Author + information
- C. Michael Valentine, MD, FACC, President, American College of Cardiology∗ (, )
- David A. Cox, MD, FACC, MSCAI, President, Society for Cardiovascular Angiography and Interventions,
- Thomas F. Deering, MD, FACC, FHRS, President, Heart Rhythm Society and
- Randall C. Starling, MD, MPH, FACC, FHFSA, President, Heart Failure Society of America
- ↵∗Address for correspondence:
Dr. C. Michael Valentine, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
American Board of Internal Medicine (ABIM) maintenance of certification (MOC) continues to be a subject of interest, generating multiple questions from cardiologists of all subspecialties. MOC changes announced in January 2014 evoked a widespread response from medical specialty societies, including the American College of Cardiology (ACC), the Society for Cardiovascular Angiography and Interventions (SCAI), the Heart Rhythm Society (HRS), and the Heart Failure Society of America (HFSA). Since then, positive responses and changes by the ABIM have occurred, including suspension of patient voice and patient safety requirements; elimination of mandatory practice improvement activities, as well as the requirement for cardiac subspecialists to maintain certification in general cardiology; and acceptance of most continuing medical education (CME) credits for MOC medical knowledge (Part II) credits.
However, despite these changes, dissatisfaction remains in some quarters. The key issue now is the assessment requirement (previously known as the Part III, 10-year “high stakes” examination). The ABIM’s own “Assessment 2020” Task Force, chaired by Harlan Krumholz, MD, FACC, recommended that the 10-year examination be replaced by a more meaningful, less burdensome assessment process (1).
In response to these recommendations, the ABIM created the “Knowledge Check-In” (KCI) option as an alternative to the traditional examination, consisting of a shorter testing cycle (2 years vs. 10 years), a shorter length (3 h vs. 8 h), more frequent availability (4–6 times per year vs. 2 times per year), immediately reported results, the ability to use UpToDate during testing, and removal of the need to pass every assessment attempt (2). In fact, certification status may only be impacted if the diplomate is unsuccessful on 2 consecutive KCIs and is then unsuccessful on a traditional 10-year MOC examination.
The KCI can also be taken at home, in the workplace, or in a testing center, as opposed to the traditional 10-year examination that is only offered in proctored testing centers. The KCI is also recorded on a web-camera for subsequent spot-checking by the ABIM, and, like the traditional examination, it currently spans the full knowledge breadth of the specialty or subspecialty discipline. KCI opportunities are being phased in between 2019 and 2023 for the following 5 cardiology disciplines: cardiovascular disease (2019), clinical cardiac electrophysiology (2020), interventional cardiology (2020), advanced heart failure and transplant cardiology (2020), and adult congenital heart disease (2023).
One of the criticisms of the traditional 10-year examination is that it reinforces “binge studying”–cramming efforts to accumulate enough facts to pass the examination followed by potentially minimal effort to keep up with the knowledge domain until the next examination in the cycle. Principles of adult learning suggest that a more effective and useful pattern of learning is to participate in a continuous (lifelong) effort that allows for the gradual accumulation of new insights while reinforcing other earlier learnings (3).
Bearing these principles strongly in mind, the ABIM and the ACC (with the strong collaboration of SCAI, HRS, and HFSA) have initiated a project with the purpose of marrying the concept of lifelong learning to the assessment requirement of MOC. The project, known as the Collaborative Maintenance Pathway (CMP), is still under active development with the ABIM. It is anticipated that when a final agreement is reached, the CMP will use self-assessment programs (SAPs) in each cardiovascular discipline to allow cardiologists to follow a continuous, rigorous, and comprehensive study of their specialty areas throughout their professional lifetimes. Two currently available SAPs (ACCSAP for general cardiology and CathSAP for interventional cardiology) are now in the process of being modified to provide the CMP option. Two entirely new SAPs (EPSAP and HFSAP) are being created for this purpose as well.
Under the proposed CMP, the respective SAPs are expected to consist of 3 components: 1) a comprehensive didactic review of the entire discipline including written material, videos and slide decks that the learner may access in his/her own style and at his/her own pace; 2) a library of several hundred practice questions presented in a modular format corresponding to the topic area under study; and 3) a set of “performance” questions requiring a passing score, which will be made available on a modular basis when engagement with the learning material has been documented and when CME credits have been granted for the module. The didactic material of the SAP will be divided into 5 modules of approximately equal length, so that yearly assessments will cover approximately 20% of the discipline’s knowledge.
The entire CMP process is expected to provide, in a 5-year cycle, all the CME required for licensure in most states (∼25–30 h per year), all the medical knowledge (Part II) points required for MOC (100 points per 5 years), and a convenient, online assessment activity that will complete the MOC requirements for participating cardiologists (assuming a passing score on the performance questions for each of the annual modules).
It is anticipated that the discounted fee for the SAP component of the CMP will be priced approximately 25% lower than the cost of the current ACCSAP product. Members in good standing of the ACC, SCAI, HRS, and HFSA will all be eligible for the planned discount. ABIM fees will be assessed by the ABIM separately from the SAP component. The entire CMP (ABIM and ACC) process is expected to cost <$500 per year.
So, What Should I Do?
Because the ACC and the ABIM are still working out the details of the CMP, it is difficult to give specific, solid advice that will apply to everyone. Under the best-case scenario, the ACCSAP-CMP option (for general cardiology) will be available in the third quarter of 2019. In that case, cardiologists choosing to maintain their ABIM certification in cardiovascular disease and who are due for their 10-year assessment will have 3 choices: 1) take the traditional 10-year examination at a proctored testing center; 2) take the KCI assessment (failure to pass this assessment will have no immediate consequence on the certification status of the participant and there will be another opportunity to pass the KCI in 2 years); or 3) begin the ACCSAP-CMP program. There are expected to be at least 2 opportunities to pass the first module assessment, which will likely focus on arrhythmias. These options, available in 2019, are presented graphically in a simplified form in Figure 1. A full and complete description of the options available (excluding the proposed CMP option) is available on the ABIM website (2).
Because the KCI and CMP options for clinical cardiac electrophysiology, advanced heart failure and transplant cardiology, and interventional cardiology will not be available until 2020, the 10-year examination is the only option for diplomates with assessments due in 2019. In 2020 and beyond, assuming an agreement is reached between the ACC and the ABIM, subspecialists in these disciplines will have a choice among the 3 options (the 10-year examination, the KCI, or the SAP-based CMP).
The ACC Board of Trustees has consistently stated the direction of the College with respect to ABIM MOC: 1) to be the trusted source of information about MOC; 2) to create and provide a wide range of MOC-related educational opportunities; and 3) to work with the ABIM to improve the MOC process for those members of the College choosing to maintain their ABIM certification. Along this journey, the College has sought to collaborate with our cardiovascular subspecialty societies to pursue these goals, and the actions reported in this communication continue to fulfill the directives of the ACC Board of Trustees.
- 2019 American College of Cardiology Foundation
- American Board of Internal Medicine
- American Board of Internal Medicine
- Knowles M.S.