you as right-now and fresh and on top of your game as possible,” Dr. Stratman said.

He encouraged dermatologists to contact the ABD with any MOC-related questions, addressing them to Pam Zuziak (pzuzuak1@hfhs.org).

Dr. Stratman noted that he and his fellow board members are still studying an extensive report recently submitted to the ABMS on recommendations to reform MOC. It’s possible that the ABD will need to tweak its pilot program in response. So he recommended checking the ABD website often during this period of change.

“If you have an inbox email from the ABD, it’s going to be something that you should open and read. It’s not going to be an advertisement,” he promised.

Dr. Stratman reported having created many MOC-related educational materials during the past dozen years.

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