Physician disapproval of current maintenance of certification programs prevalent

1. Physicians believe that current maintenance of certification programs are ineffective in achieving their intended purpose of improving patient care and physician knowledge and skill.

2. Through grounded theory analysis of discussed themes, suggestions for improvement include increasing support from organizations, value to physicians and patients and integration of activities to align with actual patient care.

Evidence Rating Level: 2 (Good)

Study Rundown: In a world of rapidly increasing medical information and techniques, it can be difficulty for physicians to stay abreast. Current initiatives to aid this process include the American Board of Medical Specialties-approved maintenance of certification (MOC) program. The MOC program intends to demonstrate physician accountability and transparency to the public as well as encourage physicians to improve their knowledge and skills. However surveys show that physicians are concerned the current MOC process may not be effective and relevant to meet it’s stated goals. This qualitative study aims to understand physician perception of MOC benefits, limitations and barriers in order to determine how MOC programs can be improved to better satisfy physician and patient goals.

Overall, focus group participants indicated that the current MOC process does not successfully achieve its goals of better patient care and appropriate assessment of physician practice. Despite consistent acknowledgement that MOC programs are a good idea, many physicians described frustration with the current system. The MOC process was commonly believed to be “just a hoop” to get through, and that they are “irrelevant, inefficient and unintegrated”. Limitations of this study include potential of overlap of themes identified and also lack of quantitative evidence to support their proposed solutions. However, this is a novel study detailing physician perceptions on the MOC process using rigorous qualitative methods with diverse participants.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Ensuring physicians’ competence – Is maintenance of certification the answer?

In-Depth [qualitative study]: This grounded theory qualitative study analyzed themes produced by 11 focus groups of board-certified, practicing internal medicine and family medicine physicians. The focus groups took place from September 2011 to April 2012. Each focus group consisted of 3 to 5 physicians and lasted 1 hour. Discussions about MOC programs began with the question, “Based on your understanding of the MOC process, what is the most difficult part of MOC activities?” Other questions inquiring about ideas on how to simplify MOC activities were also asked. Following grounded theory technique, anonymized focus group transcripts were analyzed to identify recurring themes concerning the value of, barriers to and processes of MOC. To build a new conceptual model and identify potentially useful changes, interrelationships between themes were also analyzed, and 6 overarching themes of solutions were identified.

Physicians emphasized that all phases of MOC were more effective if done as a group. Nearly all participants identified MOC part IV (i.e., practice performance projects) as the most frustrating. Author analysis of focus group discussions defined 6 areas of improvement for MOC programs: 1) increasing the value for physicians and their patients, 2) enhancing integration with clinical practice, 3) ensuring effective instruction and assessment, 4) increasing relevance to individual physician needs, 5) introducing more coherence across all MOC activities, and 6) improved support to physicians from organizations.

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