Lifelong learning. This sounds like something familiar, friendly and desirable to anyone who is in active practice.  But it has taken on some new connotations for those of us who are recertifying or about to recertify in family medicine through our American Board of Family Practice. Following our residencies, lifelong learning was something that we as individuals selected, directed, assessed, and utilized, as we needed for our practice. Those of us who wished to maintain board status were happy to turn over our record reviews, report our license and CME status and pay to take the exam once every six or seven years. But today, the American Board of Medical Specialties, under pressure from the public, is seriously scrutinizing lifelong learning. In response, our ABFP, as of January 2004, mandated Maintenance of Certification (MC-FP) to “enroll” us in a process to prove to all interested parties that our personal lifelong learning is effective. Not everyone is happy.

All diplomates who passed their recertification examination in July of 2003, and everyone who comes after must enroll in the MC-FP and pay their enrollment fee. That fee is $1,150. It includes the cost of all prospectively monitored activities of the MC-FP and the cost of the examination at the end of six years.

Alternatively one may choose to pay $200 a year for six years, or pay for individual components of the MC-FP and pay the fee for the examination separately in six years. That could potentially be more than $1,000 plus $50 dollars for each of the self-assessment components during each year, which could result in a total cost of about $1,500. Some of the required MC-FP components are familiar and some are new and not yet developed. The four components are: Professionalism, Cognitive Expertise, Performance in Practice, and Self-Assessment and Lifelong Learning.

“Professionalism” benchmarks require one to continue to maintain an active unrestricted license in all states in which one holds a license. Any restriction placed on any license results in the rescinding of the certificate simultaneously and must be reported within 60 days. When the license is reinstated, the certificate will be honored for the remainder. Achieving “Professionalism” requirements during the six-year MC-FP cycle also includes a mandated peer review by 10 medical professionals and patient satisfaction reports from 25 patients. This is expected to be conducted by the Board by phone or Internet but the mechanism is still under development. “Cognitive Expertise” will continue to be measured by the certifying examination. Also, once during the six-year cycle, “Performance in Practice” will require demonstration of ability to perform a quality-improvement initiative in your practice with an audit that is measured against evidence-based quality indicators in a specific disease domain. The mechanism is under development. At least the time you spend doing this will count toward CME requirements.

The “Self-Assessment and Lifelong Learning” component is also new, but the mechanism is in effect now. It requires that one continue to demonstrate 300 hours of approved CME and also completion of six Self-Assesment Modules, one each year of the six year cycle, over the Internet. Many of these components require access and working knowledge of the Internet, including enrolling in the MC-FP process and accessing and completing SAMs. For more information contact the ABFP or access their Web site at www.abfp.org/moc/about.aspx.

This seems daunting to most of us. Is it worth it? We have elected to initiate these changes already in the training process for our residents across the country because we believe that these self-evaluation mechanisms may improve the quality of the care that they deliver during their practice careers. Unfortunately, we do not yet have a great deal of evidence that it is ultimately going to increase our patients’ satisfaction or quality of care. Nevertheless, the public, as represented by institutions such as the ABMS or the Institute of Medicine, isn’t going to wait for that. They want these changes now.

One can choose. One can withdraw from certification status if it does not affect one’s practice and continue a personally directed life-long learning process as in the past. Or, one can consider participating in this gargantuan educational pilot project, relax and learn something new about oneself and practice. Fortunately, while there is not a great deal of flexibility in the process, there are several disease domains to choose and learn from in the SAMs and “Performance in Practice” components. Should one really be uncomfortable about sharing and verifying a lifelong learning process with others? Ultimately it is a personal decision. Good luck.