ABFM: What's next for MOC

Exploring new opportunities and approaches to Family Medicine Certification

By Ashley Webb, ABFM Director of Outreach and Elizabeth Baxley, ABFM Executive Vice President

Requirements for maintaining board certification with the American Board of Family Medicine may feel elusive or confusing to busy family physicians who are juggling many demands and priorities. As we have had more opportunities to meet with you at your state chapter meetings, or by phone from our offices in Lexington, it is clear from your questions and feedback that we have an opportunity to improve our communication with you and your state chapter executives, in order to support your efforts to participate in the Family Medicine Certification process.

Over the years, we have alternatively heard messages of “please change” activities and requirements for certification to be more relevant and less burdensome, and “you are always changing things” and we can’t keep up with what we are supposed to know. Communicating effectively with over 90,000 board-certified family physicians across the U.S. is a challenge, indeed! But we are committed to working with you to answer your questions regarding the certification process, ensuring that information about your choices to meet requirements is easy and clear to understand, and to hear from you in ways that will help us improve Family Medicine Certification into the future.

Through participation in board certification, family physicians are demonstrating their commitment to professionalism, lifelong learning, self-assessment of knowledge currency and identification of gaps, improving care in practice (regardless of practice type or setting), and regular assessment of cognitive expertise. We know that this matters to patients and the public, and we believe it matters to your peers within family medicine and across specialties. Mostly, we believe that it matters to you, as an individual physician participating in the process. The components of board certification map to these values, and ABFM has listened and learned from your feedback to continually enhance the process. So, let’s explore the requirements along with recent changes that we hope you will find to be helpful.

Family Medicine Certification is currently built on 10-year cycles, with three, 3-year stages and a 10th year in which cognitive expertise is assessed. Stage requirements include maintenance of an active, valid and unrestricted medical license and completion of 150 hours of approved CME credit every three years, as well as completing one knowledge self-assessment activity, one performance improvement activity and achieving 50 points through a combination of these activities.

  • Knowledge Self-Assessment is accomplished in one of two ways, each of which can be found in your Physician Portfolio:
    • Knowledge Self-Assessment modules are topic specific and can be done on your own, or as part of a formal KSA study group at your state chapter or AAFP meetings, depending on your preference. Previously, these were referred to as SAMs (self-assessment modules) and included a linked clinical simulation. In response to Diplomate feedback, the simulation was de-coupled from the knowledge assessment in 2016, leaving the 60-question module with critiques and references for learning as what is needed to meet requirements for one KSA per stage. Each KSA adds 10 certification points to your portfolio and with that you also earn eight prescribed hours of CME. KSA completion data demonstrates that each KSA averages 4-6 hours to complete.
    • A relatively new option introduced in January 2017, Continuous Knowledge Self-Assessment, provides 25 questions through your Physician Portfolio per quarter that cover the breadth of family medicine practice. Questions can be answered all at once, or a few at a time, in a manner that best suits your schedule, and are followed by the correct answer, a critique that explains each of the options, and references for further review when knowledge gaps are identified. There is also the option to comment on specific questions, if desired, and to review all comments – thus creating an online clinical discussion community. CKSA questions are similar in format to those seen on the Family Medicine Certification Examination. Once 100 questions have been completed over four quarters, a performance report is provided that will estimate the probability of passing the Family Medicine Certification Examination, along with a likely score. After successful completion of each quarter, 2.5 certification points and 2.5 CME credits are earned; after participating in four quarters of CKSA, you will have satisfied the minimum KSA requirement for that stage and earn 10 certification points. There is no formal scoring for this activity beyond what you may wish to utilize for your own purposes. Average time for completion is one to two hours per quarter.Find more information about Self-Assessment and Lifelong Learning.

  • The goal of the Performance Improvement requirement for certification is to demonstrate that, as a board-certified family physician, you can reflectively look at information about your practice, identify an opportunity for improvement, put an intervention in place, and re-measure to see if that change resulted in an improvement. When first established in 2004, this consisted of Performance in Practice Modules that were downloaded from the Physician Portfolio and completed using patient data and surveys. Today, while a similarly-constructed activity is available for this requirement, we recognize that it is far more common for family physicians to already be engaged in doing quality improvement in practice, and when that is the case, the goal of the PI requirement is already being met. We also appreciate that more options were needed for physicians whose practice scope and environment is different (hospital-based, urgent or emergent care settings, locum tenens, hospice/palliative care, sports medicine, etc.). Finally, for those physicians who are no longer clinically active, it did not make sense to continue to require a clinically based PI activity. As a result, the following changes have been made over the last five years to support greater choice and relevance while eliminating the need for unnecessary redundancy of work:
    • The Self-Directed PI Project is best suited to an individual or small group of family physicians to report on a project already implemented in practice, or to provide a roadmap for creating a quality improvement project that is meaningful to their current scope of practice. As more Diplomates are learning of this option, the trend toward selecting this option has grown and the feedback has been very positive. The application process has been streamlined (averaging ~10 mins to complete) to require only the necessary information to demonstrate the cycle of measure, intervention and remeasure, and to attest to level of participation in the effort. More information about this can be found at in your Physician Portfolio. This pathway is ideally suited for family physicians in noncontinuity practice, as it allows selection of any area of improvement they wish to make, regardless of practice setting.
    • For larger groups of family physicians (> 10), the Organizational PI Activity option is worth consideration. If you are participating in an ACO, CIN, health system network, or similarly constructed group of physicians who are working on improving care together, your organization can apply to be a sponsor for reporting your efforts in this work to the ABFM for your PI credit. Information about this option can be found at www.theabfm.mymocam.com/extsponsor/. This pathway also allows for state chapters and other organized entities to become sponsors of Performance Improvement activities and to report on your behalf.
    • If you are participating in NCQA recognition programs, a Practice Transformation Network, or CPC+, You may be able to receive credit for a certificate/recognition or award you have achieved for your improvement work (e.g. NCQA, CPC+, Practice Transformation Network, etc.). You can log into your Physician Portfolio and attest to your participation.
    • If you are using ABFM’s PRIME registry to help you manage data from your EHR, you can select something you wish to improve on from what is already being measured on your dashboard, implement an intervention, and PRIME will remeasure and seamlessly submit your data to ABFM for PI activity credit using the PI activity within PRIME registry.
    • The Residency Performance Improvement Program pathway is a means for residency programs to demonstrate their ability to develop and oversee the successful completion of PI projects for residents and faculty that meet the ABFM Family Medicine Certification requirements. Approved sponsors will be able to develop and oversee PI projects without having to submit an application for each activity for ABFM review. Learn more on the website.
    • Another exciting new option is the Precepting Performance Improvement Program. If you are teaching students or residents in your practice at a level of 180 hours of 1:1 during your 3-year stage, this option, developed through collaboration with the Society of Teachers of Family Medicine, allows you to receive PI activity credit for improving your teaching skills. Linking to an approved academic sponsor, who will help develop, oversee and report PI projects for teaching physicians, provides a pathway to earning your PI activity credit in a new way that supports the clinical preceptor, which is vital to the training of future physicians. Learn about the Precepting Program.

  • Perhaps the most exciting new option offered by the ABFM is in the area of cognitive expertise. In December 2018, we launched a pilot of longitudinal assessment as an alternative to taking the one-day Family Medicine Certification Examination every 10 years in a secure test center. This approach, entitled Family Medicine Certification Longitudinal Assessment, is more aligned with adult learning principles, promoting more enduring learning, and greater retention and transfer of knowledge into practice, than infrequent, episodic examinations. ABFM prepared for implementing this option beginning in 2017, with the launch of CKSA, which tested the feasibility and performance of the platform and acceptance by Diplomates to the option of answering questions over time that promote assessment of current medical knowledge and clinical decision making. Like CKSA, FMCLA provides 25 questions per quarter, can be done on a flexible schedule and at the location preferred by the Diplomate, and permits the use of references as needed. Because FMCLA is a testing process, just like the one-day exam, the questions are timed and collaboration or discussion of items with colleagues is not permitted.

The pilot for FMCLA is two years in length and initially was limited to Diplomates whose current 10-year certification period would end on December 31, 2019. This process allows us to collect sufficient feedback and data to evaluate the quality, acceptability, and comparability of this approach to the one-day exam in assessing cognitive expertise. Participant feedback is being sought at multiple steps along the way, with the information supporting in continuous improvement of the process. We anticipate that the pilot will be successful and anticipate being able to offer the alternative for longitudinal assessment to currently certified family physicians who are seeking to maintain their certification going forward. Learn more about the program.

Going forward, ABFM is interested in learning more from you regarding feedback on the current certification activities and ideas for new topics and programs that would improve the certification process. There are a number of ways for you to become more involved with the ABFM. One that may be of most interest and impact is joining our new virtual feedback group, the Engagement Network, where you can weigh in on a variety of topics through periodic short surveys and open exchange of ideas that will help ABFM staff and Board of Directors in making decisions about Family Medicine Certification and other ABFM activities.

We have recently launch a new website (www.theabfm.org) designed to provide clearer, more concise information in an easy-to-navigate format with enhanced search capabilities. In 2020, we plan to release a redesigned Physician Portfolio, which we expect will make tracking your progress and selecting activities, as well as reporting on license and CME information, much easier. We will be seeking input from board certified family physicians at every step along the way of the design of the new portfolio; if you are interested in this, you can volunteer at the Get Involved link.

Finally, we plan to be working even more closely with your state chapter leaders and visiting as often as we can, to share updates and listen to your ideas. For more information, you can periodically check the abfm website to see if we are going to be in a location near to you.

Supporting family physicians, and the discipline of family medicine, is core to who we are at ABFM. If you have any questions or need help in planning or reporting your certification activities, our capable staff at the ABFM Support Center are here to help you at (877) 223-7437 or via email at help@theabfm.org.