Are You Ready for Maintenance of Certification Self-Assessment 2.0?It’s Here, It’s Cheaper, and It’s Easier

The American Board of Dermatology (ABD) launched its Maintenance of Certification (MOC) program for board-certified dermatologists in 2006 in response to the American Board of Medical Specialties mandate that participating boards create and oversee a MOC program for certified diplomates. The purpose behind MOC was and continues to be reasonable: help ensure the safety of the public by assessing in an ongoing fashion that competency is being maintained by board-certified specialists.¹

With the launch of MOC, the ABD relied on its educational partners to respond to MOC elements by creating educational materials and activities to help diplomates satisfy time-specific requirements, which included a self-assessment (SA) component. To meet the SA component, each diplomate accumulates at least 100 points of SA credit every 3 years during each 10-year MOC cycle (at least 300 SA points per 10 years). Self-assessment credit was traditionally awarded for activities that quizzed diplomates using board style test questions that showed respondents their answers compared with peers. By 2014, partners in all corners of dermatology education were creating qualifying activities. Many of these activities were offered at significant expense to diplomate participants. Most educational organizations that offered the qualifying SA activities justified the costs to the diplomates in terms of the technology needed to meet the ABD’s requirements for self-assessment: specifically, to show audience performance on each question, to track individual scores, and to provide educational materials such as handouts to each learner after the activity. To many diplomates, this appeared like a conflicted money grab rather than the necessary cost of providing the education. Expense, limited relevant activities, and time away from patient care to meet MOC components were the most frequent complaints heard by the ABD during the first 10 years of MOC.

Every ABD director is an active participant in MOC and experiences firsthand the challenges inherent in MOC. Through firsthand experience and listening to its diplomates, the ABD recognized that the first iteration of MOC for dermatology was far from perfect. In 2015, the American Board of Medical Specialties (ABMS) released new MOC standards that allowed individual boards more autonomy in defining qualifying activities.² In response, in its June and November 2015 meetings, the ABD focused on improving MOC, with special attention to the diplomates’ concerns surrounding cost and desires to gain SA credit for Continuing Medical Education (CME) activities they may already be doing. With input from diplomates and dermatology organizations, the ABD went back to the drawing board. One area of focus has been the simplification and expansion of practice improvement offerings in partnership with various dermatology education organizations available free of charge.³ Patient and peer surveys are now optional instead of required and are available free of charge.³ In addition, ABD has broadened the definition of what now qualifies for SA credit while remaining true to the spirit of self-assessment. One of these new activities is journal-based SA.

Regular readers of JAMA Dermatology are familiar with a monthly section in the journal called Clinicopathological Challenge. This section meets the spirit of MOC SA in that it presents a clinical vignette that includes history, physical examination, and ancillary investigations including skin biopsy findings, followed by a board-style quiz question, followed on the next page with the answer and discussion of the correct diagnosis and incorrect choices. American Board of Dermatology diplomates who review these cases to quiz and advance their medical knowledge are fulfilling SA requirements. Each published case in the Clinicopathological Challenge is eligible for 1 MOC SA credit from the ABD. After completion of an activity, diplomates can log on to the ABD website at http://www.abderm.org to self-report these accumulated credits under the activity title “JAMA Dermatology CPC Challenge.” This may be done after each exercise or after accumulating many credits. The opportunity to earn CME credit for those participating in these cases is also now offered by JAMA Dermatology.

There are several ways to obtain SA credit. For those who find great value in reading this section of JAMA Dermatology, enough SA credit is available (about 36 credits yearly) to meet minimum MOC SA requirements (100 credits every 3 years). Diplomates seeking retroactive credit for JAMA Dermatology CPC Challenge may claim up to 36 points of MOC SA for each of the previous 3 years. For others who do not find these cases to be relevant to practice, you may wish to use the CME-designated article in each issue of JAMA Dermatology for MOC SA credit. After you read the article, then take the online CME quiz and follow the links to part of the article providing discussion of the correct and incorrrect responses. To complete the CME quiz online, you must be a paid subscriber to JAMA Dermatology, a member of the American Medical Association (AMA), or use prepaid tokens. The AMA designates this educational activity for a maximum of 1.0 AMA Physicians Recognition Award (PRA) category 1 credit (per issue). Diplomates may claim 1 point of MOC SA for each quiz question, which is 5 points per article or 60 points of MOC SA per year. Many other new expanded opportunities to earn SA credit exist and can be found at https://www.abderm.org/public/announcements/new-self-assessment-sa-activities.aspx.⁴

Self-assessment will remain a component of MOC. The ABD agrees that opportunities to earn SA credits should be inexpensive, relevant, available, and, when possible, earned in conjunction with CME education. The JAMA Dermatology Clinicopathological Challenge and article-based CME quiz are excellent activities that achieve all of the above.

Corresponding Author: Erik J. Stratman, MD, Department of Dermatology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449 (stratman.erik@mfldclin.edu).

Published Online: April 6, 2016. doi:10.1001/jamadermatol.2016.0877.

Conflict of Interest Disclosures: Dr Stratman is a director of the American Board of Dermatology. Dr Horn is the Executive Director of the American Board of Dermatology. No other disclosures are reported.