ABIM rolls out shorter, tailored MOC exams in oncology


Oncologists who specialize in treating hematologic malignancies or breast cancer will have more options for fulfilling their maintenance of certification exam requirements beginning next year.

The American Board of Internal Medicine (ABIM), in partnership with the American Society of Clinical Oncology (ASCO), will begin offering a more frequent, more specialized, and lower-stakes exam as an alternative to the current 10-year examination.

The new pathway was announced by ABIM and ASCO in May 2018 after 2 years of gathering feedback from physicians about the need for an exam that tests them in their area of practice – rather than all areas of oncology.

Now the groups are rolling out the first three assessments created under this model – general oncology, hematologic malignancies, and breast cancer. This will be followed in 2022 by exams in gastrointestinal malignancies and lung cancer/thoracic malignancies. Additional new exams will roll out in even-numbered years based on the level of physician interest.

Registration will begin on Dec. 1, 2019, for the 2020 exam, which will be offered in March and September.

Here’s how it works: Oncologists who choose the new ABIM/ASCO Medical Oncology Learning & Assessment pathway will forgo the 10-year exam in favor of shorter exams every 2 years. The new exam – which is about one-third the size of the traditional exam – is given online and can be taken at home, at the office, or at a test center.

The 2-year exam is pass/fail and physicians are allowed one retake. If they fail twice, they must take the 10-year exam.

The cost over 10 years will be the same, regardless of whether one takes the traditional exam or follows the newer path, according to ABIM.

ABIM and ASCO also have designed education around the exam. After registration, test-takers will be supplied with study materials and after the test they’ll receive additional, tailored education on questions that they got wrong.

Giving physicians feedback on how they can improve is a major change, said Richard G. Battaglia, MD, chief medical officer for ABIM. He said that one of the main messages they heard from physicians was that the exam needed to have educational value.

Dr. Richard G. Battaglia of the American Board of Internal Medicine

Dr. Richard G. Battaglia

The other message they heard over and over, Dr. Battaglia said, is that practice tends to focus over time and that physicians want to be assessed on what they see every day.

For that reason, the big shift is in the tailored nature of the exam. All of the 2-year exams offered will contain a core module with questions that every oncologist should know, related to symptom management, disease assessment, and principles of genetics and genomics. That core module will make up 25% of the test.

The remaining 75% of the exam will be disease focused, with questions on diagnosis, testing, treatment, prognosis, and common case examples, said Jamie Von Roenn, MD, vice president of education, science, and professional development at ASCO.

Dr. Jamie Von Roenn of the American Society of Clinical Oncology

Dr. Jamie Von Roenn

While test takers will have access to resources, such as UpToDate, during the exam, Dr. Von Roenn said don’t expect to be tested on obscure knowledge or asked about rare conditions. “All of the questions are clinical vignettes,” she said. “These are common questions that oncologists face in practice.”

The 2-year general oncology exam will follow the same overall blueprint as the traditional maintenance of certification exam, but will be “very clinically based,” Dr. Von Roenn said. “We’re not asking for things that you can look up,” she said. The exam will instead be focused on how to apply knowledge to common clinical examples.

For that reason, Dr. Von Roenn and Dr. Battaglia said physicians won’t need to spend time and money on intensive exam preparation.

“I actually suspect that people who are busy clinicians wouldn’t need to study, period,” Dr. Von Roenn said.

Richard Larson, MD, reviewed some of the materials for the hematologic malignancies exam and said the test is focused on practical scenarios.

“It’s certainly reasonable to take the test without taking a lot of time to prepare for it,” if physicians are attending annual meetings and grand rounds, and staying current on the medical literature, said Dr. Larson, professor of medicine in the department of hematology-oncology at the University of Chicago, “We’re not aiming at the zebras.”

Thomas LeBlanc, MD, who was not involved with the development of the exam, called this a welcome and overdue change.

Dr. Thomas W. LeBlanc, Duke University, Durham, N.C.

Dr. Thomas W. LeBlanc

“As someone who sees and treats only patients with blood cancers, it doesn’t make sense for me to be tested on largely solid tumor knowledge, with very little of the exam content being in the area of my practice,” said Dr. LeBlanc, associate professor of medicine at Duke University, Durham, N.C. “That’s what the old examination process is like. If I haven’t kept up on how to treat colon cancer, how does that reflect anything meaningful about my abilities as a leukemia specialist?”

Dr. Battaglia encouraged any oncologist with an assessment due date coming up in the next 2 years to consider the new format. For physicians whose oncology certification has lapsed, they can regain certification by successfully passing two of the general oncology exams.

Another reason to consider trying out the new test in 2020 is that physicians can take it with “no consequence.” While normally physicians have an assessment requirement every 10 years, physicians due to pass an exam in 2020 will not be penalized if they take this shorter test option next year and are unsuccessful. They instead will get a chance to try again in 2022.

Regardless of what specialty area clinicians choose for the 2-year exam, their certificate will be in medical oncology. Opting for the 2-year exam won’t affect other certificates. Clinicians can continue to take the 10-year exam for other areas in which they are certified, Dr. Battaglia said.

Dr. Battaglia said that ABIM is looking for ways to decrease the burden on physicians who are dual boarded, and is having conversations with the specialty boards of medical oncology and hematology about how to do that, but those are early-stage discussions. “It’s on our radar screen,” he said.

The American Society of Hematology has suggested to ABIM that “longitudinal, formative assessments” are a more appropriate way to engage physicians in maintaining certification. ASH submitted comments to the American Board of Medical Specialties, which oversees ABIM, earlier this year on the best ways to overhaul maintenance of certification. While the society continues to advocate for this change, ASH officials are also working with ABIM to implement changes to the current hematology recertification assessment requirement.

“The society is looking forward to working with ABIM to ensure future hematology maintenance of certification exams are more focused on the needs of each practitioner as reflected in the mix of patients and diseases cared for in that practice,” said Alan Lichtin, MD, a hematologist at the Cleveland Clinic who serves as chair of ASH’s maintenance of certification working group. “ASH is currently exploring opportunities to work with ABIM to identify common practice profiles, with the intent to introduce an updated Knowledge Check In for hematology in 2021.”

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