ABIM has made some changes to the Maintenance of Certification (MOC) process recently, and physicians may be wondering how these changes will affect them. One significant change that diplomates should be aware of is the elimination of practice improvement modules. The goal of ABIM is to continuously refine processes to create an MOC program that is not only thorough, but practical. It is ABIM’s view that all MOC activities, including certification and recertification exams and practice improvement modules, should be truly reflective of a typical physician’s experiences, creating an MOC process that not only assesses but also aligns with diplomates’ daily practice of medicine.

ABIM Exam Blueprint Review

The changes in practice improvement modules have their roots in a structured blueprint review that was conducted by ABIM in the spring and summer of 2015. ABIM used the new blueprint in the Fall 2015 exam and will continue to update exams through 2017. ABIM will be conducting a similar review in the subspecialty sections, planned for completion by 2020. The purpose of this comprehensive blueprint review is to:

  • Garner feedback from diplomate surveys and external sources to match the exam blueprint to what physicians need to know in clinical practice
  • Analyze feedback to determine which topics are appropriate for exam questions
  • Eliminate questions on topics that are deemed “low importance” to physicians
  • Increase the number of questions on topics that are seen as “high importance” to physicians

ABIM performed this review in order to revise the blueprint to include more relevant details. For example, the updated blueprint emphasizes diagnosis and management of prevalent conditions, capturing more of the information that has become available in recent years.

Although the blueprint may be seen as a document that only affects the ABIM recertification exam, it is much larger than that. The ABIM blueprint influences not only the content that makes up the exam, but also the content that is covered in outside educational and MOC activities, including exam prep, CME activities, and practice improvement modules. ABIM aims to create a cohesive, integrated MOC for the lifelong learning of physicians. Even if the frequency or structure of the exam is altered in the future, a blueprint is still necessary to ensure that relevant content is being tested.

A Change in Approach to MOC

With the changes to the exam blueprint, ABIM will also change their approach to practice improvement modules. More and more external activities count for MOC points, which has caused ABIM to rethink how to conduct practice assessment and to offer new, more efficient options for physicians to complete their MOC activities outside the exam. With that in mind, ABIM plans to reduce the number of activities they produce, allowing for the following changes to take place:

  • Requirements will be updated to better serve diplomates
  • ABIM Practice Improvement Modules® (PIMs) will be discontinued
  • The Approved Quality Improvement (AQI) program will be expanded
  • Medical Knowledge Modules will be updated and reduced

The elimination of practice improvement modules will occur in tandem with changes to the MOC program. With these changes, ABIM will transition to a new and improved program that ABIM hopes will provide more relevant, focused learning in a more streamlined process for physicians.

Why Eliminate Practice Improvement Modules?

As ABIM conducted their extensive structured review of the exam blueprint, one thing became abundantly clear: practice improvement modules were not serving physicians as well as they could be. They determined that practice improvement modules were not user-friendly, even though sponsors and societies who produced the programs took great pains to make them so. Practice improvement modules were also not seen as relevant to a physician’s daily practice, or even relevant to other educational and quality-improvement programs that physicians undergo on a regular basis.

Therefore, ABIM began to take steps to reduce the MOC program’s reliance on practice improvement modules as a way of assessing physicians. In December of 2015, ABIM announced that they would no longer require Practice Assessment, Patient Voice, and Patient Safety through the end of 2018; completion of these programs will still earn MOC points for diplomates.

Now that the impetus for ABIM’s discontinuation of practice improvement modules has been clarified, it’s time to discuss how this will affect you, the practicing physician, as you keep up with MOC.

What if a Physician has Already Begun a Practice Improvement Module?

As of February 16, 2016, ABIM has eliminated 16 practice improvement modules, which represent the bulk of ABIM-produced practice improvement modules. These practice improvement modules have been removed from the ABIM website and physician portal. ABIM will keep the Clinical Supervision PIM, due to the positive feedback they received on that particular practice improvement module.

Rest assured, if you have already downloaded and begun to work on an existing practice improvement module, you will be able to finish what you’ve started. Diplomates who are currently working on an open practice improvement module may continue to do so as long as the PIM is completed by April 22, 2016. All points earned from such PIMs will be reflected in the diplomate’s MOC points total. Physicians who are working on open PIMs should have the necessary time to complete their practice improvement module by the deadline and still earn certification credit.

What Is the Alternative to Earning MOC Points with Practice Improvement Modules?

ABIM’s Approved Quality Improvement (AQI) program has been broadened and improved to meet the needs of physicians who are working to meet MOC requirements. Some of the changes to the AQI program include:

  • Updating criteria to recognize activities and skills that are more relevant to physicians in daily practice
  • Expanding the AQI program to include more quality and safety activities that physicians conduct in practice
  • Making the AQI process more streamlined and efficient, so it fits in with a physician’s practice

AQI offers a growing number of opportunities for physicians to earn points for MOC, while encouraging activities that are aligned with their daily practice of medicine. By focusing on activities that physicians must perform for an effective, innovative, safe medical practice, AQI is meant to offer a seamless integration of medical practice and MOC. ABIM is also opening the way for sponsors and societies to submit a broader range of programs and educational activities for the AQI program, so it can act as a replacement for practice improvement modules.

According to ABIM, the newly streamlined and expanded AQI will deliver activities that promise meaningful engagement between MOC and the daily practice of medicine. ABIM is also changing their approach to annual learning opportunities. With the updates and improvements to the Approved Quality Improvement and the Medical Knowledge Module programs, it is ABIM’s view that physicians can easily replace the MOC points they once earned through practice improvement modules.

Changes in the Medical Knowledge Module Program

ABIM has collaborated with the Accreditation Council for Continuing Medical Education (ACCME) to integrate lifelong learning into physicians’ daily practice in a way that practice improvement modules did not, by opening up opportunities for physicians to earn medical knowledge credit at the same time as they are earning MOC points.

The program has been consolidated to release only one version of each of the Annual Update modules in a given year; this version will be valid for anywhere from 12 to 15 months, and then be replaced by another update. The reason for this change is to focus on recent medical advances, highlight information that is relevant to physicians’ daily practice, and eliminate outdated modules more quickly and efficiently. The primary purpose of the Medical Knowledge Modules, after all, is to promote the “just-in-time learning” that physicians need to quickly grasp, such as innovations in disease diagnosis, treatment, and awareness. More frequent updates to fewer, more focused modules will aim to provide diplomates with the most current clinical knowledge to integrate into their day-to-day practice of medicine.

Going forward, ABIM will release new modules in the first quarter of each year and discontinue them at the end of the first quarter of the following year. The Annual Update modules for 2014 and 2015 will be retired off-cycle and be subject to a 90-day grace period to provide diplomates with the time to complete any previous work they have done on the module, and still earn MOC points. These updates will be added to existing modules to make sure everyone is aware of the new deadlines. This partnership will reduce the need to keep discipline-specific modules available for an extended period of time.

Letting Practice Improvement Modules Go for a More Efficient MOC Process

ABIM intends for MOC activities to reflect a typical physician’s experiences in daily practice, so that the MOC process that physicians can easily integrate into their practice. With the recent changes eliminating practice improvement modules and expanding other educational activities, it would seem that ABIM hopes to open the way for an MOC process that will not only measure physician’s performance, but become a tool to enhance that performance with relevant information and education.

You can read more about ABIM MOC requirements and the exam blueprint on NEJM Knowledge+: