In 2006 the American Board of Neurological Surgery begins rollout of its Maintenance of Certification, or MOC®, program. The ABNS was founded in 1940 to provide initial certification to practitioners of neurosurgery who meet specific training and practice requirements. In recent years the public, payers, other healthcare organizations and governmental agencies have called for periodic recertification of specialists.
In March 2000 all member boards of the American Board of Medical Specialties, including the ABNS, adopted a commitment to modify their current or planned programs for recertification into programs for MOC. After analyzing the arguments for the establishment of an MOC program, ABNS directors concluded that regulatory bodies will very soon require neurosurgeons to participate in the process. ABNS directors are committed to making available to all diplomates a meaningful and practical MOC program, one that takes into account the concerns of diplomates and meets the standards of the ABNS, as well as those established by the ABMS.
Through its MOC program, the ABNS supports its diplomates’ dedication to lifelong learning. The guiding principle in this endeavor is to foster excellence in patient care.
The ABNS MOC program is designed to reflect the realities of today’s neurosurgical practice. Emphasis is placed on core neurosurgical knowledge and practice common to all neurosurgeons. The process is designed to permit diplomates to include the areas of their individual expertise when devoting time to continuing medical education activities, selecting a module for the cognitive examination and submitting key cases from their practice.
Diplomates are enrolled in the program upon issuance of time-limited ABNS certificates and submission of a completed MOC application. Time-limited certificates, current for 10 years, were first issued to new ABNS diplomates in 1999. In order to maintain their certification, diplomates certified during or after 1999 must participate in the MOC program. Each individual’s progress through the MOC program requirements will be tracked online.
Non-time-limited certificate holders may participate in the program at any time. Current for the life of the individual, non-time-limited certificates were issued to all ABNS diplomates certified before 1999. A non-time-limited, original certificate will not expire regardless of the individual’s participation in the MOC program. Individuals in this group, however, are strongly encouraged to participate in the MOC program.
Program Requirements
There are four basic components of all specialty MOC programs: evidence of professional standing; evidence of lifelong learning and self-assessment; evidence of cognitive knowledge; and evidence of performance in practice.
Into this framework, the ABNS MOC program has integrated seven requirements: chief of staff questionnaire; CME hours, both category 1 and category 2; cognitive examination; communication assessment tool (the CAHPS); key case analysis; Self-Assessment in Neurological Surgery Examination (the SANS); and unrestricted license to practice medicine.
The four basic components and the individual ABNS requirements, plus the frequency with which they must be updated, have been integrated as follows.
- Evidence of Professional Standing
- Full unrestricted license to practice medicine in all jurisdictions in which the diplomate practices will be verified every three years.
- Unencumbered hospital admitting privileges to practice neurosurgery will be verified every three years.
- Questionnaires will be completed by the chief of the medical staff of the diplomate’s primary hospital every three years.
- Evidence of Lifelong Learning and Self-Assessment
- Lifelong Learning: At least 150 CME hours must be accumulated every three years and must include a minimum of 60 category 1 neurosurgical hours with the remainder in either category 1 or category 2. At least 80 percent of the 150 hours must be specific to neurosurgery. The ABNS reserves the right to establish the activities that qualify for CME categories 1 and 2; a list of accepted activities will be available on the ABNS Web site. Self-assessment exercises and examinations can be used to satisfy portions of the requirement. Accrual of CME hours will be tracked in conjunction with the American Association of Neurological Surgeons, and the information may be verified online.
- Self-Assessment: The diplomate must participate in a Web-based educational program. For this the ABNS has selected the SANS examination. Its development and administration is done by the Congress of Neurological Surgeons. Participation in the examination will be verified electronically and forwarded to the ABNS data repository every three years.
- Evidence of Performance in Practice
- Key Cases: Every three years diplomates must submit the details of 10 consecutive cases of one procedure selected from a list of procedures that cover the subspecialties. If the diplomate practices general neurosurgery or a subspecialty not represented, he or she may send in 10 consecutive cases of the most frequent procedure. Questionnaires must be filled out by the diplomate regarding each reported consecutive case. The list of cases so far consists of the following: (1) Anterior Cervical Discectomy; (2) Chiari Decompression; (3) Clipping of Anterior Circulation Aneurysm; (4) Craniotomy for Cerebral Glioma; (5) Craniotomy for Temporal Lobectomy; (6) Endovascular Embolization of an Anterior Circulation Aneurysm; (7) Lumbar Discectomy; (8) Radiosurgery of a Metastatic Brain Tumor; (9) Release of Tethered Cord; (10) Removal of Intracranial Hematoma; (11) Surgical Treatment of Pituitary Tumor; (12) Surgical Treatment of Trigeminal Neuralgia; (13) Ulnar Nerve Transposition; (14) Non-surgical Treatment of Back Pain. Key case participation will be validated and feedback given to diplomates for analysis.
- Communication Assessment Tool: Practice assessment of physician-patient communication must be submitted every three years. Patient perception of physician performance in the areas of interpersonal and communication skills will be measured using a survey given to 20 patients who respond via telephone or the Internet. Participation in the communication assessment survey is validated and feedback given to the participant for analysis.
- Chief of Staff Questionnaire: Every three years a chief of staff questionnaire must be submitted by the diplomate. The questionnaire will allow the ABNS to verify the diplomate’s standing at his or her primary hospital and will cover the MOC areas of professionalism, communication skills and participation in systems-based practice.
- SANS: Content is developed by the SANS CNS editorial board to assess the competencies of interpersonal skills, professionalism, practice-based learning and improvement, and systems-based practice. Items are then refined to meet the standards of the ABNS and the National Board of Medical Examiners for cognitive knowledge examinations.
- Additional Modules: Other modules, including one on patient safety, will be added as developed. Participation is expected to be every three years.
- Evidence of Cognitive Knowledge
A cognitive examination must be taken and passed in the eighth, ninth or 10th year of each 10-year MOC cycle. Prior to taking the examination, the applicant must have met these criteria:
- Active continuous participation in the MOC program (all three-year cycles — i.e., CME hours, key cases, SANS, communications assessment tool, unrestricted license and chief of staff questionnaires) or successful reinstatement in the process if there was a period of non-participation.
- No fees outstanding to the ABNS.
This secure computer-based examination will be given at regional testing centers. It will consist of 200 questions and will be entirely clinically based. The pass rate is anticipated to be very high. A significant portion of the content of the MOC cognitive examination will be similar in style and content to the material presented in previous SANS examinations. Three different modules will be offered:
(1) General Examination: Consists of 200 basic clinical neurosurgery questions.
(2) Spine Examination: Consists of 150 of the basic clinical neurosurgery questions, plus 50 complex spine questions.
(3) Pediatric Examination: Consists of 150 of the basic clinical neurosurgery questions, plus 50 pediatric questions.
As soon as the results become available, participants will receive their examination score reports and notification of their passage or failure. Participants who do not receive their results within 16 weeks should call the ABNS office and request a report. Examination results will be communicated to the diplomate via a written report mailed to the diplomate’s postal address; no results will be communicated via telephone, fax or e-mail.
Most diplomates who participate in the MOC cognitive examination will be successful. Those who do not pass will be encouraged to continue the MOC process and retake it at the earliest possible time, as long as they are within their 10-year cycle. An examination fee must be paid each time the examination is taken. Diplomates may retake the examination as long as they continue to meet the program requirements expected of active participants.
- For Time-Limited Certificates: Diplomates with time-limited certificates are required to pass the MOC cognitive examination. The examination may be taken during the eighth, ninth or 10th year of the MOC process. Individuals who have not passed it by the end of the 10-year period may reinstate their diplomate status only by repeating all the requirements for initial ABNS certification, including passing the primary and oral examinations and thereby earning a new, valid, time-limited certificate. Consequently, diplomates are encouraged to take the MOC examination in the eighth or ninth year of their 10-year cycle so that, in the event they do not pass, they can retake it prior to the expiration of the 10-year period.
- For Non-Time-Limited Certificates: Diplomates with non-time-limited certificates who wish to satisfy the requirements of the MOC process but do not pass the cognitive examination by the end of their 10-year period will not lose their certification; however, they will no longer be considered active in the MOC process unless granted an exemption by the ABNS.
Ralph G. Dacey Jr., MD, M. Sean Grady, MD, Hunt Batjer, MD, and William Chandler, MD, are directors of the American Board of Neurological Surgeons, www.ABNS.org.