2014 Annual Report of the American Board of Psychiatry and Neurology, Inc.

The 2015 ABMS MOC Standards require Member Boards to “identify professionalism expectations for all diplomates” and “incorporate professionalism learning and assessment activities” into MOC Programs. ABPN diplomates fulfill Part I requirements by simply maintaining an unrestricted license(s) to practice medicine. There are no changes to this requirement which has been in place since the ABPN’s first examination in 1935. The ABPN has also developed a “Statement on Professionalism” which is available on its website (www.abpn.com) and has established a new Professionalism Committee with members who are recognized experts on professionalism and ethics. This new committee is charged to develop relevant questions on professionalism that the ABPN will use in its certification and MOC examinations.

The 2015 ABMS MOC Standards require Member Boards to “establish requirements for Lifelong Learning and Self-Assessment”, “document that diplomates are meeting the learning and self-assessment requirements”, and “integrate Patient Safety principles” into their MOC Programs. ABPN diplomates fulfill Part II requirements by completing self-assessment (SA) and continuing medical education (CME) activities as well as Patient Safety Courses. Taken together, SA and CME complete a medical knowledge quality improvement cycle. The rationale for SA activities is based upon evidence suggesting that many physicians are limited in their ability to accurately assess their own knowledge. SA activities are intended to help diplomates do that type of assessment in a more objective manner.

The 2015 ABMS MOC Standards require that diplomates complete an average of 8 CME credits of SA activities per year. Those SA activities are usually provided through SA examinations developed by professional organizations (e.g. APA, AAN, etc.). The ABPN now requires that all SA activities be preapproved so that diplomats are assured that any SA activity they complete will fulfill ABPN requirements.

The 2015 ABMS MOC Standards now also permit Member Boards to accept approved non-CME types of SA activities. Based on feedback from diplomates and its own deliberations, the ABPN has decided to accept the following six types of non-CME SA:

The ABPN requires diplomates to complete 24 CME credits of SA activities in its 10-Year MOC Program and every 3 years in its Continuous MOC Program (CMOC). Eight (8) CME credits of SA requirements will be waived for each of the above 6 types of non-CME SA activities completed. Diplomates may have up to 16 of the required 24 CME credits of SA waived in the 10-Year MOC Program and every 3 years in the CMOC Program. Two different types of non-CME SA activities must be completed to have 16 CME credits waived.

In Part II of its MOC Program, the ABPN also requires diplomats to complete an average of 30 Category 1 CME credits per year. This requirement is similar to what most state medical boards mandate for physicians to maintain their medical licenses. Diplomates may count CME credits obtained from SA activities toward this overall CME requirement.

The only major new requirement established by the 2015 ABMS MOC Standards is for diplomates to complete a Member Boardapproved Patient Safety Course “prior to or early in” their participation in MOC. The ABPN has decided to interpret this time requirement to mean that diplomates must complete an approved Patient Safety Course sometime during the period 3 years before to 3 years after they enter the MOC Program. The ABPN has established standards for Patient Safety Courses and will make every effort to approve Patient Safety Courses developed and administered by accredited institutions such as hospitals and residency programs. The ABPN will not implement this new requirement until 2016 so that professional organizations like the APA and the AAN have ample time to develop relevant Patient Safety Courses.

The 2015 ABMS MOC Standards require Member Boards to conduct an “ongoing examination of diplomates’ knowledge of core content, judgment, and skills in the specialty no less than every 10 years.” ABPN diplomates fulfill Part III requirements by passing a secure, proctored, practice relevant MOC Examination administered at Pearson VUE Centers conveniently located around the United States and Canada. To be eligible to take the MOC Examination, diplomates must possess an unrestricted medical license(s) and attest on the ABPN website that they have completed all other MOC requirements (i.e. SA, CME, and PIP). No patient data, SA activity scores, or other MOC results are to be sent to the ABPN. Random audits will be conducted of diplomates who apply for the MOC Examination. Passing an MOC Examination merely means that a diplomate does not need to take that MOC Examination for another 10 years. To remain certified, diplomates must fulfill all the other MOC requirements.

Only one set of MOC activities (i.e. SA, CME, and PIP) are required for multiple ABPN certifications. Separate MOC Examinations are required for each certification, but Combined MOC Examinations are available that cover up to 3 different certifications.

The ABPN MOC Examinations are clinically oriented and practice relevant. High pass rates are expected and have been observed. In the future, the ABPN will discuss ways in which the MOC Examinations might be modified to more closely resemble what happens during diplomates’ professional activities, including the possibility for diplomates to have access to relevant reference material during MOC Examinations.

The 2015 ABMS MOC Standards require Member Boards to “incorporate practice assessment and improvement activities” into their MOC Programs “throughout diplomates’ careers.” ABPN diplomates fulfill Part IV requirements by completing Performance in Practice (PIP) Unit activities. PIP activities complete a clinical quality improvement cycle. The rationale for Part IV requirements is based upon evidence suggesting that the performance of many physicians tends to deteriorate over time.

Each PIP Unit consists of a Clinical Module and a Feedback Module. ABPN diplomates are required to complete one (1) PIP Unit in the 10-Year MOC Program and every 3 years in the CMOC Program. As with SA activities, Clinical Modules and Feedback Modules must be preapproved by the ABPN.

PIP Clinical Modules require diplomates to compare data obtained from at least 5 of their patients in a similar category (e.g. diagnosis, treatment) seen over the previous 3 years against peer standards of care (e.g. practice guidelines) that include at least 4 quality measures. Diplomates themselves choose which specific category they want to study as well as the 5 specific patients within that category. Based upon the comparison against peer standards, diplomates learn if there are opportunities for them to improve their patient care and take whatever improvement steps are indicated. Within 2 years, diplomates then recollect data from at least 5 patients in the same category (same or different patients as originally studied) to see if the indicated improvements have been made or their original excellent performance has continued. The 2015 ABMS MOC Standards now permit the ABPN to be more flexible in its Feedback Module requirements. Diplomates may now select ONE type of Feedback Module they want to complete from the following menu of 6 options:

Free forms for each type of Feedback Module are available on the ABPN website.

Similar to the Clinical Module, the Feedback Module requires diplomates to solicit the required feedback selected, identify any opportunities for improvement, implement the relevant improvements suggested, and resolicit similar feedback within 2 years.

If diplomates happen to work in systems with quality improvement activities that are consistent with the ABPN Clinical Module requirements and/or feedback activities that are consistent with the ABPN Feedback Module requirements, the ABPN will award diplomates Part IV MOC credit for those activities (requires preapproval by the ABPN). The ABPN will also award MOC Part IV Clinical Module credit for those diplomates with “meaningful participation” in the ABMS Portfolio Program.

ABPN diplomates who graduate from an ACGME-accredited subspecialty fellowship in 2011 or later and pass the relevant ABPN Subspecialty Certification Examination will now receive 3 years of MOC credit (SA, CME, and PIP).

ABPN diplomates with “lifetime” certificates may now enter the CMOC Program in two ways:

The best and easiest way for diplomates to obtain all relevant MOC information is in ABPN Physician Folios found on the ABPN website. Once on the website, diplomates click on ABPN Physician Folios to obtain their secure password that enables them to access their personalized MOC site. Here they can see their own MOC requirements, update their medical license(s), attest to the completion of MOC activities (SA, CME, and PIP), obtain information about ABPN-approved MOC products, and record and track their completed MOC activities.

The changes I have described in the ABPN MOC Program should make it easier for our diplomates to comply with its requirements and document their progress toward lifelong learning. We welcome constructive feedback from diplomates about how we might improve our MOC Program to make it a more relevant and meaningful component of their professional development. Any MOC Program must balance the need for credible requirements with the burden it places on diplomates. Ours is no exception. The modifications we have been able to make in our MOC Program as a result of the 2015 ABMS MOC Standards should bring us closer to striking that balance.