At the Alliance for CME conference last January, a hot topic was CME providers' role in helping physicians meet the new maintenance of certification requirements (MOC), which are currently being rolled out by the specialty boards under a mandate from the American Board of Medical Specialties. If specialty societies become involved in self-assessment for physicians, one of the MOC requirements, it could open up a Pandora's box, cautioned Susan E. Adamowski, EdD, director, new assessment initiatives, American Board of Psychiatry and Neurology, Deerfield, Ill. We asked her to elaborate on that comment and other related issues. Adamowski views the process from both sides, as she was formerly director of education for the American Academy of Physical Medicine and Research in Chicago, and the American College of Occupational and Environmental Medicine in Arlington Heights, Ill.
Q: Why did you say that providers' involvement in self-assessment could be a sticky wicket?
A: Under the MOC requirements, physicians must provide evidence of self-assessment and lifelong learning. Note that this requirement states that evidence of self-assessment must be provided as part of maintaining certification. This does not mean that the results of the self-assessment must be shared. Such results can be considered discoverable evidence if there were ever a malpractice suit against the physician. CME providers need to learn what documentation is required by the board of the specialty they are serving. They can document that the self-assessment was completed, but they shouldn't keep the physician's answers on file anywhere. Self-assessment is not punitive. The self-assessment should ideally drive the lifelong learning program. One would hope that physicians would seek CME in areas in which they discovered themselves to be underprepared.
Q: Are there particular MOC requirements that CME providers can help physicians meet?
A: The fourth component of MOC is evidence of performance in practice. Most of the boards are currently struggling with this and might very well welcome partnership and assistance. Again, the ABMS says that evidence is required; it doesn't say that the boards have to do the work to provide the evidence. This could be a wonderful opportunity for CME providers.
Most CME that I have seen relates to medical knowledge and somewhat to patient care. There are very few educational opportunities that relate to communications skills, professionalism, and systems-based practice. These are ripe areas for the development of lifelong learning programs that could offer CME credit and perhaps also provide evidence of performance in practice.
I know when I was director of education for two different specialty societies, we never put on programs on communications skills because we thought they were soft and touchy-feely — and they are — but they're also extremely necessary. We're currently the only board that uses live patients when conducting oral exams, and I have seen absolutely brilliant candidates who were so good I really felt that if I had a psychiatric or neurological problem, I would be happy to have that person treat me. I've also seen other candidates who cannot even establish basic rapport with the patient.
Also, many people don't understand what systems-based practice is, another of the core competency areas. As an example: If there were a psychiatrist treating a patient in private practice and that person could no longer afford to pay, that psychiatrist would have an ethical responsibility to direct the patient to low-cost or no-cost care. The psychiatrist needs to understand the mental health resources in his or her community, plus the local and national government agencies that could be tapped to get care for that person.
Q: What other areas are troublesome for CME providers and boards when collaborating in the MOC process?
A: The biggest sticky area is getting providers and boards to the same table to talk — and then to teach them to speak understandable languages to each other. Practicing physicians with time-limited certification must be involved with MOC if they want to continue in their profession. They don't need CME the way they need MOC. They can do CME on their own; they don't have to participate in organized CME.