Maintaining certification: Keeping current is an evolving process

April 1, 2008

Over the years, "keeping up with the Joneses" in terms of certification has been an evolutionary process, and it's not likely to become static any time soon.

Key Points

Minneapolis - Over the years, "keeping up with the Joneses" in terms of certification has been an evolutionary process, and it's not likely to become static any time soon.

The current method by which dermatologists confirm that they meet continuing education and clinical skill mandates is the Maintenance of Certification (MOC), says Steven Webster, M.D., clinical associate professor, University of Minnesota, and associate executive director, American Board of Dermatology.

"Maintenance of certification for dermatologists assures the public - the patients - as well as insurance carriers, the government - really, all parties - that the dermatologist is competent in his or her specialty. Increasingly, liability carriers are wanting to see this. And patients want to see it, too," Dr. Webster says.

Certification has evolved over the years to better meet the needs of physicians and patients, and also, increasingly, to address insurance and litigious issues.

The first board was established in 1917, and in 1933, four boards created the American Board of Medical Specialties (ABMS). By 1991, 24 boards had been approved.

Each of these boards has its own certification protocols. All 24 boards issue time-limited certification, so board-certified specialists must meet certain criteria to keep their certifications.

For dermatologists, the American Board of Dermatology is the governing body that monitors and issues certification, and these criteria are measured and met by MOC.

Dr. Webster tells Dermatology Times, MOC is "a process designed to document that physician specialists, certified by the American Board of Dermatology - one of the member boards of ABMS - maintain the necessary competencies to provide quality patient care."

MOC at a glance

Dr. Webster says, "Certification by an ABMS member board is the 'gold standard' of credentialing for physicians."

Furthermore, the government, businesses, payers and providers are also joining together on the healthcare quality issue, he says. Because of this, he says, "Physicians need to be out front on the quality issue, not reacting to others' proposals or mandates."

Dermatologists who have been practicing for many years need to be proactive about keeping up with the curve, and need to be flexible enough to adapt to the morphing certification requirements.

Dr. Webster says that "old salts," as well as residents graduating in 2008, will enter the dermatology Maintenance of Certification program, a 10-year cycle resulting in renewal of certification.

This is composed of several segments: Component I - Licensure; Component II - 40 hours Category CME/year; self assessment examinations at two- to three-year intervals; Component III - Secure, proctored, timed, closed-book examination taken during years eight to 10; Component IV - Evaluation of Practice Performance, QA/QI program with comparison to national norms, development of a quality improvement program and a re-evaluation in two to three years and a patient and peer survey.

Growing pains

While it is a critical component of proving qualification and competence for dermatologists, MOC isn't without its growing pains. One of these pains is the method by which the certification is awarded.

Currently, Dr. Webster says, physicians have what is essentially a "take-home" test - they work from modules and meet the requirements on their own time.

In 2010, this will change to become a proctored exam. This is not necessarily a good thing, Dr. Webster says.

Why? Because the art of practicing dermatology is about assessing the patient, and when needed, using the resources available - textbooks, the Internet and other communications tools - to research a condition. In other words, practicing good clinical medicine.

"The current open-book method, I think, is much more adept at accurately addressing those skills. We should be testing the skill of the clinician, not just his or her book-knowledge," he says.

Moving forward, Dr. Webster hopes that MOC will be able to find a way to test this type of clinical skill in a proctored environment.

Medicine is evolving so rapidly, he says, that maintenance testing needs to assure that physicians not only retain what they had learned in school, but that they're adept at staying abreast of the rapid advances and discoveries occurring in medicine - and applying that knowledge and those skills in their clinical practice.

"We know you know the minutia," Dr. Webster says of the purpose of testing; "but we need to know that you also know how to deal with the patients."

Dr. Webster advises physicians to visit the American Board of Dermatology booth at the American Academy of Dermatology meetings.

"Your input is vital to how the program develops. It's not just extraneous," he says.