Research

Inspiring Innovation

As a forward-thinking Board, we are continuously exploring the directions in which technology, education, and medicine are heading to consider how changes in these domains will impact board certification.

Last month, we hosted a two-day Innovation Summit to envision the roles that artificial intelligence (AI), adaptive learning, and other emerging technologies should play in continuing certification to help physicians demonstrate their proficiencies and provide better patient care.

Dr. Chu
“Anesthesiology Learning Design: Evolving and Adapting to Meet the Needs of Today’s Learners,” Lawrence Chu, M.D., Stanford University | 2019 Innovation Summit

Our Board brought together thought leaders who talked about how AI is changing education, supporting patient engagement and contributing to the evolution of medical practice. We discussed how informal social networks are promoting knowledge sharing. Summit attendees were counseled that successfully evolving continuing certification will require agility, offerings across multiple modalities, and embedding assessment and learning opportunities into the workplace.

We know that physicians are lifelong learners. Our patients and profession depend on it. Our MOCA 3.0 Users’ Group, the volunteer diplomates who are guiding our work to evolve MOCA, has told us continuing certification must meet diplomates where they are, making it seamless for them to engage in the program.

So, what does what we heard at the Summit and from our diplomates mean for the future of our continuing certification program?

We left the Summit excited to explore this question. We quickly shared the meeting’s key themes with the full Users’ Group. They affirmed the recommendations of our Summit discussants, who told us that continuing certification content must be immediately applicable, come in small “snackable” packaging and help promote knowledge building that distinguishes our diplomates as board-certified physicians.

Can We Train Physicians Completely Online? Not Yet, But Maybe Sooner Than You Think,” Rishi Desai, M.D., M.P.H., Chief Medical Officer, Osmosis | 2019 Innovation Summit

At our April Board of Directors meeting, we reflected on all that we heard and considered what we can do to advance excellence in the practice of anesthesiology. We explored how we could evolve our longitudinal assessment to allow diplomates to choose their own adventure using adaptive- and micro-learning. We thought about how that might look. For instance, what if we could simulate a trip to the cath lab that would walk a diplomate through an evolving scenario to prepare him or her for the anesthetic management of a future complex cardiac case?

Such innovations could address diplomates’ desire to direct their learning and maximize their assessment opportunities. MOCA Minute might evolve beyond multiple-choice, single-best-answer questions to include video demonstrations, diplomate-directed cases, and short-answer responses.

“Using Registry Data for MOCA®,” Nirav Shah, M.D., University of Michigan | 2019 Innovation Summit

These are some of many ideas that we shall explore this year as we continue to conceptualize the components of MOCA 3.0. We are also evaluating how we can work with other organizations to facilitate diplomates’ review of their own cases in registries to guide learning and improve future outcomes. 

Furthermore, we’re investigating how we can use technology to collect physician learning without requiring diplomates to input data through the portal.

Considering our finite resources and the ever-evolving nature of technology, we want to ensure we are good stewards of our diplomates’ dollars. We’re working with learning experts to understand the most effective approaches to adult learning and knowledge retention. And we’re asking the collective diplomate corps to share with us the tools they are currently using to learn. To the extent that we can, we will sync these two to continue adding greater value for our diplomates.

Let us know what technology you use to augment your learning and what innovative solutions you think we should consider as we evolve our continuing certification program.

About the Author

Dr. Keegan is a professor of anesthesiology and full-time clinician, who works as a consultant anesthesiologist and intensivist in the operating rooms and intensive care units at the Mayo Clinic in Rochester, Minn. He is a director of the ABA and serves on the Research, Assessments, In-Training Examination, Standardized Oral Examination and Critical Care Medicine Examination Committees. 

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18 comments

  1. MOCA sounds fascinating for an academic person like me, I participated in it and intend to keep participating till my retirement. However my understanding that this effort and expenses need to be translated to outcome, we still don’t have (to my knowledge) any proof that participants have better patient outcome. Another question I asked during discussion of MOCA program, if we have an exam with 99% pass rate, do we really need to have it?

    1. Hi Dr. Sabry. Congratulations on being the first to pose a question on the blog. As Chair of the Assessment Committee, I have been asked to respond to your question concerning the pass rate. You have correctly identified that the MOCA assessment component has a high success rate. You are correct in identifying that an assessment is designed to determine a level of knowledge. An assessment is also designed to identify areas of weakness. Both components of an assessment are important. It is hoped that individuals will take those areas in which they answered incorrectly, research the answer, and apply the information. I remember one question that I answered incorrectly concerning prophylactic anti-emetics. I reviewed the attached article and have changed my practice. It is both goals, determining a level of knowledge and identifying areas of weakness, that defines the purpose of the MOCA Minute questions. Thanks, Bob

    2. Until MOCA involves no cost in dollars to the anesthesiologist, it will be a smokescreen for one set of well-positioned doctors stealing from another wholly and totally for financial gain. This expensive and highly questionable initiative (from its beginning) had no legitimate basis: conscientious physicians have always “kept up”–with myriads of options to do so. Effectively legislating responsibility does not work. The ABA can end MOCA now and regain its lost credibility. Make all certificates permanent.

      1. “We know that physicians are lifelong learners.”
        OK, then, how do you justify MANDATING this process? Since we are all lifelong learners, we can engage in our own learning activities in a way that suits us. Additionally, if your ABA learning activities are so well designed and valuable, we would, of course, purchased them of our own volition. This is so clearly and blatantly a money grab on the part of the ABA. The truth is that board certification was never meant or designed to be time-limited. State medical licensure already has ongoing learning requirements. So, why should the Board duplicate this? The answer is obvious: to make money, plain and simple. If the Board created certification, then allowed physicians to continue lifelong learning in compliance with their state medical board requirements and their own learning preferences, there’s no money in that!
        If the Board has a desire to develop cutting-edge learning process for physicians, then it should do that, charge a suitable fee, and compete with the other CME producers. Instead, they blatantly wield the MOC process like a cudgel, extorting money from their physician members, much like a neighborhood gang extracting protection money from business owners.

        1. Everyone needs to join NBPAS immediately and abandon MOCA.

      2. I disagree. I have perm anesthesia certification and one of the earliest pain certifications. In my experience, many practitioners become lazy over time and neglect thier reading and review of older material. MOCA forces individuals (whether they like it or not) to review material in an ongoing basis, rather than cramming for an exam every ten years.

        Having taken the pain exam three times, I can say that the MOCA questions are far more relevant than the traditional board questions, which one is left to wonder if you actually took a pain exam.

        You are obligated to keep up with the current and established information in your area. MOCA is a good step in involving physicians in this process in an ongoing basis. The few sheckles it costs us is quite small in the scheme of things.

    3. Yes, thanks Dr. Sabry for your great question about proof that participating in maintenance of certification leads to better patient outcomes. The ABA has published research showing that physicians who met the MOCA program requirements were less likely to be disciplined by their state medical licensing agency. Other studies related to the impact of Maintenance of Certification on medical practice do exist. However, it is challenging to prove that an individual physician’s participation in MOCA directly improves patient care for several reasons, including for example that we deliver care with other providers such that it is difficult to attribute an outcome solely to the anesthesiologist. Other challenges include how to best control for how sick patients are when comparing different practitioners’ outcomes, and medical databases often do not include anesthesia outcomes with standardized definitions that are commonly agreed on. The ABA is continuing its efforts to address these important issues with research, including working with investigators outside the ABA.

      Finally, in my own practice I know that if I get a question wrong on MOCA Minute, I am prompted to read up about the topic and that helps me keep up to date, which then helps me make better patient care decisions for those coming to the OR for surgery.

      Thank you, Alex

    4. Continuing education needs to be a checkmark. Hospital privileges are tied to certification. Remember we work with lots of docs grandfathered and do fine without MOCA. Just a BS hoop to jump. Keep it simple. Real life is happening now.

  2. Based on Dr. Macario’s reply, it would seem that the ABA would be better stewards of the ABA’s limited resources if they focused on determining how to measure, with a fair degree of certainty, that a given educational intervention works, rather than focusing on building better interventions without any way to judge their effectiveness. Personal experience indicates that MOCA is indeed intended more to move money from the hands of practicing physicians into medical certifying bodies, and less to improve real patient outcomes. A mantra of process improvement is that “if it can’t be measured, it can’t be improved”. Today, the ABA doesn’t even know what to measure, much less how to measure it effectively, and there would thus appear to be little reason to expect any significant improvement of patient outcomes due to MOCA.

  3. Extortion plain and simple. Stop fattening your wallets at the expense of anesthesiologists who actually WORK.

  4. The ABIM has pushed this MOC on all specialties through the ABMS over the past decades stating the public demands this. That is all bogus. Throughout ALL of medicine we are seeing PAs, NPs and of course CRNAs COMPETING with physicians as “providers”. They can and do earn the same wages, without 10% of the educational efforts. The MOC is merely a subscription program to finance the “boards” and without evidence that anything is accomplished. The AMA started with CME and the AMA-PRA “award” in the 60’s to allow physicians to purchase “credentials” (https://www.ama-assn.org/education/cme/ama-pra-credit-system). Top Doctors followed. (https://www.castleconnolly.com)The AMA has long stopped representing physicians and excelled in selling insurance and other products. Now the ABA has stepped in to make that cash flow, extorting from all colleagues who wish to practice, forcing purchase of a product which was introduced as “voluntary” and then mandated. Yes they took example of the frog in the cooking pot, slowly raising the temperature an cooking this profession, while the less educated, lest costly are taking over, the production of non-physician practitioners already exceeds that of physicians entering residency…and the non -physicians are, well…CHEAPER! Let us see just how expensive the ABA can make physician practice before we become completely unaffordable!
    whiole the ABMS boards currently rake in $600 million in gross revenues, the CME industry is already a 2.2 BILLION industry. They all want a piece of that pie off of the backs of working physicians who are “burning out”! No proof of value, but the money flows!

    1. I understand that some minds won’t be changed, but think it’s important to correct misconceptions and misinformation. The MOCA program fee has not changed since 2012 – it is $210 per year. We do not offer CME and do not benefit financially from diplomate participation in CME. The goal of the MOCA program is to promote lifelong learning, improve medical practice and enhance patient outcomes. Our community of anesthesiologists has worked closely to design a continuing certification program that adds value to our practice and meets our mission. We invite you to participate in the program so you can experience it firsthand.

      1. Dr Cully: I have been there and done that and been in academics over 30 years. I have NEVER learned anything from the ABA testing program. IF it were that good the ABA would not need to RENT certification (extorting doctors to “pay and play”) and would have KEPT re certification voluntary as it was when it was first “introduced” during that past decade. This is clearly and simply REGULATORY CAPTURE! The CME industry is supporting all the academic programs behind MOCA and we all know those certified doctors who are NOT excellent.
        Trying to sell MOCA for $210 a year when it was FREE under the lifelong program is simply a sleight of hand attempt to put lipstick on the pig!
        There is clearly a business model to MOC and MOCA which supports the $600 MILLION a year in gross receipt so the ABMS certification industry. see https://pdfs.semanticscholar.org/397a/340b4bb8f7a000dee4e2265ccddd9bc93b30.pdf and especially Anesth Analg. 2014 Jun;118(6):1378-86. doi: 10.1213/ANE.0000000000000061.
        Maintenance of certification and licensure: regulatory capture of medicine.
        These facts speak for themselves!
        Physicians/anesthesiologists are becoming too expensive vs the non-physician providers! These costs are more than merely the fees paid the ABA with lost time from work, family etc and were found to be “STUNNING”: “The results are stunning. On average, direct cost of the MOC program is expected to be $2,349 per doctor over ten years. General internists and hospitalists can expect the lowest direct costs ($1,774 over ten years) while hepatologists can expect the highest direct costs ($3,802 over ten years).

        But these costs pale in comparison to the time costs of doing the MOC activities. The researchers estimate that it will cost each doctor over $21,000 over ten years to do MOC activities. Cardiac electrophysiologists will be hit the hardest and should expect their time costs to be over $48,000 over ten years.” SEE https://www.kevinmd.com/blog/2015/08/the-real-cost-of-moc-is-stunning.html

    2. On point my friend. Just like government oversight. Excessive. We are our own best critics. We learn for ourselves. Just never ending hoops to keep us from our family and hobbies even more.

  5. I see you only post replies that fit YOUR message! Too bad, but then everyone reading here knows this is a site to advertise your product and nothing more!

  6. Gosh, I don’t think MOCA Minute is nearly as bad as these end-of-the-world colleagues suggest. I find it helpful to keep current on topics that I probably otherwise would not be so motivated to go study realistically on my own.

  7. MOCA minute is tolerable and not onerous. The Part IV stuff is a money grab and part of the grand extortion scheme. ABA could stop part IV now if it wanted to. You already have another thousand of my dollars for the silly computer sim stuff. Keep it and discontinue part IV. Shame on you.

  8. As a well-qualified anesthesiologist who uses real life and high-quality CME to maintain my professional distinction, it’s insane to deny the 20% of non-boarded anesthesiologists from input and access to possibly useful learning and simulations that are unavailable otherwise.
    The arbitrarily-given, counter-productive, and unproven “certification” that wastes the rigorous, taxpayer
    -funded residencies of thousands of others, should at least stop educational restrictions that on their face, make a mockery of the purported goal of an inclusive excellence in anesthesia.

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