How are physicians expected to keep current with medical knowledge when it is estimated that as many as 10,000 new studies are published each month?
Some American Board of Medical Specialties’ Member Boards are helping board certified physicians by hand selecting journal articles for their relevance and timeliness, such as safe opioid prescribing or addressing the Zika virus. The certifying Boards are then using these articles as part of their educational and assessment process to help physicians acquire the latest evidence to use in their clinical practice.
The American Board of Obstetrics and Gynecology (ABOG) has been using article-based self-assessment for many years. The journal articles focus on new and important advancements in obstetrics, gynecology, and women’s health care. Board certified obstetricians/gynecologists receive a list of at least 50 papers from the current medical literature three times each year. From those, they must choose 30 articles and correctly answer four questions per article about the content via an online assessment tool.
In response to the emergence of the Zika virus in 2016, ABOG quickly incorporated information and resources about the virus, including the Centers for Disease Control and Prevention’s recently revised guidelines, into the self-assessment activity. In fact, the six articles on Zika virus that were released throughout that year were accessed more than 94,000 times by 28,000-plus board certified obstetricians-gynecologists.This year, ABOG added a new article category – Emerging Topics – for clinically relevant patient-management articles on current high-interest topics intended for quick dissemination. Among the topics covered are opioid misuse, intimate partner violence, and postpartum depression.
Also in 2016, ABOG launched a Maintenance of Certification (MOC) pilot program that integrates self-assessment andthe Board’s assessment of knowledge, judgment, and skills. The latter is determined by taking ABOG’s computer-based MOC examination every six years. As part of the pilot, obstetricians-gynecologists will read 180 new articles and answer 720 questions during a six-year MOC cycle. If the obstetricians-gynecologists reach a threshold of performance during the first five years, they will be exempt from taking the MOC exam. More than 2,000 board certified obstetricians-gynecologists are participating in the pilot. In a survey of pilot participants conducted in 2017, most respondents found the articles to be beneficial to their clinical practice. If ABOG permanently adopts the pilot, which the Board will decide later this year, the majority of respondents believed it would make MOC more valuable and relevant.
For the American Board of Pediatrics (ABP), Question of the Week (QOW) is its most popular self-assessment tool that incorporates journal articles and papers focused on recent medical advances. QOWgives participants a pediatric case study, an abstract with commentary, hyperlinked references, and a question every week for 50 weeks of the year. The medical pearl at the end of each question offers bonus material, often in the form of a humorous anecdote or little-known fact. Board certified pediatricians can earn both MOC and continuing medical education (CME) credit for completing QOW. Questions remain in an archive and can be answered for credit for up to three years from the release date, so participants can skip some weeks or answer more than one question other weeks. QOW is accessible at any time, in any location, and from any device that has internet access. After answering a QOW, participants can post comments to discuss cases with their peers. As of November 2017, nearly 20,000 board certified pediatricians were participating in QOW.
In addition to QOW, all of ABP’s self-assessments activities use articles that focus on recent information relevant to their topic. In addition to subspecialty-specific self-assessments, ABP produces a number of self-assessments on stand-alone topics such as attention deficit hyperactivity disorder, health literacy, and care of the transgender child. Currently, ABP has more than 50 self-assessments that earn both MOC and CME credit.
ABP plans to incorporate the use of articles/practice guidelines into its Maintenance of Certification Assessment for Pediatrics, known as MOCA-Peds as well. MOCA-Peds is the Board’s online, non-proctored assessment platform that is currently wrapping up its pilot phase before going live in 2019. More than 5,000 board certified pediatricians – approximately 75 percent of those eligible – enrolled in the 2017 MOCA-Peds pilot. More than 95 percent of the original participants successfully completed the pilot’s first year.
“Must-read” articles from the peer-reviewed literature play a pivotal role in the American Board of Ophthalmology’s (ABOp) Quarterly Questions assessment program. Launched in 2017, the program measures fundamental knowledge needed in daily practice and new practice-related advances gleaned from recent journal articles. Each year, participating board certified ophthalmologists answer 40 knowledge-based questions and 10 article-based questions. The journal portion requires reading five articles from a list of 30 options.Article topics range from patient safety to the effects of smoking to risk factors for macular edema following cataract surgery. Ophthalmologists participating in ABOp’s MOC program can access all Quarterly Questions articles at no cost through ABOp’s website and may claim CME credit as well.
Preliminary analysis of the Quarterly Questions program has been extremely favorable. Nearly 20 percent of ophthalmologists engaged in MOC participated in the program’s optional pilot year, with 94 percent reporting that the article-based questions were useful for learning new, relevant information. Eighty-five percent of participants said the information they learned while completing the activity would help them provide better care to their patients in the future and 99 percent said they would recommend the program to a colleague. In 2019, Quarterly Questions will replace ABOp’s proctored exam.
Since 2004, the American Board of Emergency Medicine (ABEM) has been creating “reading lists” from the emergency medicine literature to promote continuous learning. Each list consists of 10 to 15 readings, which emphasize the most current and relevant research in emergency medicine, medical toxicology, emergency medical services, and pediatric emergency medicine. Board certified emergency physicians must complete four self-assessment tests in each five-year period of their 10-year certification. The open-book tests, which consist of 20 to 30 questions, are accessed online. Physicians do not have to complete the test in one sitting, and may even take it in groups, akin to a journal club. A new test is posted on ABEM’s website each year and is available for three years. Ninety-eight percent of survey respondents found the readings relevant to the clinical practice of emergency medicine.
In January, the American Board of Allergy and Immunology began its Continuous Assessment Program (CAP) pilot. Every six months, board certified allergists/immunologists receive 40 questions, 30 of which are based on peer-reviewed articles and 10 are core/general knowledge questions, for a total of 80 questions annually. They can determine when and where they would like to answer the questions, which don’t have to be answered in one sitting as long as they are answered within the allotted six months. Additionally, allergists/immunologists can receive CME credit for participating in the CAP pilot, which is expected to replace the Board’s MOC secure exam.
In 2019, the American Board of Psychiatry and Neurology (ABPN) will implement a pilot program that is a professional journal article-based assessment designed as an optional alternative to its current 10-year MOC exam. Board certified psychiatrists/neurologists who are eligible and volunteer for the pilot will be required to read a minimum of 30 ABPN-approved articles, but no more than 40 articles, and answer four out of five questions correctly on the first attempt for 30 of the articles. The questions will be administered as online, open-book “mini-tests” accessed via the internet from a personal computer. The pilot project will run for three years, and, if successful, ABPN plans to transition psychiatrists/ neurologists into this program as a permanent alternative to the secure MOC exam. The Board began soliciting participants to participate in the pilot this past December.
It’s clear that article-based assessment has proven to be a key element in the continuing certification process as it not only promotes learning new information, but integrates that knowledge into practice. This approach makes the assessment experience more relevant to clinical practice without losing sight of objectively assessing physicians’ knowledge, judgment, and skills in a particular specialty.
© 2018, American Board of Medical Specialties. All rights reserved.
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