Maintenance of Certification

This article explores Maintenance of Certification (MOC), also known as Continuous Certification (CC), and provides both tips for effectively managing a MOC program, and a snapshot of a successful MOC program carried out at Nemours Children’s Health.

MOC is a continuous learning and testing process that aims to ensure physicians keep abreast of the latest medical knowledge, develop improved practice systems, and — perhaps most importantly — show a commitment to lifelong learning through a series of varied educational and quality improvement endeavors. The main goal is to maintain current best practices to improve institutional and patient outcomes.

MOC consists of four parts: professional standing, lifelong learning and self-assessment, knowledge assessment and quality improvement. Continuous learning and quality improvement are the meat and potatoes of MOC and are the only components managed by any organization’s MOC portfolio program.

To gain MOC part 2 points, physicians attend various CME activities and complete a self-assessment with a feedback component afterwards. MOC part 4 is obtained through participating in quality improvement (QI) projects, which normally extend from six to 12 months. Most major institutions have a dedicated professional or small team to manage MOC and other CE activities, which can be structured in a variety of ways.

As a reminder, accredited CME providers are not required to submit MOC applications for approval to the certifying boards that are collaborating with the ACCME. Instead, accredited CME providers can use the ACCME Program and Activity Reporting System (PARS) to register activities for these programs, and providers attest to meeting certain MOC requirements and data policies. As of 2024, the ACCME has collaborations in place with:

• American Board of Anesthesiology (ABA)
• American Board of Internal Medicine (ABIM)
• American Board of Orthopaedic Surgery (ABOS)
• American Board of Otolaryngology-Head and Neck Surgery (ABOHNS)
• American Board of Pathology (ABPath)
• American Board of Pediatrics (ABP)
• American Board of Surgery (ABS)
• American Board of Thoracic Surgery (ABTS)
   

Nemours’ MOC Portfolio Program

Nemours Children’s Health is one of the largest integrated pediatric health systems in the country, functioning as a multistate, multisite children’s hospital system with two anchoring children’s hospitals in Florida and Delaware. The institution embodies a commitment to all aspects of children’s health through high-quality clinical care, research, quality improvement, education and community outreach. The organization aims to create the healthiest generation of children and believes in the concept of being well beyond medicine. Nemours promotes a robust MOC program, serving over 1,100 physicians across the enterprise, with over 80 open or ongoing projects for physicians to enroll in. Nemours is considered a large healthcare institution, and their MOC portfolio program has been highlighted on a national level as an exemplar by both the American Board of Pediatrics (ABP) and the American Board of Medical Specialties (ABMS).

Benefits of MOC

MOC serves several benefits to physicians, providers and patients. By participating in QI activities with their internal institutions, physicians not only remain up to date with the latest and greatest in technologies and techniques, but it also saves them time, money and paperwork. The MOC program team usually helps physicians with aim statements, measures and data, complete paperwork on physicians’ behalf, pay submission fees, and help physicians gain points for work they may already be doing. QI engagement can also activate physicians’ financial incentive bonuses.

A focus on patient safety and improvement of processes and outcomes leads to increased patient satisfaction, encourages cross campus and interdisciplinary collaboration, helps meet institutional goals, and ensures better data security. It has also been suggested that MOC provides a return on investment (ROI) to institutions for physician non-value-added effort. Nemours used an ROI equation adopted from the University of Utah which uses variables of number of completions per year, total hours spent on projects and average physician salary: [(# completions in year)*(30 hours)/(2080 hours)]*(average physician salary).

This allowed us to quantify the value-added work that the continuous education and quality improvement work brings to the institution, equaling $173,077 of potential savings for the 2023 year. MOC also adds a little extra boost of confidence to the communities served, as patients and their families can remain confident that their child’s providers and trainees are committed to excellence.

Implementation of MOC

So how did Nemours reach such numbers and maintain over a decade of success? It can be a daunting task to get started with such a big feat, especially if you have a large organization with many physicians to support. Where do you get started? How do you create an infrastructure? Who all should be involved? How do you get physician engagement? Is there money for this? What’s the secret sauce?

These questions are pertinent to address, especially in the planning process.
Based on over 12 years of experience managing the MOC portfolio program, the core Nemours MOC team has identified several key drivers of sustained program success.

Rolling Out the Plan

Planning is essential to ensure that pathways exist for accreditation and reporting, stakeholder engagement and program infrastructure. A simple program or project management plan can be used to ensure that the program captures all necessary stakeholders, processes and timelines for your program’s goals and target audience. Various program management and communication plan templates exist online, offering even a novice a good launching point. Think of planning as a roadmap to success. Getting a MOC program on an organization’s strategic plan and in the budget with leadership is pivotal. The ability for the MOC program to get a seat at the table on the enterprise’s educational roadmap was necessary for Nemours’ program to make its next big leap.

Leadership Buy In

Leadership buy in is one of the top important drivers of any program’s success, especially the larger the organization. At Nemours, the education department was able to work in tandem with the department of quality and safety to get a spot on the Nemours Strategic Plan Educational Road Map. This was a gamechanger.

Leveraging leadership buy-in, a specialist role was hired to bring all the moving parts together, create an infrastructure, and operationalize the MOC program. This is where the tough point of financial support comes in. Leadership personnel are the ones who decide budget allocation, so a spot on their agenda is often crucial for program success. It is acceptable in this scenario to constantly be in the C-suite’s ears to get your program elevated, in conversation, on the agenda and, eventually, funded.

Infrastructure

An infrastructure for your MOC program is necessary to support operations and sustainable growth. It is another core pillar of any program’s success. Think big and work down when capturing all the smaller ins and outs that create the big picture. The project management plan will lay out the various aspects that are needed for the program to thrive. For example, data and communication tracking systems, accreditation outlets and processes, workflow, reporting, job aides, etc.

The newly created MOC coordinator role at Nemours was able to provide the expertise and manpower to create this infrastructure, bridging gaps between quality and safety, education, credentialing and various other silos needed for the program to come together, thrive and grow.

Communication

It takes a village to make a MOC program work. While a dedicated professional role for MOC is instrumental, no single department has all the knowledge, skills, nor resources to successfully implement an MOC program. The communication plan identifies stakeholders and provides an outline for capturing all the moving parts. Examine how your institution is organized and plan out a workflow for MOC to be distributed. Make connections with your organization’s GME department to engage residents and fellows early on and provide QI basics training and structured mentored projects. Work with faculty development/CME teams to implement QI basics workshops eligible for CME credits and provide sessions on maintaining MOC certification. When possible, reflect the bigger picture for stakeholders so they see where they fit in and can reconnect to purpose.

Marketing and communications are essential to physician engagement and programmatic success. Nemours’ MOC team started with web presence. We created a MOC webpage packed with refreshed resources, such as a freshly branded MOC brochure, professionally filmed MOC video and interest forms that directly connect physicians to our team for consultation. It is advised to attend departmental and divisional meetings to get the word out, even post flyers in physician breakrooms and other high traffic areas. Ensure your institution’s onboarding team and physician liaisons have brochures and other appropriate information to share with incoming physicians.

Nemours’ MOC team reached out to various stakeholders and mapped out the best workflow processes, using modernized and updated platforms and communication outlets that help the program hum. The whole MOC portfolio would probably crumble without our virtual huddle board, for example. This master board is a way to ensure all the moving parts and various communication across the team is in one place and up to date. And our internally created QI Tracker is a real time repository of all ongoing projects, assessments, and participants — another integral tool for operational success.

The use of programmatic emails helps funnel different aspects of MOC into different buckets with all necessary team members queued in and ensures the program can continue even when certain team members leave the institution. Nemours created shared Outlook email accounts for both parts 2 and 4, for example.

Sustainability   

The numerous above elements, as well as time, all tie together, working in tandem to create program sustainability. Successful program operations necessitate clear, effective and ongoing communication — and, most importantly, determination and patience. The very definition of sustainability is: “Kept in process or continued over time”. Therefore, real systematic change and engagement takes time. Don’t get discouraged if folks don’t come running with excitement when you roll out your program (or don’t even know your program existed after several years of marketing efforts). Each of these situations is an opportunity to identify other avenues to advertise the MOC program. The backing of a dedicated position through the budget and a place on the strategic plan help with sustainability, but that is just the beginning. For sustainability, MOC program leaders must keep their head on the swivel for new and exciting ways to implement, operationalize and advertise MOC.

Importance of Sharing the Journey Nationally

By networking through conferences and workshop presentations, national focus groups and the ABMS monthly sponsors agendas, Nemours has been able to share its journey of MOC success with other institutional MOC leaders and learn about what other MOC programs are doing. By joining the ABMS monthly portfolio sponsor calls, Nemours was able to learn and reflect on best practices and various MOC structures and successes from our national peers.

A small learning resource group emerged from these monthly calls, which proved to be a very helpful collection of professional peers helping one another with various continuing education topics and concerns. Nemours’ MOC coordinator was even invited to provide one-on-one coaching with new MOC leaders to assist them on their journey.

Summing It Up

All the elements outlined in this article have proved instrumental in the success and sustainability of Nemours’ MOC portfolio program, a commonality which seems to echo throughout the medical education community. However, concentration on any one of the elements alone will not lend to a sustainable program. All the moving parts must work together in tandem to get the MOC program off the ground floor and moving forward to gain traction. So, give it time. Have patience. Make projects meaningful and make a difference in patient care!

Scan the QR code below to view a MOC video from Nemours: