Recertification is a requirement for all physicians in the United States. Board certified doctors in all 24 medical specialties recognized by the Accreditation Council for Graduate Medical Education (ACGME) now receive time-limited certificates, valid for a ten-year period.
The American Board of Ophthalmology adopted this practice in 1992. The recertification process has evolved over the last 20 years, and can be confusing because the requirements and time frame for the components differ depending on the year certification was obtained. The ABO website makes the requirements easy to understand by describing each one in detail and also presenting a personalized chart on each diplomate’s account page. This article reviews the various steps of recertification, which is now called Maintenance of Certification (MOC). The American Board of Medical Specialties (ABMS) guides the MOC process, but each of the 24 member boards sets the criteria and curriculum for its own specialty.
The process began in July 1992 when the ABO began to issue time-limited certificates and required recertification every 10 years. Initially, diplomates were offered a choice of retaking the oral boards or completing an open book, take home exam (CREW) over a 2-month period. In March 2000, the ABO transitioned to the MOC process and replaced the CREW examination with the DOCK (Demonstration of Ophthalmic Cognitive Knowledge) exam, which is a 150 item, timed, closed book, computerized, proctored multiple-choice exam. Finally, in 2012, the MOC process became a continuous one in which various components are completed in a specific order throughout the 10-year cycle.
There are six general core competencies of physicians for quality patient care, and each one is assessed in the MOC components. These competencies are: professionalism, patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, and systems-based practice.
The four components of the MOC process are:
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Evidence of Professional Standing—valid, unrestricted medical license
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Practice Performance Assessment—ORR (Office Record Review), 3 of 32 diagnostic modules are selected and 5 patient charts for each module are reviewed for the requested information. This is completed online within a 30-day period. ORR will soon be changed to PIMs (Practice Improvement Modules), which are also self-directed online activities but require review of 30 patient records. Another tool is the PEC (Patient Experience of Care) Survey to assess patient perceptions.
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Lifelong Learning and Self Assessment—2 parts:
Part A: Obtain 30 category 1 CME credits per year and 3 ethics credits. Beginning in 2012, eight of the annual 25 credits must qualify as Self-Assessment CME, 1 must qualify as Patient Safety, and no ethics CME are required.
Part B: 2 PORTs (Periodic Ophthalmology Review Tests), which are 50-item online self-review tests, 1 core (fundamental knowledge for any practicing ophthalmologist) and 1 in a Practice Emphasis Area (i.e., subspecialty, selected from 10 different PEAs), each of which must be completed in a 30-day period. The PEAs are: cataract/anterior segment, comprehensive ophthalmology, cornea/external disease, glaucoma, neuro-ophthalmology and orbit, oculoplastics and orbit, pediatric ophthalmology and strabismus, refractive management/intervention, retina/vitreous, and uveitis.
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Cognitive Expertise—DOCK exam consisting of 3 50-item modules (1 core and 2 PEAs (one PEA can be selected twice except Refractive Management or Uveitis)) completed in a 4-hour test session.
The content of the PORT and DOCK tests is based entirely on the Practicing Ophthalmology Curriculum (POC) developed by the American Academy of Ophthalmology (AAO) at the request of the ABO. The POC content, which is revised every three years, reflects the most relevant clinical information for practicing ophthalmologists and is comprised of core ophthalmic knowledge and the 10 PEAs. The POC topic outlines for each PEA are available free on the AAO website, and there are AAO study tools available for purchase as well.
The MOC components are completed in the following timeframe: ORR/PIMs is required once in years 3-4 with registration from February through December, 2 PORTs are completed in years 5-7 with registration from February through December, and the DOCK is taken in years 8-10 during September with registration from February to June and late registration June to August (with a $300 late fee). The cost of the PORTs is $1000 and the cost of the DOCK is $1000. Additional PORTs can also be purchased if desired for $100 per module. Starting in 2012, diplomates pay a $200 annual fee.
Recertification was a controversial subject throughout the 1990s, and still is among some physicians. While no one enjoys taking tests, and during our graduate years most of us hope that there is a light at the end of the training tunnel (i.e. no more examinations after board certification), that notion is no longer the reality in medicine. Fortunately, most of us are good test takers (we’ve certainly had enough practice), so rather than viewing MOC as an onerous task, it serves us well to embrace the process and accept it. The bad news may be that we must recertify every ten years, but the good news is that the failure rate for the DOCK exam is only 1-3%.
More detailed information regarding this topic can be found on the ABO and AAO websites.