Maintenance of certification (MOC) has become a contentious issue for physicians across the nation. Many physicians are required to complete continuing medical education (CME) courses to maintain their state medical license and specialty MOC; however, the requirements may feel overwhelming when the main goal is to continue lifelong learning in our individual fields of study.
In this study, the authors evaluated general internal medicine physicians’ scores on the American Board of Internal Medicine’s (ABIM) MOC written examination over the past ten years. States that required increased total CME hours noted a statistical improvement in written assessments for general internal medicine MOC compared to their counterparts in states where the CME requirement remained unchanged. Thus the authors suggest a relationship showing a directly proportional increase in CME hour requirements to an increase in physicians’ clinical knowledge.
The article does not suggest the specific amount of CME hours that should be required for physicians to maintain appropriate clinical knowledge. Some states require over 50 CME hours per year while others may not even have a requirement at all. How much CME is necessary to remain competent cannot be addressed by this study.
MOC programs for physicians not only require CME hours and written examinations but additional criteria such as chart reviews and quality improvement projects. Are these other criteria needed to maintain appropriate clinical knowledge? These questions may best be answered by the medical specialties themselves, and not the state medical boards.
Lately, physicians have expressed concerns about the rising costs for CME, increased regulations mandated by state medical boards, and burdens imposed by medical specialty boards. In May 2016, the American Board of Internal Medicine announced its plan to revamp their maintenance of certification process by offering an alternative for the written examination. One proposed alternative would resemble continuing medical education courses with corresponding assessments over the 10-year renewal period that are individually tailored to identifiable areas of weakness in clinical knowledge for the physician. Following this announcement, other medical specialties should explore alternative pathways as well.
commentary by Tyree Winters
OBJECTIVE: To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge.
DATA SOURCES: Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013.
STUDY DESIGN: We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge. We measured changes in clinical knowledge by comparing initial and MOC examination performance 10 years apart. We constructed difference-in-differences estimates by regressing examination performance changes against physician demographics, county and year fixed effects, trend-state indicators, and state CME change indicators.
DATA COLLECTION: Physician data were compiled by the American Board of Internal Medicine. State CME policies were compiled from American Medical Association reports.
PRINCIPAL FINDINGS: More rigorous CME credit-hour requirements (mostly implementing a new requirement) were associated with an increase in examination performance equivalent to a shift in examination score from the 50th to 54th percentile.
CONCLUSIONS: Among physicians required to engage in a summative assessment of their clinical knowledge, CME requirements were associated with an improvement in physician clinical knowledge.