Regardless of profession, the highest performers share a common trait: all are lifelong learners, continuously searching for opportunities to enhance their abilities. Since its inception, the Maintenance of Certification in Anesthesiology™ program (MOCA®) has endeavored to support our diplomates as they seek opportunities to maintain and improve their skills and clinical knowledge.
As a certifying board, we find ourselves at an interesting juncture between the Vision for the Future Commission report recommending enhancements to continuing certification programs, the American Board of Medical Specialties (ABMS) developing new program standards in 2020 and our Board forging ahead with our innovation strategies, guided by diplomate input and feedback. So, what will come next for continuing certification?
A Brief History of MOCA
In 1999, the American Board of Medical Specialties (ABMS) established the ABMS Program for Maintenance of Certification (ABMS MOC®). In doing so, ABMS spurred Member Boards to implement programs that assure the public that board-certified physicians demonstrate a commitment to quality clinical outcomes and patient safety. Following this decision by ABMS, we launched MOCA in 2004.
The Traditional MOCA program had four parts designed to help board-certified anesthesiologists demonstrate they were maintaining their certification and staying up to date on medical knowledge.
In 2016, following advancements in technology and learning science, and most importantly, feedback from our diplomates, we replaced Traditional MOCA with MOCA 2.0®; the continuing certification program that diplomates participate in today. It took five years of planning and significant diplomate input to evolve to MOCA 2.0, which provides our clinicians with a web-based, personalized approach to knowledge assessment and increased opportunities to continuously learn so they can provide high-quality patient care.
At the core of MOCA 2.0’s redesign is MOCA Minute®, our interactive, longitudinal self-assessment tool that replaced the 10-year MOCA exam. This transition to MOCA Minute represents our dedication and desire to move toward innovative, effective and relevant evaluation techniques that support continuous knowledge acquisition and retention. Development and implementation of MOCA Minute has taken considerable investment, effort and time that has paid off by providing more timely and personalized incremental learning that fits more readily into diplomates’ busy schedules. It also has resulted in greater diplomate satisfaction. While MOCA Minute has been embraced by most anesthesiologists, our work to make MOCA even better for our diplomates’ practice is never finished.
About the Physicians Users’ Group & MOCA 3.0
In the fall of 2018, we asked 17 volunteer physicians to help guide the development of the next generation of MOCA, which we’re referring to as MOCA 3.0. This group is representative of our diplomate corps and is at the center of leading us into the next iteration of MOCA by continuing our ongoing efforts to make the program more relevant, customizable and convenient.
Each of the diplomates in the Users’ Group is actively participating in MOCA 2.0. The diverse members in the group include private practitioners, academicians, subspecialists and residents preparing to take their certifying exams.
Their work started with the redesign of our web-based Physician’s Portal and the development of a new mobile application to provide our diplomates with a more personalized and seamless digital experience. These new platforms will launch in January 2020 as the first phase of MOCA 3.0 and are setting the foundation for a larger initiative to further transform the continuing certification program.
As the Board of Directors’ liaison to the Users’ Group, my role is to listen to the group’s insights and requests, share their feedback with our full Board, and prompt discussions that align the Board’s future course with their needs and our mission.
Innovation Summit and the Vision for the Future Commission’s Final Report
Shortly after the release of the Commission’s final report, we hosted a two-day Innovation Summit to aid in our strategic approach to enhancing MOCA. We brought together thought leaders in technology, education, and medicine to examine how advances at the intersection of these fields are likely to impact board certification. They emphasized the importance of informal in-person and online networks, the value of co-created content, and how artificial intelligence (AI) is revolutionizing education. Additionally, they highlighted that we must strive to engage learners on their own terms as today’s clinicians are learning in drastically different ways than previous generations.
We presented the key themes from the Summit to our Users’ Group, who affirmed what we heard and added their own insights. They said that clinicians are lifelong learners who want to improve their practice—and they need our help identifying learning opportunities and resources. The Users’ Group also said that, while MOCA Minute questions do help to surface knowledge or skill deficits, it’s often an organic part of their workday—like the release of a new drug or a conversation with a colleague—that highlights an opportunity for improvement.
“I really like the MOCA 2.0 program. I think it’s very easy to use – user-friendly. Definitely the fact that you can pull up the questions on your mobile device is easy. I like the fact that you get 30 questions every quarter and you get immediate feedback on your answers. “
– Kimberly Nichols, M.D.
Diplomate Testimonial, ASA Annual Meeting 2016
Following the Innovation Summit, the Commission’s report, and the feedback we’ve heard from our Users’ Group and diplomates at-large, we have a solid understanding of what our board-certified anesthesiologists want from a continuous learning and assessment program. Our next task is to translate these ideas into a seamless digital experience that supports approaches like micro-, adaptive- and on-the-job learning that facilitates continuous education and professional development for our diplomates.
To accomplish this, our next step is to host a Learning Theory Workshop this summer where learning theory experts will help us establish guiding principles to augment our single-best-answer assessments with tools such as adaptive models, like those described at Innovation Summit and by our Users’ Group.
Meanwhile, the group continues to help us grapple with the tough questions — How can we capture meaningful learning that anesthesiologists do each day without creating undue burden? — while also helping us evaluate existing programmatic tools like the Personal Portfolio, CME Explorer and Knowledge Assessment Report for enhancement. In September, the group will meet in Raleigh to test the redesigned portal and new app ahead of its January 2020 launch. From there, we will work with our Users’ Group and the collective diplomate community to continue evolving MOCA 3.0 into an interactive, diplomate-centered program that supports physicians’ learning and helps them demonstrate their commitment to quality outcomes and patient safety.
What improvements would you make to the Knowledge Assessment Report, the Personal Portfolio, or the CME Explorer?
What enhancements would you make to MOCA Minute? How would you modify quality improvement (Part 4) to make project completions more seamless?
If you are doing good in moca minute, drop the test to twice a year instead of 4 times a year. Simulations requirements should be able to be completed online
The simulations shouldn’t be obligatory. All requirements should be able to be completed online!
Simulation is not required for diplomates in MOCA 2.0. Diplomates have many options for earning quality improvement (Part 4) credit. Simulation is one of them, but participation is not mandatory and hasn’t been since 2016.
Simulation is the only option that isn’t excessively time consuming. Additionally, when simulation became optional the amount of credit for other activities changed, such that activities that received say 25 credits were reduced to 20 or 15 credits.
art 4 is useless, excessively burdensome, has no relation to clinical practice and needs to be dropped immediately. It does not matter what Part 4 options exist.
The ABA should poll diplomates which MOC activities they believe are relevant. That poll has never been done. The only polls conducted ask if we like the new options better than the old. We are never asked which activities should be required. This is unacceptable, and it is also exceptionally dishonest.
The MOCA 2.0® redesign was a community effort. We conducted surveys, hosted forums and focus groups, convened a users’ group and set up an email box that we used exclusively to collect feedback and ideas. In June 2015, we conducted an email survey of MOCA participants to ask specifically for Part 4 recommendations. More than 1,200 diplomates responded. Their input was used to develop the current activity list. Diplomate feedback is continuing to help drive the program’s future direction.
Providing a variety of options to fulfill the quality improvement component allows anesthesiologists to engage in activities that fit well with quality measures in place at their existing practice, such as group discussion of case evaluations or developing clinical care plans within their practice. Many diplomates are participating in activities they may not realize they can earn credit for and can call our Communication Center for guidance on how to get credit.
We believe including quality improvement activities as part of continuing certification is important to encouraging quality and safe patient care. We welcome suggestions on other quality improvement activities that diplomates think are worthwhile. We are committed to doing all that we can to continue to add value to the program as it evolves into its next iteration, MOCA 3.0.
Simulation is the ONLY option that is order of magnitude less onerous without multiple hoops to jump through and can be completed in a day – let’s not kid ourselves. The bottom line is that physicians are tired of spending thousands of dollars on MOCA.
First, the ABA does an incredible job of only allowing the Best of the Best to become Board Certified. I have nothing but praise for the process up to becoming Board Certified. 3 of the 4 parts of MOCA 2.0 are fair, well thought out, and doable.
The only areas that are not up to par are the MOCA questions. Like using DOS or Fortran, these questions continue to use the format of out of date medical school curve building methodologies. Alternatively, since the MOCA team strives for excellent, upgrading to a core knowledge reinforcing model where 90% of ABA Physicians answer correctly is the next natural step in MOCA question excellence.
Specifically, when as low as 7% of the Best of the Best, ABA Boarded Anesthesiologists are answering a MOCA question correctly, it’s seems obvious to everyone that the question is flawed, not based on standard and universally accepted principles, has NO CME attached, and is designed to “trick” the test taker, Use of statistics to sugar coat crap questions is like putting a bow on a pig. But I do believe in the ABA efforts to strive for continued excellence so I know the MOCA Minute will morph in the right direction.
Recommendations:
1. Only keep questions that are backed by a reasonable degree of medical certainty, are backed by CME, and are backed by CREDIBLE studies (no opinions or academic rarities designed to trick the test taker; these are great for students and residents but NOT for ABA Boarded Physicians
2. If 90% of ABA Physicians get the question right, it’s probably a balanced question, written well, and based on core knowledge. No more than 10% “experimental” questions. Add Bonus Challenge questions for the “gunners.”
3. Get rid of the MDT that basically looks to be clouding the reality of poorly written questions.
Most of us ABA Boarded Physicians are now around 50 years old and are now typically in Management and Executive positions such as Residency Program Directors, Hospital System Board of Directors, State Oversight Boards, and various other leadership positions consistent with the ABA Best of the Best quality threshold. I thank the MOCA question writers for their hard work and honest efforts. Please consider the above recommendations for ABA Boarded Physicians. Respectfully Submitted.
Thanks for your very thoughtful feedback. MOCA Minute is an assessment tool designed to help physicians identify areas where they could use additional study. It also serves to inform the Board about whether diplomates are keeping their knowledge current. The questions assess “walking around” knowledge; topics practicing anesthesiologists should know, along with some emerging topics that may be new knowledge for most of us in practice, such as opioids and dual anti-platelet therapy. The critiques provide multiple references in most cases so diplomates can use the resource they find most credible or get information from multiple sources. Most diplomates meet the performance standard and demonstrate that they are keeping their knowledge current.
The MOCA Minute question and feedback process is based on psychometrics, adult learning principles and research. Dozens of clinically active anesthesiologists draft the questions, which then go through a rigorous review process.
The questions may not always be perfect, which is why we offer an opportunity for diplomates to offer feedback on every question. And we’re responsive to this feedback. Most diplomates tell us they find MOCA Minute useful. Even so, we’ll continue refining it to assure question quality and verifiable answers grounded in research and learning science theories.
Often MOCA Minute questions do not fit into any practice of mine (e.g., I do not work in an environment in which I have an opportunity to perform regional anesthesia). Yet, this past two quarters, a large number of the questions were related specifically to regional anesthesia. It would be great if we could have more flexibility in personalizing the areas covered by the MOCA Minute questions. I think making sure that MOCA 3.0 has this type of flexibility and allows diplomats to tailor their learning experiences will be important if you wish to maintain strong support for continuing maintenance of learning and certification.
I would live to have an interactive forum where I can participate with other board certified anesthsiolgists to discuss interesting cases and bounce questions and ideas off of one another
Agree 100%. Plus to implement webinars with discussions. EACTA already is doing this. Why ASA and ABA couldn’t do the same. Plus permit drug and technology companies to sponsor these webinars .
The only thing I would change is getting rid of part 4 entirely. It is utterly useless, time consuming, cumbersome, and the simulation courses are outrageoulsy expensive. everything else is great, especially MOCA minute. MOCA minute is easy to use and extremely relevant to my practice.
Agree 100%.
The “academics” made this simulation courses their pet projects.
“Simulations” overrated. Left them to residents! We are Board Certified Anesthesiologists for Gods sake!
Thank you. We need more people to pressure the ABA to get rid of Part 4. We need the ASA to stop making online simulation courses, and actually represent us, practicing anesthesiologists, and tell the ABA to get rid of Part 4.
I think you are 100% correct. I feel exactly the same way.
Agree. Part four is time consuming and lacks value for practicing anesthesiologists. Help prevent burnout by eliminating this unnecessary portion.
As I have voiced before, the MOCA minute app needs some polishing – for example if one selects an answer, but does not click submit prior to the time running out, the question is marked as incorrect whether or not the correct answer had been selected – this is unfair. Whatever answer had been selected should be submitted automatically. Some questions are more complex and could benefit from a small amount of additional time to answer. Finally, while I appreciate efforts to improve MOCA, I also fear that this will drive up costs. My largest source of current dissatisfaction is the exorbitant cost for MOCA on top sim fees, etc, it is out of hand in my opinion.
I am so happy that my generation fought this and was successful for those certified before 2000. I am sorry to say that we stopped fighting when we were grandfathered and we left the next generations saddled with this. I still cannot see how any of this is actually helpful to patients and certainly not diplomats. Taking tests successfully does not necessarily make good anesthesiologists.
Remember JCAHO was (is) a product of the AMA and we all know how well it protects patients. I liken it to test taking.
Do you recall voting on the board of directors? Shouldn’t the ABA be run by the diplomats? Would you now vote to keep MOCA if given a choice?
Again, sorry we only thought of ourselves.
I do find MOCA minute questions overall helpful, but agree with above that customizing questions to our practice breakdown (100% peds here) would be helpful.
I find that the exorbitant cost of Part IV simulations is not worthwhile especially if you live in a city without a simulator option. I would prefer the removal of part IV.
We heard from diplomates that Part IV was onerous and expensive, particularly because of the simulation requirement. That’s one reason we made simulation optional in 2016 and added several other options for diplomates to demonstrate their commitment to practice improvement. Since January 2019, diplomates are only asked to attest to having completed Part IV activities by providing the title of the activity and the number of hours you spent doing it. No further documentation is required.
It seems that every new iteration of board certification has another new requirement with both an additional cost and additional time requirements.
I don’t feel the cost of simulation courses or the time expense in travel is worth it and request removal of Part 4. After 20 years of active practice I don’t feel the need to “practice” on my off day, to great expense and inconvenience.
I think the MOCA minute questions are helpful. For the sake of overall learning it is good that the questions cover most of what I do in my regular practice while also keeping me up to date with things I do not do regularly.
I agree that Part 4 needs some improvement. An effort should be made to make project requirement and submission easier.
I applaud the work that has been done so far.
I agree with the other’s comments about part IV being either overly time consuming and/or overly costly for those of us not in large institutions or academic practices.
We unfortunately were not “grandfathered” into lifelong board certification and I personally find the MOCA program nothing more that jumping through hoops and paying something similar to “protection money” to be able to keep practicing as most facilities in my area now require board certification.
I have attended a simulation course and found that the gimmicky part of the simulation was not very useful. There was some useful info, but it could have been sent in an email and have been just as effective.
My suggestion for MOCA 3.0….Tie in low cost/free CME with the process. There are 2 areas in MOCA where this would make sense.
1. We should envision a process using technology in such a way that every time I read a review article or read a textbook I get rewarded with CME credit. For example, say I am at work and a patient with a pheochromocytoma comes in. Obviously I am going to pick up textbooks and review articles and refresh my memory on the condition.MOCA should strive to find ways to credit me with CME For doing this. Wolters Kluwer has an excellent database called UpToDate that has phone based and computer apps that do exactly this. Maybe a partnership can be made with them to provide access to all ABA diplomates with their service for free or a small fee?
2. It does not make sense to me to have to pay $200 a year do the MOCA minute, read the critiques, and not get any CME for it. We should get some kind of CME for the time invested on this.