Matthew Levine, MD, PhD
Assistant Professor, Perelman School of Medicine, University of Pennsylvania
Chair, ASTS CME Committee
The American Board of Surgery (ABS) has specific criteria for a 10-year cycle of maintenance of certification (MOC) for board certified general surgeons. This 10-year cycle until recently involved three-year cycles of MOC, which repeat three times and then are followed by a recertification exam every 10 years. The ABS MOC program consists of four parts: 1) Professional Standing (licensure and hospital privileges), 2) Lifelong Learning and Self Assessment, which will be the subject of this narrative, 3) Cognitive Expertise (the recertification examination), and 4) Evaluating Performance in Practice (involving participation in local, regional, or national outcomes registries (for which UNOS and SRTR qualify). The major effort involved in this, aside from the recertifying examination, is the MOC requirement. Strategies to gain MOC credits for the ABS within the realm of transplantation will be discussed below.
In early July 2017, the ABS officially altered the requirements for MOC. These changes will significantly relax the requirements for self-assessment MOC and due to the recent nature of these changes, they will be summarized in detail here.
For the past decade, Part 2 ABS MOC involved three-year cycles of MOC requiring 90 hours of CME credits, of which 60 involve self-assessment with testing that require 75% correct in order to obtain credit. This amounted to a requirement for 20 hours of annual self-assessment credits to be obtained with tabulation and submission every three years.
The new Part 2 ABS MOC requirements have reduced this requirement by half. Cycles of submission of MOC credits will be lengthened from three to five years. Therefore, only two such cycles will be required for each 10-year period of exam-based recertification as opposed to three such cycles previously. With each new five-year submission period, 150 CME credits will be required, of which only 50 must include self-assessment. This amounts to a requirement of 10 self-assessment hours per year over the longer 5-year cycle. There will be a requirement for an additional 20 hours of non-self-assessment CME per year. These credits are generally easier to obtain and are satisfied by attendance at Grand Rounds/M&M meetings in most institutions as well as by attendance at conferences that do not grant self-assessment credits. These changes in ABS guidelines are new and may have caveats yet to be determined or disseminated. Information regarding these changes can be monitored at the ABS website.
MOC must be completed by December 31 of the fifth year of each cycle. Diplomates must provide proof of completion to the ABS via a brief online form and submissions are subject to audit.
Over the past several years there has been a significant effort by the ASTS via the CME Committee to produce current CME/MOC materials with transplant content so that transplant professionals can maintain certification by studying within their field of practice. Under CME Committee leadership preceding mine, a number of steps were taken to create CME/MOC content within the ASTS Academic Universe. This has continued, and there are currently approximately 30 hours of modules on the ASTS Academic Universe site that will renew over time. These modules cover different topics in transplantation and were largely created by CME Committee members from recent American Journal of Transplantation (AJT) published manuscripts. These modules do have a nominal per-module fee attached for access by ASTS members and nonmembers.
A second source of MOC credits comes from the AJT directly in the form of a monthly Images in Transplantation feature. This feature, which is available at no cost to AJT subscribers (all ASTS members), allows the accumulation of an hour of MOC credit per AJT issue if the testing is completed. These features are available for 12 months on the AJT website. Thus, at any one time, 12 are available. In each five-year cycle, 60 hours of MOC will be available via this feature, but doing so will require attention throughout the five-year period – only 12 will be available if this is left to the last moment to complete. I strongly suggest that ASTS members utilize this resource longitudinally to maximize impact.
A third avenue for transplant-specific MOC content is a recent partnership between ASTS and AJT called “ASTS MOC – Education through the AJT.” This feature allows selected high impact manuscripts at AJT to be rapidly tracked for MOC content preparation by the authorship group, assisted by ASTS CME Committee members. Operationally we expect content of 1-2 articles most months in AJT going forward. This MOC content will be housed in the ASTS Academic Universe and does come with a nominal per-module fee for members and non-members of ASTS. Each successfully completed module yields 1 hour of MOC credit. These modules will be available for three years on the ASTS Academic Universe site after creation. Once this program matures, it should yield a renewing source of MOC content that should be more than 30-40 hours of available content at any given time. The first MOC article was published in January of 2017, and there has been one article in each of the subsequent issues of AJT.
A fourth method of MOC credit in transplantation is obvious but significantly underutilized: MOC credits available from attendance at the ASTS Winter Symposium and the ATC. In the past four years, the planning committees of these meetings along with the CME Committee have initially piloted and then fully developed a program of MOC with self-assessments that has averaged 8-13 hours of credit available at these meetings. Essentially, one could obtain all needed MOC credits in a five-year cycle by attending even one of these meetings and completing the self-assessment modules that are provided to attendees after the meeting. In past years, a small percentage of attendees have taken the self-assessment exams to get credits. This is a resource that has the potential to alleviate much of the burden of MOC accrual and is an added rationale to attend these meetings. These modules are at no added cost for meeting attendees.
Overall, ASTS leadership has paid careful attention to the needs of the membership and has provided a number of resources for transplant-specific MOC modules that are sufficient to meet the ABS requirements without having to study topics well outside of the practice of the transplant surgeon. The work of prior CME Committee chairs Mike Ishitani and Richard Knight set the stage for the production of this MOC portfolio, and Nerissa Legge, the ASTS liaison for CME and MOC content, has greatly facilitated these efforts. The help of Allan Kirk and Jill White at AJT has been essential in building the partnership with AJT that has facilitated much of this MOC content production. We should acknowledge the efforts of ASTS CME Committee members, who have produced the majority of these modules.
Strategically, it is worth planning ahead and taking advantage of these modules throughout the five years of the recertification cycle, as 50 hours of credits take a long time to accumulate and some content is available on a rolling basis. It is harder to get 50 credits if one waits until the month prior to the due date. The relaxation of the ABS MOC requirements will allow for a fairly painless process of MOC accumulation for most transplant surgeons as long as it is treated as a process to be completed over a 5-year period and not left to the last moment.
With these policy changes, the ABS also issued a policy statement stipulating that some specialty-specific approaches to the 10-year cycle of written examination recertification are being considered. This change may apply to transplant surgery in the future, but details are not yet available. It should be noted that while currently only the meeting-related credits are certified for the American Board of Internal Medicine (ABIM) for non-surgeon members of ASTS, we are exploring the feasibility of extending ABIM certification to a greater part of the MOC portfolio available to ASTS members.