ASH Advocates to Overhaul Maintenance of Certification (MOC)

Latest Updates

Aril 29, 2024

ASH convened a meeting of 14 internal medicine specialty societies along with leadership from the American Board of Internal Medicine (ABIM). During the meeting, ABIM leadership answered numerous questions regarding ABIM’s stance and policies on MOC, CME, and assessments.

March 25, 2024

ASH convened a meeting of 14 internal medicine subspecialty societies along with leadership from the American Board of Medical Specialties (ABMS). The meeting resulted in a robust discussion regarding ABMS’s role in establishing continuing certification standards and the governing process of the certifying boards.

March 2024

ABIM announced that a new hematology-focused LKA for malignant and classical hematology will launch in 2026. This long-awaited enhancement to the LKA is the direct result of ASH’s previous work to address member concerns regarding the lack of relevance of ABIM assessments. In 2020 ASH partnered with ABIM and funded a national practice profile study of more than 2,000 board-certified hematologists. The goal of the study was to identify the top three to five most common areas of specialization within the field of hematology. Based on data gathered, three hematology profiles were identified and are currently being developed by ABIM: malignant hematology, classical (non-malignant) hematology, and general hematology (covering both malignant and classical hematology). These profiles were to be included in the ABIM Hematology LKA in 2024, but ABIM has delayed the availability of these three profiles until 2026.

While ASH welcomes ABIM’s long overdue announcement, we regret that our members will still need to wait nearly two more years before having the option to select their area of specialization as part of the LKA pathway.

February 9, 2024

The ASH Executive Committee (ASH Board) approved the appointment of the Continuing Certification Task Force charged with providing guidance on issues related to continuing board certification, specifically in the development of ASH policy positions regarding the American Board of Medical Specialties (ABMS) and the American Board of Internal Medicine (ABIM) continuing certification policies and programs. The Task Force is comprised of the following members:

Robert Brodsky, MD (Chair)
Srinivas Devarakonda, MD
Janice Lawson, MD
Richard Lin, MD, PhD
Martha Mims, MD, PhD
Rachel Rosovsky, MD, MPH
Robert M. Stern, MD, EdM

January 29, 2024

ASH held its third meeting with a growing number (15) of internal medicine subspecialty organizations. The meeting finalized core MOC principles, intended for sharing with each organization's governing bodies to foster collective agreement. Additionally, a comprehensive list of questions for ABMS leadership, attending the next organizations' meeting on March 25, 2024, was generated to be shared with ABMS in advance of the meeting.

December 14, 2023

The Clinical Infectious Disease Journal published a letter from the Infectious Disease Society of America (IDSA) to ABIM endorsing the immediate actions ASH requested in its September 27, 2023, letter to ABIM regarding the current LKA.

December 7, 2023

ABIM convened its annual meeting of the Liaison Committee for Certification and Recertification (LCCR) with representatives of 32 internal medicine specialty organizations as well as ABIM staff and governance. The meeting aimed to allow medical societies to share concerns about ABIM's Maintenance of Certification (MOC) program and its impact on their members. Despite a consensus on shared concerns, there is uncertainty about when and how ABIM will address the raised issues, despite their willingness to listen.

November 27, 2023

ASH convened the second meeting with a growing number (13) of internal medicine subspecialty organizations. The meeting resulted in a draft of core principles for ongoing certification, aiming to establish core principles that all participating organizations will support in the end.

October 30, 2023

ASH organized a meeting with leaders from 12 internal medicine subspecialty organizations to evaluate the concerns raised by our collective members regarding ABIM’s MOC program, align efforts, and strategize for significant changes. The American College of Cardiology (ACC) leadership explained the rationale behind the recent announcement by ACC, Heart Failure Society of America (HFSA), Heart Rhythm Society (HRS), and Society for Cardiovascular Angiography & Interventions (SCAI) to establish a new certification board for cardiology. The meeting also established the need to convene monthly meetings of the organizations to maintain progress and momentum. 

OCTOBER 2023

Drs. Robert Brodsky (2023 ASH President) and Mikkael Sekeres (Committee on Communications Chair) appeared as guests on the Healthcare Unfiltered podcast (which can be viewed on YouTube or listened to on Apple Podcasts), where they discussed how the statement came about. 

September 28, 2023

ABIM posted a response to ASH’s letter on the ABIM Blog.

September 27, 2023

The ASH Executive Committee (ASH Board) sent a formal letter to Dr. Richard Baron, ABIM President and Chief Executive Officer. The letter strongly urged ABIM to take the following immediate actions:

1. Establish a new MOC program that does not involve high-stakes assessments (i.e., 10-year exam and the new Longitudinal Knowledge Assessment (LKA)) but rather is self-driven by each physician and involves mandatory self-reporting of educational activities (similar to the systems in Canada and Australia/New Zealand).
2. Revise the current LKA system requirements immediately (as a transition to the new MOC program) by:
• Removing the time limits to answer each LKA question so physicians can research the answers as they would do in their practice.
• Allowing physicians to consult a colleague when answering questions, as they would do in their practice.
• Reducing the number of LKA questions physicians receive every three months to no more than 15.
• Eliminate redundancy between the MOC requirement to have a current license (which requires CME in almost all U.S. jurisdictions) and the requirement to report CME to ABIM.

The response on social media to ASH’s letter to ABIM has been overwhelmingly positive.

July 2023

A groundswell of concern was raised about the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program requisites. ASH members actively urged ASH leadership to compel ABIM to adopt a fresh, streamlined continuing certification initiative. This new approach aims to foster lifelong learning, support continuous professional development without excessive burdens, and prioritize transparency.

ASH Principles for Maintenance of Certification

Initial Board Certification

Diplomates must successfully pass the ABIM “high-stakes” internal medicine board certification examination. In addition, diplomates that pursue a subspecialty must also pass the ABIM “high-stakes” subspecialty certification examination.

Continuous Certification

A continuous certification process for medical specialists should enhance a physician’s clinical practice. It is essential that the continuous certification process is clinically relevant, transparent, and contributes positively to the quality of healthcare provided by physicians.

Relevance and Practicality

It is imperative that the continuous certification process remains relevant and practical to the evolving field of medicine and aligns with physicians’ current scope of practices, negating the need to relearn aspects of the subspecialties that are not pertinent to their ongoing professional activities and scope of practice.

Assessments

The focus must shift from “punitive assessments” towards self-guided learning and continuous medical education (CME) activities. This approach promotes a more holistic and integrated form of professional development. However, any required assessments should be “non-punitive,” aiming to identify knowledge or skill gaps. Their primary function must guide the learning process, rather than act as stringent assessment tools. Additionally, assessments for continuing certification must be customized to align with each physician's current scope of practice. This approach acknowledges the variety of specializations within each medical field and underscores the necessity for physicians to remain current in their respective areas of expertise.

Learning Resources

The continuous certification process must provide accessible learning resources that address identified knowledge or skill gaps and rely on adult education principles. Physicians should be encouraged to use a wide range of resources meaningfully to update their knowledge. These activities should continue to be recognized and count towards Maintenance of Certification (MOC), aiming to replace the need for assessments. This approach fosters an environment of continuous learning and professional development, ensuring that the certification process remains relevant, enhances physician knowledge, and improves patient care.

Streamlined Online Process for CME Activities

Develop and incorporate an efficient, streamlined online system for the collection and reporting of CME activities, facilitating ease of use and reducing administrative overhead for physicians.