Maintenance of Certification

Four Key Requirements of the MOC

Many SIR members who obtained Certificates of Added Qualification (CAQ's) in Vascular and Interventional Radiology in the mid-1990's have been contacted recently by the American Board of Radiology (ABR) regarding upcoming "Maintenance of Certification" (MOC) examinations. The MOC process represents more than just a periodic examination, and is a new approach to the ABR's responsibility of assuring that the practitioners they certify in radiology and its subspecialties practice knowledgeably, safely, and skillfully.

There has been an increasing move away from lifetime certification on the part of medical specialty boards, and toward "time-limited" certificates. This reflects the sentiment that a single examination passed just at the termination of formal training does little to guarantee that a physician keeps up with current knowledge and practice in their chosen specialty. Recognizing this, the American Board of Medical Specialties has developed the MOC concept.

The basic elements of Maintenance of Certification include four key requirements:
(1) Documentation of professional standing
(2) Documentation of a commitment to lifelong learning and periodic self-assessment relevant to one's specialty
(3) Evidence of cognitive expertise determined by periodic examination covering fundamental knowledge, current and valid practice related knowledge, and knowledge of important issues in the practice environment
(4) Assessment of practice performance

The "examination" portion of the MOC process, then, is only one part of the overall strategy, and a part that, if the other portions of the MOC are fulfilled, should be quite straightforward. As currently envisioned, the concept of subspecialty certification (formerly referred to by the ABR as CAQ) will be maintained in the ABR MOC process.

A great deal of work to be done in carrying the MOC process forward. In this regard, the various radiological specialty groups such as SIR will play a large role, working with the ABR to develop practice performance measures, self-assessment tools, and relevant, current educational programs and materials.

Visit the ABR Web site to learn more about the MOC.

 

Practice Quality Improvement (Part IV)

Practice Quality Improvement, MOC and You

James R. Duncan, M.D., Ph.D., and Donald L. Miller, M.D.

Practice quality improvement (PQI) is a component of the MOC process, and it is required to maintain your CAQ. Even so, that is not the reason why you should do it. You should do it because it’s in your best interest, and most certainly in your patients’ best interest, to continually improve your practice. To believe otherwise is to do a disservice to your patients and to hand the initiative to your competition.

What component of your practice should you look at? The American Board of Radiology made an insightful choice when it decided that optimizing radiation dose would be an ideal way to introduce diplomates to process improvement. Radiation dose is optimized when imaging is performed with the least amount of radiation required to provide adequate image quality and imaging guidance. The detrimental effects of ionizing radiation are known. Dose data are easily tracked. Optimizing radiation use benefits both your patients and you, since your occupational dose is due primarily to scatter dose. Anything that reduces patient dose will reduce scatter dose and, therefore, will reduce your dose.

You probably have worked to optimize your radiation use already. Every time you decrease frame rate; use dose-reducing pulsed fluoroscopy; lower the image intensifier; collimate the beam; or engage in other dose-reduction strategies you demonstrate your knowledge and commitment to optimizing radiation use. How good of a job are you doing? What more could you do? You need to analyze your efforts in an organized, scientific fashion. SIR and the SIR Foundation, in conjunction with ABR, have developed a PQI project template to help you do just that. It will provide a guide for collecting data on estimated radiation dose and for using those data to drive process improvement.

If you are not already collecting radiation dose data on every case, SIR will soon provide downloadable instructions and a template on how to begin capturing these data. Please check this Web site often for information about the template. If you have specific questions about the instructions or template, please contact Hilary Bikowski, SIR director of education, by phone at (703)691-1805 or by email.

Frequently Asked Questions

What is the objective of MOC, Part IV – PQI?

Simply stated, maintenance of certification (MOC), conceived at the American Board of Medical Specialties (ABMS MOCTM) nearly a decade ago, is intended to ensure that diplomates fulfill their professional responsibility to help make health care safe, efficient, effective, timely, patient-centered and equitable.

There is a national imperative to oversee and measure the activities of all medical professionals since these activities directly impact patient outcomes. Although other health care stakeholders have expressed interest in taking on this role, there is no organization or authority better suited to set performance standards and provide oversight than the member boards of ABMS. MOC, which began as the response of all 24 medical certifying boards to public concerns regarding quality of care and medical error, is rapidly transforming into the accepted framework for career-long individual professional development.

Through Part IV, diagnostic radiologists, radiation oncologists and radiologic physicists are required to demonstrate commitment to practice quality improvement (PQI). The mandate to provide tangible evidence of a critical evaluation of each diplomate’s practice performance is at the core of PQI. Remember that the overriding objective of MOC, especially Part IV, is to improve the quality of health care through diplomate-initiated learning and quality-improvement activities.

How do I choose a PQI project?

A PQI project must meet the following criteria:

  • Be important to patient care
  • Be relevant to your practice
  • Be achievable in your practice environment
  • Have identifiable metrics suited to repeated measurements throughout the MOC cycle
  • Include an action plan to address areas for improvement and remeasurement to assess any progress and/or improvement
  • Be reasonably likely to result in improved quality/safety

How do I actually "do" a project?

For each project, you should gather and analyze data. Then you should implement a plan for improvement, based on the results gathered. Finally, you should measure again to see if progress has been made.

How do I show ABR that I have satisfied the requirements of Part IV?

Sign on to your personal database (PDB) at www.abronline.org and attest to your yearly PQI participation. You should retain all source data about the project in case you are randomly selected by ABR for an MOC audit.

For specific questions about radiation oncology, diagnostic radiology or radiation physics, click here to read the fall 2008 issue of The Beam, pages 6-7.