The American Board of Medical Specialties (ABMS) consists of 24 medical specialty Member Boards. Each specialty board within the ABMS adheres to 4 components in their individual Maintenance of Certification (MOC) programs. MOC ensures that the physician is committed to lifelong learning and competency in a specialty and/or subspecialty by requiring ongoing assessment of 6 core competencies. Assessment of these competencies happens in a variety of ways and is carried out by all Member Boards using a process that is designed to keep certification continuous.
The 4 components of the MOC process assess (Table):
• Professionalism and professional standing (Part 1)
• Lifelong learning and self-assessment (Part 2)
• Assessment of knowledge, judgment, and skills (Part 3)
• Improvement in medical practice (Part 4)
These components are outlined in detail on the American Board of Psychiatry and Neurology (ABPN) Web site, along with a list of ABPN-approved MOC products for self-assessment, CME, and improvement in practice.1
The internal objective of MOC is to encourage diplomates to participate in lifelong learning. The external objective is to demonstrate and document ongoing competence of board-certified physicians to the public and outside organizations. ABPN Directors, President, and CEO, as well as MOC Examination Committee members must participate in MOC.
The ABMS provides an evidence library on their Web site that highlights research studies and articles that support the value of board certification and MOC.2 It reflects an effort to systematically present the empirical evidence in the current peer-reviewed literature.
MOC cognitive examination: information and pass rates
The ABPN MOC written examinations are designed to measure clinical competencies required for patient care. They are developed by nationally and internationally renowned volunteer content experts in the fields of psychiatry and neurology who serve on the various committees. The content experts determine the critical knowledge and skill domains that define the core competencies for experienced practicing physicians. Every item is reviewed, modified, and approved by a committee of content experts to ensure they address topics that are significant to practice and are reasonably challenging and scientifically written. The final examinations are made up of items selected by the examination committees from the approved item pool. All ABPN examinations meet the published content specifications and possess all major desired psychometric properties.
The pass-fail standards for ABPN MOC examinations are recommended by the Standard Setting Committee and reviewed and finalized by an oversight committee for the specialty or subspecialty. They use standard-setting methods to review the content of every question in the examination and make content-based judgments. The oversight committee reviews the recommended standards and makes the final decision.
The standard-setting methods the ABPN uses are criterion-based and not norm-based. Therefore, theoretically, everyone can pass or everyone can fail. The recent average pass rate for the psychiatry MOC cognitive examination is 99%. High pass rates are expected, since diplomates are about 10 years into their practice and in tune with current knowledge in the field. Another reason for the high pass rate is that diplomates have gone through the arduous process of becoming board-certified and have demonstrated their knowledge by passing the certification examination. A diplomate has 2 opportunities to pass the MOC cognitive examination before being reported as “Not Certified.” The two opportunities often fall within the same calendar year.
Security measures are in place at test centers to prevent cheating on the examinations:
• Examinees may not access personal items (eg, cell phones, pagers, study materials, notes)
• Examinees may use the restroom but cannot leave the test center
• Electronic devices are not permitted in the exam room
• Two forms of identification are required
• Examinees are required to place each hand on a palm vein device on arrival at the testing center and whenever entering or leaving the testing rooms
• Electronic signatures and photographs are taken of the examinees
New MOC standards
In keeping with the evolving nature of the MOC requirements for all physicians, the ABPN must remain consistent with the ABMS guidelines. The ABMS recently approved new MOC program standards for implementation in 2015, which have been adopted by the ABPN.
Ms Vondrak is Director of Examination Administration and MOC and Dr Faulkner is President and CEO of the American Board of Psychiatry and Neurology, Inc, in Buffalo Grove, Ill. They report no conflicts of interest concerning the subject matter of this article.
1. American Board of Psychiatry and Neurology, Inc. http://www.abpn.com. Accessed March 26, 2014.
2. American Board of Medical Specialties. ABMS Evidence Library. http://www.abms.org/ EvidenceLibrary/default.aspx. Accessed March 27, 2014.
3. American Board of Psychiatry and Neurology, Inc. Approved MOC Products. http://abpn.com/moc_products.asp. Accessed March 27, 2014.
4. Multi-Specialty MOC Portfolio Approval Program. http://mocportfolioprogram.org. Accessed March 27, 2014.