Maintenance of Certification: The Distant Yet Not So Distant Horizon

Moving from classroom learning to lifelong learning…transitioning from board review and Self Assessment Exams-Resident (SAE-R) to continuous practice improvement and Self Assessment Exams-Practitioner (SAE-P). These are the catch phrases of continuing medical education (CME) and maintenance of certification (MOC).

I will be the first to admit as an intern at a small community hospital in the country who still gets a bit starry eyed at treating aspiration pneumonia with intravenous Unasyn that maintenance of certification was not on my radar screen. However, MOC is something I will be keeping a closer eye on even as I remain in the nurturing realm of graduate medical education (GME), because I realize that, like all other residents, I will eventually be making the transition from episodic learning to continuing medical education.

GME is the heart of what residency is. For most of us this is our daily life – learning and doing in a clinical environment with attending physicians observing, supervising, and evaluating us. Lecture sessions and self-assessment exams are also a core part of this. Sitting for specialty boards is the realization and the end of GME and a marker of transitioning to CME and lifelong learning.

There was a time in the not-so-distant past when board certification was where it all ended. Physicians never had to document their continuous improvement in quality and persistently prove what a practicing physician should know over the course of a decades-long clinical career. Over the years this has changed, and we now have a system where clinicians are being mandated to document continuous lifelong learning, competence, performance, and patient outcome measures.

Younger practicing physicians in our field must be able to demonstrate knowledge of a central core curriculum, even in a field as diverse as ours. They must also be able to demonstrate through practice data that their clinical practice conforms to national standards. Self assessment and demonstrating lifelong learning through Self Assessment Exams for Practitioners (SAE-P), for example, are part of the mix for documenting self-improvement. And continuous quality improvement (CQI) projects can be a key to demonstrating patient safety and patient-centric improvements in clinical care. Learning about new innovations and keeping abreast of the fundamentals of our field through CME credits that come in a variety of formats are all part and parcel of maintaining certification.

As a resident, a key message to remember about MOC is that while somewhat remote, it is an area of our professional lives that is not so distant. It is likely to play a great role in our continued growth as professionals. We should become curious about it. It is not necessarily something to dread but something that can be seen as a powerful force for our own professional development. It is also something that is best tackled in an organized fashion – and a key area which shows the importance of robust documentation. I think with the right attitude MOC will be less onerous and could even foster personal growth as well as improve quality in the practice environment.

Source: AAPM&R Medical Education Meeting, March 2007.
 

Bruce Hsu, MD
RPC Medical Education Committee
PGY-2 Thomas Jefferson University Hospital
Rehabilitation Medicine, Philadelphia
 

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