Recently, the American Board of Internal Medicine (ABIM) announced a significant change in their requirements for maintenance of certification (MOC). This came in response to long-standing dissatisfaction expressed by MOC candidates.

Feedback from physicians indicate they felt that requirements were confusing, irrelevant, and borderline punitive. They asked for more relevant exam content that would portray a more reliable standard of physician knowledge, as well as options that would work within their practice, rather than take time away from it.

In response to what they heard through surveys, focus groups, and other discussions, ABIM began looking at the options available for MOC, with an eye to revising the requirements and presenting a recertification program that would assure that doctors would stay current with relevant medical information and integrate it into their daily practice of medicine. To come up with a solution that would work for practicing physicians, the ABIM council spent over a year and a half consulting 200,000 ABIM board-certified physicians as well as 27 medical societies. According to ABIM, capturing input from the internal medicine community is an essential part of developing an updated MOC process that would truly meet the needs of doctors (and, by extension, patients).

Short Assessments Unveiled as a Possible Solution

Last month, ABIM announced that they were taking steps to address these issues in their Spring 2017 update: they introduced the ABIM Knowledge Check-In. This new assessment option will allow physicians to take an assessment in their home, office, or testing center every 2 years, rather than one 10-hour exam every 10 years. And rather than waiting for exam results to come in the mail, most MOC candidates will receive their results upon completing the assessment. The requirements would let physicians forego the the long-form exam as long as they passed the assessments.

The ABIM Knowledge Check-In will be available as a pilot program beginning in 2018 for internal medicine and nephrology diplomates. Expansion into all subspecialties will be ongoing through 2020; the tentative rollout schedule can be found on the ABIM website. At this time, physicians whose certification expires in 2017 must continue with the current requirement (the long-form exam) in order to maintain their certification status.

ABIM has a tentative rollout timeline for the Knowledge Check-In as follows:

2018 (Pilot)20192020
Internal Medicine
Nephrology		Cardiovascular Disease
Geriatric Medicine
Endocrinology, Diabetes, and Metabolism
Gastroenterology
Hematology
Pulmonary Disease
Rheumatology		Advanced Heart Failure & Transplant Cardiology
Clinical Cardiac Electrophysiology
Critical Care Medicine
Hospice & Palliative Medicine
Interventional Cardiology
Medical Oncology
Sleep Medicine
Transplant Hepatology

*Adult Congenital Heart Disease will be available the first year the MOC assessment is offered in 2023.

How the ABIM Knowledge Check-In Works

The ABIM Knowledge Check-In will follow a 2-year cycle, and MOC candidates can choose from a selection of dates to schedule a time that is convenient for them. It is a shorter assessment that will take approximately 3 hours to complete as opposed to the full day of testing required for the long-form exam, and it will be offered 4 to 6 times a year. ABIM’s goal is that with more frequent exams, physicians can be confident that they are staying up to date with the most current, relevant medical information for their practice. The Knowledge Check-In will have more of a continuous learning component, providing information for improvement and remediation following the assessment. To maintain certification, physicians can choose to take the Knowledge Check-In every 2 years, or continue taking the long-form exam every 10 years.

The Knowledge Check-In is also a lower-stakes assessment experience. Physicians do not need to pass every Knowledge Check-In to maintain certification. However, if they fail the assessment twice in a row or do not take the assessment every 2 years, they will need to take and pass the 10-year exam to maintain their certification.

The cost of the MOC process for diplomates has been another major concern for candidates, and ABIM has responded with revisions to the MOC model. Although the costs for the 10-year assessment will likely stay consistent with current levels, ABIM will be introducing additional payment options to lessen the burden on candidates. ABIM has not finalized the fee for participating in the Knowledge Check-In program, but it announced that it will release details in fall 2017 so that candidates have time to plan for the rollout of the assessment pilot program.

For the initial rollout in 2018, there will be no consequences for physicians who do not pass the assessment. This means that if physicians pass the 2018 ABIM Knowledge Check-In, it will be considered a pass, but if they fail, this round will not count and they will have a clean slate to retake the assessment in 2020. The pilot program will enable physicians to try this new option free of penalty, so that they have an opportunity to adapt to the revised process. ABIM hopes that presenting the initial assessments free of consequence will prompt more physicians to take them as practice, which will provide information that ABIM can use to evaluate the process and make adjustments for future assessments if necessary.

Other Changes to the ABIM MOC Process

In addition to rolling out the shorter assessments every 2 years, ABIM is considering several other changes to MOC to make it a more flexible, relevant process for physicians. For example, ABIM is revising the 10-year exam to ensure that it will be more applicable to physicians’ daily practice of medicine. Some other changes include:

  • Introducing an open-book element to the ABIM exam that occurs every 10 years
  • Introducing an open-book element to the 2-year Knowledge Check-In assessments
  • Making assessments more focused, with deeper, practice-related topics rather than wide, general knowledge in each discipline

Has ABIM addressed physicians’ concerns with a process that maintains high standards while providing a learning and assessment process that is less burdensome, yet more effective?