ASH Advocates to Overhaul Maintenance of Certification (MOC)
For more than two decades, ASH has critically examined the foundational assumption that the Maintenance of Certification (MOC) program leads to positive practice changes and enhances patient care quality. Since 2014, ASH has been actively urging the American Board of Internal Medicine (ABIM) and the American Board of Medical Specialties (ABMS) to undertake a comprehensive overhaul of the entire MOC program.
Although ASH's advocacy has brought about noteworthy modifications to ABIM's MOC program, substantial efforts are still required to achieve comprehensive improvements.
Bookmark and visit this webpage often for the latest updates on ASH’s efforts.
Latest Updates
NOVEMBER 5, 2024
If you are due for recertification in hematology in 2025, you may want to consider enrolling in the Longitudinal Knowledge Assessment (LKA) to meet your MOC requirement as opposed to taking the long form exam.
Why? In 2020 ASH funded a national practice profile study of more than 2,000 ABIM 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. As a result, starting January 1, 2026, two new focused LKAs—malignant hematology and classical (nonmalignant) hematology—will be available in addition to the general hematology LKA.
If you’re interested in enrolling in the focused LKA assessment, you will need to enroll in the general hematology LKA in December 2024, participate in the general hematology assessment in 2025, and then enroll in the focused LKA in December 2025 that will start on January 1, 2026.
ASH continues to strongly advocate for a continuing certification process designed to help physicians enhance their competence without the stress of high-stakes assessments.
To learn more about the LKA, including how it works, by visiting ABIM’s LKA webpage at: www.abim.org/lka
JUNE 6, 2024
Senior Staff from ASH and ABIM met to discuss ASH’s stance on the MOC program and ABIM’s future plans. During the meeting, ASH emphasized its strong advocacy for a continuing certification program that moves away from punitive assessments. Instead, ASH supports a system that focuses on identifying knowledge gaps among physicians and providing a clear pathway for them to demonstrate their progress in filling these gaps.
ASH believes that such an approach would be more beneficial and supportive for physicians, enabling them to improve their skills and knowledge in a constructive manner. The goal is to ensure that the continuing certification process helps physicians enhance their competence without the stress of punitive measures.
ABIM continued to stand firm against replacing punitive assessments with nonpunitive ones. However, ABIM is exploring the following changes to the current Longitudinal Knowledge Assessment (LKA), which ASH has been aggressively advocating for in an effort to make the LKA a little less burdensome for physicians:
- Increase the amount of time allocated to answer questions
- Eliminate the 100 MOC point requirement every five years for physicians participating in the LKA
- Reducing over time the number of questions physicians receive each quarter
ASH is committed to ensuring future improvements to the LKA are addressed in a timely manner while advocating for a continuing certification process designed to help physicians enhance their competence without the stress of high-stakes assessments.
April 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:
- 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).
- 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.
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