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A reader writes that the ongoing controversy over maintenance of certification requirements echoes another episode in American medicine a century ago.
The controversy surrounding the maintenance of certification (MOC) issue is reminiscent of Abraham Flexner and his Flexner Report of 1910. Flexner, who was an educator rather than a physician, undertook a study of the medical schools of his era, and found among other deficiencies that they placed too little emphasis on the basic sciences.
Flexner believed that the German medical school model, which used full-time professors and was devoted to medical research, was the proper model, and with the help of the Rockefeller Foundation and the Carnegie Institute he was able to overcome those who opposed his views. Eventually his ideas were accepted by medical educators in this country.
Today it seems that history is repeating itself. This time it is the American Board of Medical Specialties (ABMS) that is pushing to impose its own blueprint on medical education with its insistence on maintenance of certification (MOC).
Once again powerful forces are planning an over-emphasis on the science of medicine and ignoring the personal, the humane, and the intuitive dimensions that are intertwined with the scientific and are almost impossible to measure with computerized multiple- choice questions. And these tests cannot measure reasoning ability, which is best done in open-ended essay tests.
MOC unjustly assumes that physicians do not keep up to date and ignores the fact that hospital peer review committees look at medical mistakes and that physicians work hard not to repeat them. Besides, many of the errors in hospitals are system errors that are not attributable to single individuals.
But the most serious criticism of MOC comes from the American Association of Physicians and Surgeons. In their lawsuit they claim that the ABMS misrepresents the competency of physicians who are not certified.
And clearly, being a monopoly increases this misrepresentation’s potential to damage a physician’s peace of mind, reputation, and livelihood.
One would think that the ABMS would have the collective wisdom to devise tests that are relevant, non-punitive, and clearly designed to help physicians increase and sharpen their knowledge.
Edward Volpintesta, MD