Whether you are in healthcare, safety, or another high-stakes profession, at some point, your Board of Directors is going to come knocking and ask the question: “what are we doing about continuing competence?”
Your first inclination will be to look around at other organizations to see what they are doing. You’ll quickly find that there is no playbook, no set of standards, and no single model that will tell you what to do. While no one program has all the answers, many programs have made significant strides and established well-respected programs. The American Board of Medical Specialties (ABMS) and the Maintenance of Certification (MOC) program are among these.
This article outlines the requirements of the ABMS MOC program, principles you can apply to your own organization, and the systems you’ll need to have in place to manage an effective program. Whether you aspire to be an ABMS member board or just want to build the best program for your organization, we’ll share how to make the best of their program and make it work for your certifications.
Key Components of Maintenance of Certification (MOC)
The ABMS Maintenance of Certification program consists of four parts, each with its own objectives. As a whole, the parts ensure practitioners demonstrate that they operate within standards of professionalism and stay current in their area of practice. The four parts of the Maintenance of Certification program include:
- Part I: Professionalism and Professional Standing: Practitioners must possess a valid and unrestricted license to practice. Any restrictions or conditions due to misconduct must be explained and may be sufficient to deny certification.
- Part II: Lifelong Learning and Self-Assessment: In a rapidly advancing field, certificants must show that they stay abreast of advances in care relevant to the specialty. They must engage in exercises that surface gaps in knowledge and clinical practice to inform their learning.
- Part III: Assessment of Knowledge, Judgment, and Skill: Self-assessment is not enough. Certificants must also pass a securely administered, psychometrically valid exam every ten years. Many boards are transitioning to a longitudinal assessment delivered continuously over the course of the 10-year cycle.
- Part IV: Improvement in Medical Practice: Certificants must evaluate their clinical activity and patient outcomes against established quality indicators. Norm-referenced feedback provides direction for learning activities that can improve practice.
The Principles of Maintenance of Certification (MOC) Management for Other Credentials
The MOC program is written in the language of medical specialties, but the principles apply to other disciplines. As you consider how to develop your MOC program, the following principles may apply to your organization:
- Professionalism and Professional Standing: The principle behind this area is professional accountability. In the medical profession, licensure is a powerful indicator of professional standing. Medical licensure boards have well-established means to file complaints and conduct disciplinary reviews. In unlicensed professions, accountability can be more challenging to establish. Instead of licensure, you may look for other indicators of professional accountability such as continuous employment, multisource feedback, and customer surveys. For your program, you will want to think through how, other than certification, practitioners show that their work has been accepted by their peers or customers.
- Lifelong Learning and Self-Assessment: The principle behind this area is to practice competently. Practitioners must keep up with environmental and technological developments. There is a nuance to ABMS’s language that points to more than just a continuing education program. The self-assessment requirement encourages certificants to concentrate their learning on meaningful and relevant activities, not just those that are convenient and affordable. Self-assessments and reflective practice exercises surface weaknesses and areas of priority so certificants can be intentional about their learning plans. For your program, you can design your own way to allow practitioners to reflect on their strengths and weaknesses and translate them into a set of learning priorities.
- Assessment of Knowledge, Judgment, and Skill: The principle behind this part is that practitioners are never the best evaluators of their competence. This part stresses that practitioners need impartial and objective methods for practitioners to demonstrate competence. What is telling, though, is that ABMS does not define a particular testing modality. Each program can design a test protocol that targets the competencies considered most in-demand or highest. As you consider the most important competencies to your program, you may design specific assessments that your community will embrace. And remember, assessments aren’t just “taking a test.” They can include practical and observational tests, simulations, and even portfolio-based evaluations. The best assessment is one that is suited to your program’s competencies.
- Improvement in Medical Practice: The principle behind this part is that in medicine, there are quantitative ways to evaluate practice. The “best” test of competency is to see what happens as a consequence of practice. In medicine, some of the metrics are more quantifiable than in other disciplines, but there are likely ways in your discipline to evaluate outcomes. If you do not already have ready metrics for practitioner success, you may need to design them. An outcomes report will condense to a finite set of data—the activity performed, a metric, and a definition of success. With those three data points, you can ask practitioners to report their activity and reflect where they stand relative to their peers.
System Requirements for MOC Management
As you explore how principles behind the MOC parts apply to your program, you are probably anticipating the challenge of managing the parts. The parts, components, and rules all add up to daunting complexity. If you have tried to manage your existing certification or recertification process using custom software or a customized association management system, you know that this kind of complexity is going to be all but impossible. But fear not! That is where a configurable certification management system comes in.
All parts of the MOC process can be managed as long as you adopt a certification management system designed for continuing competence. These systems expect complexity and provide tools for you to tailor the online experience to make even the most baffling program understandable. The following sections describe how a configurable certification management system can support a complex program designed using ABMS’s MOC principles.
- Professional standing: For a licensed discipline, you’ll want to make sure the system can capture licensure information. Minimally, you’ll want the system to be able to accept license details, including an electronic image of a person’s current license. For disciplines with a more robust infrastructure, you’ll want a system that can integrate with a central licensing clearinghouse to validate licenses automatically. For unlicensed professions, you’ll want a system that collects information related to your chosen expression of accountability. Examples include work experience validation and multisource feedback exercises.
- Lifelong learning and self-assessment: You’ll need a system that tracks the kinds of learning experiences your practitioners complete to demonstrate competence and stay abreast of their field. This can include continuing education; industry engagement such as volunteer leadership, public speaking, research, and publication; professional accomplishments such as awards. You’ll want the system to capture the information you need to validate the relevance of the activity and to verify authenticity. In its most advanced forms, you’ll want to administer a reflective practice exercise so that practitioners can discern strengths and weaknesses and develop a learning plan to improve. Ideally, the system doesn’t just record what people have completed but gives them access to relevant activities that meet their needs.
- Assessment: You’ll need a system that provides external validation of competence. This can include integration with high-stakes testing and online remote proctoring but can also include on-demand longitudinal assessment, journal article assessment, and observational or practical evaluation. The system will need to manage eligibility, passing thresholds, feedback, and retake rules.
- Practice Improvement: You’ll need a system that can collect the specific data you need. Because the data will be unique to your program, you’ll need a system that can manage an extensible set of attributes, collect the data through online forms and integrations, and can impose validation rules to ensure complete data sets. The system will need to be able to render normative representations of the data and a feedback loop to encourage professional development in areas of weakness.
System Requirements for Certification Management
While some of the system capabilities to manage maintenance of certification requirements are unique to maintenance of certification, some are more general. For example:
- Integrated: You’ll need a system built to integrate with other parties, whether employers, educators, or third-party assessors. Integrations will reduce the administrative burden both for certificants and program staff.
- Sophisticated rules engine: You’ll need a system that anticipates complexity. It will need to be robust enough to manage nested cycles, such as a three-year recertification period within an overarching 10-year cycle.
- Low-code / configurable: With all the rules and requirements, you’ll need a system you can set up without programmers. It is virtually impossible to expect to hand a team of developers a set of rules of this level of complexity and expect it to come outright. By the time they are done and have it right, you’ll most likely have changed your rules. You need a system that you can change using online drag-and-drop editing features to implement quickly and accurately and evolve with your program.
- Communications: Even as the system tracks a person’s progress, the system will need to have the wherewithal to nudge participants along. The right certification management system will be able to send out Automated reminders such as alerts and ticklers to make sure no one falls through the cracks.
- Data analytics: With the right system, data will increasingly become “your friend.” If you adopt professional practice standards, you’ll need to capture the data to reflect as normative guidance. For the program as a whole, you’ll want to know how far along each of your practitioners is in their process. You’ll want to use data to discern sticking points in the process and identify targeted interventions to promote compliance.
Your System for Maintenance of Certification Management
Embarking on a journey to continuing competence is not easy. You can’t buy it off the shelf, and you can’t flip a switch. You can, however, build a program that follows the principles laid out by the ABMS MOC program. Each principle likely expresses a similar circumstance for your credential holders. And don’t shy away from designing a program just because you think it will be difficult to manage. With the right certification management system, you can build the program that is right for your credential.