Friday, December 28, 2012

Maintenance of Certification and Quality: There Are Two Sides

I had written a previous post on this subject earlier, but with two articles out this week in premier journals (the New England Journal of Medicine  and JAMA), I am seeing some interesting chatter on Twitter from well-respected physicians describing the downsides of Maintenance of Certification, or MOC.  Here are two previously written blogs (#1  and #2) outlining these “downsides”.  It is clear to me how these physicians feel about the MOC process.
There could be many ways to discuss the issue of MOC in this blog.  I will try to focus on simplicity: “for” and “against”, along with literature that highlights each of these arguments.
Arguments challenging the current process of MOC
1.       It takes physician’s time away from direct patient care.
2.       It is a “bureaucratic scam”, due to the fact that it is very costly, with the beneficiaries of monies being the leadership of the Boards comprising the ABMS (American Board of Medical Specialties).  [Interesting that this article is not referenced in PubMed, but can be found through standard non-medical search engines.]
4.       It has not been shown to benefit patients or patient care.

Arguments in favor of the MOC process
1.       If not the current ABMS MOC process, then there exists the possibility that other regulatory agencies (such as OSHA) could dictate how physicians should practice (see quote in article by Dr. Robert Wachter). 
2.       There exists a correlation between higher scores on MOC examinations and quality of care. (Article 1 and Article 2).
3.       Physicians who spend the majority of their time in practice, not just “academic types”, validate the content of MOC examinations.
4.       The farther out a physician is from training, the lower is the quality of care provided.  While this seems to be a pretty harsh statement against the “there is no substitute for experience”-argument, the current literature does support this position.

I am sure that there are many other arguments for and against MOC.  This blog is not intended to be a mathematical "weight comparison" of articles on the topic.  My own opinion on this is simple: physicians need to engage in lifelong learning (Article #1 here and Article #2 here), under the “Practice-Based Learning and Improvement” competency.  Whatever the ideal process should be for this, I cannot say with certainty, but I would much rather have those within my own specialty, who also understand educational methodologies, regulate ongoing physician certification, rather than others that are removed from the day-to-day challenges of the current practice of medicine.  The current leaders in my specialties, who dictate the regulations as they currently stand, are the ABIM and the ABP.  This was summarized in my Annals of Internal Medicine letter to the editor earlier in 2012. 
So what do you think about the process of MOC as a way for the ABMS to hold physicians to a standard acceptable to the public?  Is it working well?  If not, what could be improved?

In full disclosure, I am not employed by the ABIM or any of the ABMS boards.  I personally know one member of the ABIM, from his days as a former program director.   I have not written examination questions for the ABIM or the ABP.  I get no royalties from the ABIM, the ABP or the ABMS, and have no stock in these companies or any of their subsidiaries. 

Wednesday, December 12, 2012

Twitter within Academic Medicine

I have had the opportunity to do several presentations about Social Media in Medicine and Medical Education.  I am currently set to give a Grand Rounds for Neurosciences at the IU School of Medicine in just a few minutes at the hashtag #IUNeuroscienceGR, with audience members in neurology, neurosurgery, physical medicine and rehabilitation, and psychiatry.  We will be having a live Twitter feed broadcast to the audience.  I am excited to provide information about this topic to this multidisciplinary audience, but even more interested in learning from the audience about how Twitter is perceived within the neurosciences sphere of academic medicine.
A recent article about the use of Twitter at medical conferences highlights this phenomenon.  In addition, it was great to present at the Med2.0 conference back in September 2012 about our experience with Twitter at Grand Rounds within pediatrics at the IUSM.  I am aware of others beginning to delve into this area, including Eastern Carolina University within their Department of Medicine residency program.  Recently, one of our graduates, Dr. Joel Topf, now a nephrologist in the Detroit area, presented a similar grand rounds on the use of social media within health care.
In addition, two days from now, I have the privilege of participating in a Tweet Chat on the topic of depression, to take place on 12/14/12, at 3 pm EST, under the hashtag #IUHedu , with Dr. Joanna Chambers from our Department of Psychiatry.
It is exciting to see Twitter being used as a tool to disseminate information to health care providers and also to patients, and also that others are seeing the impact of this on how physicians and other health care professionals learn.  The more that we can get the word out about the power of sharing healthcare information in this venue, the better.  Now we just need to demonstrate improved patient care outcomes from it--that's the hard part!