MOC needs revision before physicians will recognize value

While Maintenance of Certification (MOC) is a valiant effort to ensure that physicians maintain a certain level of knowledge and skills throughout their careers, the reality is that many physicians gain little from the exercise.

A new study headed by researchers at the Mayo Clinic and published in the Journal of the American Medical Association Internal Medicine (JAMA) found that physicians believe that MOC requirements are cumbersome and provide little to no professional gain.

Since its inception in 2000, MOC aimed to improve the clinical knowledge and skills of physicians, rather than relying on self-driven improvement and a one-time certification. Yet the cumbersome and incoherent nature of the MOC process has resulted in many physicians polled viewing the program as nothing more than another hoop to jump through to maintain professional standing, rather than a useful tool for increasing competency.

At the time of the study, MOC consisted of four elements:

• The maintenance of active licensure,

• The completion of self-study and self-assessment modules,

• The passage of a multiple-choice examination, and

• A study of practice performance.

Study participants reported that parts two and four were irrelevant to their practice and an inefficient way of updating their clinical knowledge and skills. Part four-singled out as the most “difficult and frustrating” aspect of MOC-also failed to link to patient care activities, according to the report.

An overall criticism of the MOC program is that it offeres no credit for day-to-day practice improvements and that many of the tasks involved consist of low learning value activities like paperwork and data abstraction.

In common with many other mandates for the medical profession, physicians also expressed confusion and anxiety about continually changing requirements within the MOC program and a lack of systems support. Low perceived value of the MOC activities and the challenge of fitting them into their already busy schedules results in most participants procrastinating completion as long as possible.

Of all the sections, the only one that physician participants note as somewhat useful was phase three, despite the inconvenience of having to complete the examination at a secure testing facility and a lack of feedback on their responses.

Based on physician feedback, study authors identified several areas for improvement in the MOC program. Because many physicians view MOC as another hurdle to maintaining professional standing that has little benefit to their clinical knowledge, the study authors suggest that more work must be done to increase the perception of value among physicians.

“Instead of marketing and rhetoric to tell physicians about the potential benefits of MOC, the system needs a fundamental change that will create tangible, easily observable benefits,” according to the report.

The authors suggest that MOC activities should serve the needs of clinical practice rather than causing physicians to alter their practice to fulfill MOC requirements.

“Both MOC topics and MOC credit should emerge naturally from the physicians’ daily clinical workflow with minimal extra effort,” the study's authors say, adding that such a change could improve patient care while ensuring that necessary skills are developed and maintained.

Assessment strategies are also earmarked for improvement. Because few physician participants recognized meaningful learning resulting from MOC requirements and saw it only as a way to fulfill credentials, program designers must find ways to make the requirements more relevant, effective and efficient within daily clinical practice, the report states.

Physicians also noted a lack of coherence between the four phases of the MOC program, and say that each section should lead into and define the next. Redundant tasks should be minimized, and creating a more continuous process will result in a more coherent and effective program, according to study authors.

“Physicians view MOC as a unnecessarily complex process that is misaligned with its purposes and largely fails to meet their needs,” write the study authors. “It seems unlikely that current tensions will resolve until physicians’ needs have been adequately acknowledged and addressed.”