Engagement of Groups in Family Medicine Board Maintenance of Certification
ABSTRACT Purpose: The American Board of Medical Specialties' Performance in Practice ("Part IV") portion of Maintenance of Certification (MOC) requirement provides an opportunity for practicing physicians to demonstrate quality improvement (QI) competence. However, specialty boards' certification of one physician at a time does not tap into the potential of collective effort. This article shares learning from a project to help family physicians work in groups to meet their Part IV MOC requirement.
A year-long implementation and evaluation project was conducted. Initially, 348 members of a regional family physician organization were invited to participate. A second path was established through 3 health care systems and a county-wide learning collaborative. Participants were offered (1) a basic introduction to QI methods, (2) the option of an alternative Part IV MOC module using a patient experience survey to guide QI efforts, (3) practice-level improvement coaching, (4) support for collaboration and co-learning, and (5) provision of QI resources.
More physicians participated through group (66) than individual (12) recruitment, for a total of 78 physicians in 20 practices. Participation occurred at 3 levels: individual, intrapractice, and interpractice. Within the 1-year time frame, intrapractice collaboration occurred most frequently. Interpractice and system-level collaboration has begun and continues to evolve. Physicians felt that they benefited from access to a practice coach and group process.
Practice-level collaboration, access to a practice coach, flexibility in choosing and focusing improvement projects, tailored support, and involvement with professional affiliations can enhance the Part IV MOC process. Specialty boards are likely to discover productive opportunities from working with practices, professional organizations, and health care systems to support intra- and interpractice collaborative QI work that uses Part IV MOC requirements to motivate practice improvement.
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ABSTRACT: The American Board of Medical Specialties (ABMS) certification and maintenance of certification (MOC) programs strive to provide the public with guidance about a physician's competence. This study summarizes the literature on the effectiveness of these programs. A literature search was conducted for studies published between 1986 and April 2013 and limited to ABMS certification. A modified version of Kirkpatrick's 4 levels of program evaluation included the reaction of stakeholders to certification, the extent to which physicians are encouraged to improve, the relationship between performance in the programs and nonclinical external measures of physician competence, and the relationship of performance in the programs with clinical quality measures. Patients' and hospitals' value of board certification and physician participation in MOC are high. Physicians are conflicted as to whether the effort involved is worth its value. Self-reported evidence shows improvement in knowledge, practice infrastructure, communication with patients and peers, and clinical care. Certification performance is generally related to nonclinical external measures such as types of training, practice characteristics, demographics, and disciplinary actions. In general, physicians who are board certified provide better patient care, albeit the results have modest effect sizes and are not unequivocal. Certification boards should continuously try to improve their programs in response to feedback from stakeholders, changes in the way physicians practice, as well as the growth in the fields of measurement and technology. Keeping pace with these changes in a responsible and evidence-based way is important.Journal of Continuing Education in the Health Professions 09/2013; 33(S1):S20-S35. DOI:10.1002/chp.21203 · 1.32 Impact Factor
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ABSTRACT: Gender differences in dyslipidemia are widely documented, but the contributors to these differences are not well understood. This study examines whether differences in quality of care, intensity of lipid-lowering medication regimen, and medication adherence can explain this disparity. Secondary analysis of medical records data and questionnaires collected from adult patients with type 2 diabetes (n = 1,369) from seven outpatient clinics affiliated with an academic medical center as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. Primary outcome was low-density lipoprotein (LDL) cholesterol. Women had higher LDL cholesterol levels than men (mean [SD], 101.2 [35.2] vs. 92.3 [33.0] mg/dL; p < .001), but were no less likely to receive recommended processes of diabetes care, to attain targets for glycemic control and blood pressure, or to be on intensive medication regimens. More women than men reported medication nonadherence related to cost (32.7% vs. 24.2%; p = .040) and related to side effects (47.2% vs. 36.8%; p = .024). For all patients, regimen intensity (p < .05) and nonadherence related to side effects (p < .01) were each associated with higher LDL cholesterol levels. The addition of a new lipid-lowering agent was associated with subsequent nonadherence related to side effects for women (p < .001), but not for men (p = .45; test for interaction p = .048). Despite comparable quality of diabetes care and regimen intensity for lipid management, women with diabetes experienced poorer lipid control than men. Medication nonadherence seemed to be a major contributor to dyslipidemia, particularly for women because of side effects associated with intensifying the lipid-lowering regimen. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.Women s Health Issues 11/2014; DOI:10.1016/j.whi.2014.09.004 · 1.61 Impact Factor
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ABSTRACT: Over the past 25 years, three major forces have had a significant influence on licensure and certification: the shift in focus from educational process to educational outcomes, the increasing recognition of the need for learning and assessment throughout a physician's career, and the changes in technology and psychometrics that have opened new vistas for assessment. These forces have led to significant changes in assessment for licensure and certification. To respond to these forces, licensure and certification programs have improved the ways in which their examinations are constructed, scored, and delivered. In particular, we note the introduction of adaptive testing; automated item creation, scoring, and test assembly; assessment engineering; and data forensics. Licensure and certification programs have also expanded their repertoire of assessments with the rapid development and adoption of simulation and workplace-based assessment. Finally, they have invested in research intended to validate their programs in four ways: (a) the acceptability of the program to stakeholders, (b) the extent to which stakeholders are encouraged to learn and improve, (c) the extent to which there is a relationship between performance in the programs and external measures, and (d) the extent to which there is a relationship between performance as measured by the assessment and performance in practice. Over the past 25 years, changes in licensure and certification have been driven by the educational outcomes movement, the need for lifelong learning, and advances in technology and psychometrics. Over the next 25 years, we expect these forces to continue to exert pressure for change which will lead to additional improvement and expansion in examination processes, methods of assessment, and validation research.Teaching and Learning in Medicine 01/2013; 25(sup1):S62-S67. DOI:10.1080/10401334.2013.842909 · 1.12 Impact Factor