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Stratman EJ, Miller SJ. Assessment of the Focused Practice Improvement Module Pilot Program of the American Board of Dermatology for Meeting Requirements of Maintenance of Certification. JAMA Dermatol. 2017;153(7):715–716. doi:10.1001/jamadermatol.2017.0396
Board-certified specialists express concerns about maintenance of certification (MOC), including its relevance, time requirements, and expense.1 In response, the American Board of Medical Specialties modified MOC requirements,2 providing boards with greater autonomy. The American Board of Dermatology (ABD) sought to increase the relevance of MOC activities, reduce their costs, and minimize the time they require by developing new activities called focused Practice Improvement (fPI) modules that meet these goals.3
On February 8, 2016, the ABD launched 27 fPI modules created for medical, pediatric, and surgical dermatologists and dermatopathologists.4 Each module contains a practice gap summary and suggestions for improvement. Dermatologists review 5 medical records or specific office processes and then answer 2 to 4 questions about each medical record or office process. Completion time varies by individual. Initial measurements require less than 1 hour once medical records have been identified. Participants who report ideal care following their assessment have completed the exercise, and those who identify improvement opportunities implement changes to their practice and then perform a second review of the medical records of patients seen in the interval period 6 to 12 weeks later. Remeasurement intervals may vary. To conclude the module, participants answer an online survey to anonymously evaluate the completed exercise.
From February 8 through July 21, 2016, up to 318 free, online fPI modules were accessed, started, and/or completed by dermatologists, unsolicited ABD diplomates who participated in the pilot program. This article assesses these diplomates’ responses to the fPI pilot program.
We reviewed responses to online surveys completed by ABD diplomates after they had concluded 1 or more of 27 online fPI activities from February 8 through July 21, 2016. The survey questions asked whether the participating dermatologist
thought the fPI module was relevant (yes or no),
changed documentation or management (yes, no, or it reaffirmed what I was already doing),
improved care (yes, no, or it reaffirmed what I was already doing),
believed any patient experienced better outcomes (yes, no, or unknown/too early to tell), and
recommends the fPI module to others (yes or no).
This study was exempt from formal review by the Marshfield Clinic Health System Institutional Review Board.
During the study period, 318 fPI activities were started in 27 modules and 289 (90.9%) were completed. The Table lists the fPI modules that were started and completed.
Of the 289 dermatologists who completed the fPI activities, 103 (35.6%) identified practice gaps and implemented an intervention and a remeasurement phase. Of the 289 dermatologists, 283 (97.9%) assessed the activities as relevant. Most dermatologists (254 [87.9%]) reported that the modules reaffirmed their current practice, whereas 19 (6.6%) reported that the modules helped change their practice. Twenty-four (8.3%) changed their care documentation habits, 36 (12.5%) believed care improved, and 47 (16.3%) reported that at least 1 patient experienced better outcomes because they completed the fPI modules. Two hundred eighty (96.9%) recommended the fPI modules at high rates (range by module, 88.9%-100%).
In response to concerns about MOC, the ABD created relevant, free fPI activities to help some dermatologists identify and close practice gaps and to reaffirm appropriate care for many others. Other boards’ practice assessment programs show similar results.5 Dermatologists reported that some of their patients experienced better outcomes as a result of completing fPI modules.
This study’s limitations included the use of a small number of participants, which is possibly not representative of dermatologists in the United States. Participants may have been unaware that the survey was anonymous and therefore answered more positively, thinking their responses were identifiable. Although the results of the survey are encouraging, conclusions about the value or attribution to patient outcomes cannot be made about this pilot fPI modules program.
To our knowledge, the ABD’s fPI pilot program has been successful and has led to practice-changing, relevant education at no additional cost. Expanding the fPI modules for the field remains a priority for the ABD.
Corresponding Author: Erik J. Stratman, MD, Department of Dermatology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449 (firstname.lastname@example.org).
Accepted for Publication: February 3, 2017.
Published Online: May 10, 2017. doi:10.1001/jamadermatol.2017.0396
Author Contributions: Drs Stratman and Miller had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Stratman.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Stratman.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Stratman.
Administrative, technical, or material support: Miller.
Conflict of Interest Disclosures: Drs Stratman and Miller are on the board of directors of the American Board of Dermatology, the organization responsible for the Maintenance of Certification program. Their positions are unpaid.
Additional Information: Diplomates of the American Board of Dermatology can access the focused Practice Improvement modules at https://secure.dataharborsolutions.com/ABDermOrg/.