This issue of the Bulletin reviews continuing medical education and those ways in which the AANS is organized to assist its members in acquiring and recording CME credits. Since the requirements for the American Board of Neurological Surgery’s Maintenance of Certification program are evolving, the educational means for meeting them and the database for recording them are evolving as well. Meeting the MOC requirements is a continuous concern of AANS members, who must be certified by the ABNS, and therefore helping them do so is a continuous concern of the AANS.
From Recertification to Maintenance of Certification
In 1999 the ABNS issued its first 10-year, time-limited certificates. ABNS diplomates with certificates preceding 1999 are “grandfathered in,” or exempted from the renewal requirement. But even they may become subject to a need for certificate renewal by institutional credentialing or state licensing rules that insist on current evidence of continuing education and examination.
The change in ABNS policy came 26 years after the American Board of Medical Specialties, the ABMS, first recommended recertification to its member boards, six years after the policy became a requirement, 29 years after family practice became the first specialty to adopt recertification, and after all but one (pathology) of the other 24 member boards had adopted recertification. It was late, but it was inevitable, as the pressure to conform to standards adopted by the ABMS and every other specialty could not be ignored.
During the past six years, since the first neurosurgery time-limited certificates were issued, the ABMS policy of recertification — periodic testing separated by 7-10 year intervals — has been supplanted by a plan of continuous measures to verify training and performance qualifications for practice. This new concept marks a quantum change in the purpose of certification: to maintain and prove competency in practice, not just demonstrate adequate education, training, and testing ability on entering practice. Before this policy change, specialty boards certified training and knowledge testing, avoiding claims of assuring competence.
The transition in certification policy follows an evolution in political pressure and social policy. Quality and effectiveness of healthcare received a rebuke and a warning in two Institute of Medicine reports — To Err Is Human in 1999 and Crossing the Quality Chasm in 2001 — that criticized the lack of measures to prevent medical injury and improve the outcome of care. The reports helped fuel a growing public demand for accountability in medical care. Part of the response in medicine is expanded specialty board requirements that demonstrate competence among diplomates. As the ABMS states on its Web site, the MOC program “will help to reduce medical errors and enhance the quality of care provided by physicians, and lead to better patient healthcare outcomes.”
The ABMS provides a thorough review of board history and current policies in its 2004 Annual Report and Reference Handbook. It describes a series of stages over time of increasingly complex standardized certification processes, from single testing in a primary specialty to the current MOC program. Part of the “social contract” which allows professions to self-regulate and avoid the burden of state control of training and performance standards is the willingness to oversee and discipline their members. As described by Paul Starr in his 1982 book The Social Transformation of American Medicine, professions have a technical specialized knowledge, require systematic training, and enforce professional performance standards and discipline. Evolving board certification policies are the means of meeting this public demand for professional oversight while preserving the authority to define and enforce professional standards.
MOC: Every Neurosurgeon’s Personal Quest
Certification by the ABNS is not simply an issue of pride of accomplishment and professional stature. It is required for AANS membership, and is commonly a prerequisite for specialty practice membership, hospital staff privileges, medicolegal expert qualification, and in some cases, health plan participation. Evidence of current certification is used by some states in medical license renewal in lieu of a repeat state licensing exam. It is a necessary piece of every neurosurgeon’s professional bona fides, and periodic renewal soon will be every neurosurgeon’s personal quest. The AANS is committed to providing members with as much assistance as possible to help them meet the MOC requirements.
With this column I conclude my term as editor of the AANS Bulletin and turn it over to Bill Couldwell, MD. I thank John Popp, MD, for his guidance as prior editor, I thank Manda Seaver for her exemplary and professional staff editorship, and I particularly thank the members of the Advisory Board and the new Peer Review Panel for their contributions to making the Bulletin a publication of unparalleled value.
James R. Bean, MD, is the AANS treasurer. He is in private practice in Lexington, Ky.