New Option for Maintenance of Certification

In the near future, otolaryngologists will have a new option for fulfilling the exam requirement for Maintenance of Certification (MOC). Instead of taking and passing the Part III component of MOC approximately every 10 years to ensure recertification, an alternative test will soon be available that consists of a limited number of questions given more frequently to assess and provide feedback to physicians in real time through an online portal.

CertLink, the pilot program that is being developed by the American Board of Medical Specialties (ABMS), uses a web-based platform as an innovative approach to assessment. It is one program among a wide variety of MOC innovations the ABMS Member Boards are currently exploring, according to Rich Waters, MBA, CAE, vice president of marketing and communications for ABMS. “CertLink will allow ABMS and the Boards community to explore an assessment model that for some may become an appropriate alternative,” he said.

The American Board of Otolaryngology (ABOto) is one of several boards participating in the CertLink pilot that, for otolaryngologists, will launch in 2018. “CertLink is a new initiative by some of the boards to move away from the high-stakes 10-year exam, which some people refer to as summative assessment, to a more formative assessment of knowledge,” said Randy Weber, MD, past president of the ABOto and chair of the department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center in Houston.

Formative assessment refers to a more continuous way of assessing knowledge versus the traditional approach of assessing knowledge at one point in time, and diplomates who choose to participate in the CertLink pilot will be tested on a more frequent basis than the Part III MOC exam. This will allow not only for a more continuous assessment of knowledge, but, importantly, will promote continuous learning.

“I think CertLink will address the concerns of our diplomates in that this will make MOC more clinically relevant and personalized,” said David Eisele, MD, chair of the ABOto MOC committee, Andelot Professor of Laryngology and Otology, and director of the department of otolaryngology-head and neck surgery at Johns Hopkins Medical Center in Baltimore.

One particular benefit of participating in CertLink instead of the standard Part III MOC exam is its convenience. Instead of needing to prepare for a high stakes exam every 10 years and taking time away from clinical practice to go offsite to sit for the exam, CertLink comes to the diplomate via email notification that questions are available on the ABO website. Diplomates simply need to log on to the website to answer the questions [see “Benefits of CertLink,” below].

CertLink is a new initiative by some of the boards to move away from the high-stakes 10-year exam, which some people refer to as summative assessment, to a more formative assessment of knowledge. —Randy Weber, MD

How CertLink Works

Robert Miller, MD, MBA, ABOto executive director and editor of ENTtoday, describes CertLink as “basically the same thing as MOCA Minute, with minor modifications.”

MOCA Minute is a pilot project developed by the American Board of Anesthesiology (ABA) to help anesthesiology diplomates prepare for the MOCA exam. In its initial launch in 2014, diplomates were sent one question each week via email that they had to answer within one minute. After submitting the answer, the program then took the diplomate to a screen that provided a description of the right and wrong answer along with a critique and supporting references.

CertLink works in a similar fashion. According to Dr. Weber, the CertLink program adopted by each of the participating boards will be slightly different and tailored to each board’s constituents.

For otolaryngologists, the test will consist of 20 questions submitted quarterly to each participating diplomate. “Doctors, at their leisure, can answer one question at a time, or all 20,” said Dr. Miller, adding that five minutes will be allotted for doctors to answer each question. As with MOCA Minute, diplomates will be given immediate feedback, including the rationale for the correct answer and references, once they have submitted their answers. Participants who score well on CertLink will not have to take the Part III exam at the end of the 10-year cycle.

Dr. Miller stressed that participating in CertLink is optional and that CertLink does not replace the Part III exam. “We will still do the Part III exam,” he said, adding that participants in CertLink who do not do well on the new exam can still take the Part III exam and that people who prefer to take the one-time exam every 10 years can still do so.

Expectations Based on MOCA Minute Outcomes

If otolaryngologists take to CertLink the way anesthesiologists did to MOCA Minute, the pilot should be a success. According to an ABA spokesperson, nearly 92% of diplomates surveyed who participated in the initial launch of MOCA Minute said they preferred answering a fixed number of questions aimed at enhancing their learning every year to participating in the high-stakes MOCA exam. Surveyed participants also said that MOCA Minute helped them stay current in anesthesiology, and 80% said it helped them care better for their patients.

Based on these results, the ABA expanded MOCA Minute in 2016. To date, responses to the 2016 version indicate that diplomates “overwhelmingly” prefer MOCA Minute to the exam, said the ABA spokesperson.

After talking to colleagues in anesthesiology who “seem to like it,” C. Ron Cannon, MD, president-elect of ABOto, said that he suspects that, as a pilot program, the initial launch of CertLink may come with some “glitches along the way as the program is developed” but “hopes it will provide value for diplomates with continuous learning while being minimally intrusive on their time and practices.”

Diplomates who choose to participate in the CertLink pilot will be tested on a more frequent basis than the Part III MOC exam, … [which] promotes continuous learning.

Otolaryngologists Urged to Participate

“I want otolaryngologists-head and neck surgeons to know that the American Board of Otolaryngology is committed to making CertLink relevant to their lifelong learning to improve their care of patients,” said Dr. Eisele, adding that “we’re committed to monitoring and improving this process as it evolves to continuously make it better and relevant to them.”

For Dr. Weber, the pilot provides a new approach to learning and assessment that offers several advantages over the single high-stakes exam. Among these advantages is the focus on concurrent and continuous assessment and learning that helps diplomates keep up with the current literature and evidence-based medicine.

“The goal,” said Dr. Weber, “is to ensure that practicing physicians have correct medical knowledge so they can provide evidence-based care for their patients.”

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Mary Beth Nierengarten is a freelance medical writer based in Minnesota.