Forging a New Relationship with ABNM Diplomates.

T he mission of the American Board of Nuclear Medicine (ABNM) is to assure the public of high-quality patient care by establishing standards for training, initial certification, and continuing competence of physicians providing nuclear medicine diagnostic and therapeutic services. Under the existing system, the first contact physicians have with the ABNM is the certification exam. Graduates of training programs must demonstrate that they have acquired extensive knowledge of nuclear medicine by passing a comprehensive secure examination. Eighty-six percent of physicians who took the 2015 examination for the first time passed and were certified by the ABNM. Until 1991, the certification exam was the only contact most diplomates had with the board. Once they passed the certification examination they had a lifetime certificate, which most physicians regarded as a diploma that required no further effort to keep. The only way to lose the certificate was to be guilty of egregious professional misconduct. In 1992, the ABNM began issuing time-limited certificates that required diplomates to pass an examination every 10 years to retain certification. The recertification exam assures the public that physicians are keeping up with rapid advances in medicine and that their knowledge is current. Ninety-eight percent of physicians who took the recertification exam in 2015 passed and were given a new certificate. The pass rate for the recertification exam is high because most physicians are conscientious about continuing medical education. The small number of physicians who are concerned about passing the exam may take the exam up to 2 years before it is required without affecting the next date by which the exam must be taken. In 2006, the ABNM began a Maintenance of Certification (MOC) program developed by the American Board of Medical Specialists (ABMS), which includes 24 member boards. For the first time since the first ABNM certificates were issued in 1972, diplomates were expected to participate and document continuing medical education, life-long learning and self-assessment, and improvement in medical practice. Passing a secure examination alone no longer provided the necessary level of public assurance of professional competency. The MOC program, however, was difficult for diplomates to understand, required physicians to spend time documenting continuing medical education they documented elsewhere, imposed new educational requirements (selfassessment modules or SAMs) of unproven value, and required quality improvement activities in addition to the activities that physicians already performed as part of their practice. The ABNM is working hard to improve the MOC program to fulfill its mission to maintain public trust, as well as support busy diplomates by helping them keep their knowledge and skills up to date in a way that is easy and convenient. Therefore, the ABNM is embarking on an ambitious plan to completely redesign Part 3–Assessment of Knowledge, Judgment, and Skills (more commonly known as the recertification or MOC exam) and Part 4–Improvement in Medical Practice and to forge a new relationship with its diplomates that is more formative (supporting professional development) rather than simply summative (deciding who is certified). The ABNM on April 28 sent diplomates an announcement of a pilot program called CertLinkTM, developed by the ABMS and several member boards, which could replace the MOC examination with a longitudinal process of learning and self-assessment. The details of the pilot program have not been determined, but the basic feature is the delivery of multiple-choice questions to diplomates on a regular basis, with immediate feedback on answers. The process will have the flexibility to accommodate diplomates’ preferences and practice needs. Participation and learning will be the goals, rather than a passing score. It is hoped that the pilot program can be launched in January 2017. Diplomates who are eligible to participate in the pilot will not have to take the MOC examination. More details will be available later this year, and the ABNM will ask for diplomate feedback in developing the pilot program to ensure that it meets their needs. If the pilot program is successful, CertLink could eventually replace the MOC exam for all diplomates. It is hoped that all diplomates, including diplomates with lifetime certificates, will be eager to participate in CertLink, because they find it an easy and convenient way to improve their knowledge of nuclear medicine. The ABNM is also making significant changes in MOC Part 4. Instead of requiring diplomates to participate in specially designed practice improvement activities, the ABNM has expanded the list of qualifying activities to include activities that most physicians already do as part of their practice. Instead of the heavy burden of documentation that was previously required, the ABNM will allow self-attestation, which physicians can easily do online once each year. The ABNM will also give physicians a new option of a brief practice guideline– based survey that can be completed by individuals or groups of physicians, with the help of nuclear medicine technologists and administrative personnel. The survey results will be aggregated to produce a national practice profile, which will be sent to each participating physician to enable comparison of local practice with national data. The survey will be brief, easy to complete, and valuable. The ABNM is also considering giving diplomates SAM credit for participation in CertLink or completion of a Part 4 practice survey. The earned credit could potentially satisfy the annual requirement of 8 hours of SAM credit, making it even easier for diplomates to participate in MOC. The ABNM welcomes feedback on these changes. Please send your comments and suggestions to [email protected]