Maryland Psychiatrist Spring 2013

Since 1994, all diplomates of the American Board of Psychiatry and Neurology have received time-limited 10-year certificates.  The rationale proposed for this change was to ensure that physicians were maintaining a lifelong education in their specialty, and demonstrating that they were practicing with competency.  Individuals who were board-certified prior to October, 1994, need not participate in Maintenance of Certification (MOC), but may elect to do so.

In brief, MOC consists of four parts:

1. Professional Standing
2. Self-assessment and CME
3. Cognitive Expertise
4. Performance in Practice

Professional standing is basically holding an active and unrestricted license to practice in any state, commonwealth, territory or possession of the US, or any province of Canada.  Of course, in Maryland this means reapplying and paying the fee every 2 years.

Self-assessment and CME is a slightly more onerous process.  There is a schedule for a phase-in of CME and self-assessment requirements.  For example, individuals recertifying in 2013 will need 210 CME credits in the last 10 years, and no self-assessment CME, while individuals recertifying in 2017 or later will need 300 CME hours in 10 years, 80 of which must come from self-assessment CME.  The ABPN defines self-assessment CME as “participation in at least two major, broad based self-assessment activities…that must cover new knowledge and/or current best practices in one or more competency areas, and provide feedback…that can be used as the basis for focused CME, lifelong learning, and/or career development.”  Beginning in 2014, only ABPN-approved products will count toward self-assessment activities.  In general, the requirement will be 8 hours of self-assessment CME per year, as part of the 30 hours of CME total requirement.

Cognitive expertise is just passing the recertification exam.  For those who have not taken the exam lately, it is done at a testing center.  You sign up, once you have met your requirements, and schedule a date.  You go to the testing center (I went to Columbia) and sign in.  You may not bring anything in with you, not even tissues.  They let me bring in reading glasses (which I brought in case the font was too small, but it wasn’t).  You take the 200 question, multiple choice exam. There is no neurology section.  I found this out after spending 2 weeks reviewing neurology.

Performance in Practice (PIP) has two parts, and the requirement is completion of each part once every 3 years (or right now, 3 times in 10 years).  The 2 parts are Clinical Modules and Feedback Modules.  For Clinical Modules, you review 5 charts as to some elements of your practice.  Once you have completed the assessment, you grade yourself, then make up a plan of correction for your deficiencies.  You implement the plan, then re-check your charts within 24 months to verify your improvement.  If you are part of a large system or hospital that does outcomes-based evaluations of your clinical work and provides you feedback and corrective plans and audits you, you can use this to satisfy the Clinical Module requirement.  If not, you can devise your own (which will be harder) or use one of the APA’s free PIP Clinical Modules – they have modules for depression, substance use, suicide, etc.   The Feedback Modules have two parts.  You must do BOTH the Clinical and Feedback Modules for each PIP.  Feedback Modules require a survey of five patients AND five peers as to some element of your practice over the last three years.  You must then use the data gathered to devise a plan of improvement for some area of your practice, work on improving according to your plan, and then resurvey patients and peers, five each within 24 months to see how you did on your improvement.  You may resurvey the same patients and peers.

There is language in the Maintenance of Certification Program put out by ABPN that indicates that the future of the program will be to have all of these activities collected on a shorter cycle – like needing 150 CME credits in each 5 year period, with an average of 8 self-assessment CME credits per year in the cycle.  Further, the goal is to have 1 self-assessment per 5 years and 1 PIP (all parts) per 3 year cycle.  The Board states that it will be approving more self-assessments and PIPs and posting them for all of us to select on their website.

For the MOC Program publication from ABPN, go to www.abpn.com and follow the link on the left side of the screen labeled “Maintenance of Certification.”  It would also be an excellent idea to register yourself on the site and begin entering your CME and self-assessment activity – this will allow you and the Board to track your progress and determine what you need to do to fill requirements to sit for the exam.  I will tell you it’s a little clunky, but once you explore it a bit, you will get the hang of it, like many websites that are new to you.

Andrew Angelino, M.D.

Opinions expressed in the article are the author’s own, and do not necessarily reflect the opinions of the Editorial Advisory Board or the Maryland Psychiatric Society.