Maintaining the Public Trust - The American Board of Radiology

Throughout the year, consideringall oral and computer-based examsin all locations, the ABR administers44 different types of exams.Another key effort under way in training and initialcertification is the Milestones Project, a joint effortof the Accreditation Council for Graduate MedicalEducation (ACGME) and each of the specialty boards.The goal is to determine a list of key milestones in trainingthat each resident must achieve at specified timepoints to be considered ready for independent practice.The Diagnostic Radiology Milestones Working Group,chaired by Kay Vydareny, MD, ABR associate executivedirector for diagnostic radiology and past chair ofthe Diagnostic Radiology Residency Review Committee,had two very productive meetings in March andSeptember of 2011. The committee has written draftmilestones for each of the six ACGME competencies(medical knowledge, patient care and technical skills,professionalism, interpersonal and communicationskills, systems-based practice, and practice-basedlearning and improvement) and plans to present themfor feedback at the Association of Program Directors inRadiology (APDR) meeting in March 2012.Also in March 2011, the Board introduced a tighteningof its exam security policies and communicated extensivelywith candidates, training program directors, andchairs to begin a culture change in which systematicsharing of exam content in the form of “recalls” withinand across programs will be discouraged. This effort,designed to conserve ABR resources and protect theintegrity of the examinations upon which the Boardbases the assurances it makes to the public about itsdiplomates, emphasizes the importance of the corecompetency of professionalism.As I think about the explosion in work due to the needto build the future exams, even as we prepare anddeliver the current ones and adapt to the many changesoccurring in MOC, I am impressed that a staggeringlycomplex enterprise is thriving and moving ahead, owingto our talented, hard-working staff in Board Affairs,Certification Services (Candidate and Diplomate Services,Exam Delivery, and Exam Development), Communicationsand Editorial Serivices, Digital Imaging,Finance, Information Technology, and Psychometricsand Evaluation. More about these areas, including initialcertification and MOC, can be found in other sections ofthis report.Aligning MOC with Practice LifeMOC poses a “chicken-or-egg” challenge. For MOCto be recognized as a key contributor to improvedhealthcare quality, safety, and affordability, boardsmust demonstrate that MOC participants deliver bettercare and outcomes than do nonparticipants, and thatthey do so at a lower cost. Yet many diplomates wantto see this proof as a precondition to participation. Theobvious dilemma is that participation is required inorder to produce the data that will establish the valueof MOC. Nevertheless, considering the best interests ofthe public, it defies logic for detractors to argue againsta program of lifelong learning and continuous professionaldevelopment, and in favor of the pre-MOC statusquo, with state medical licensure as the only ongoingrequirement.Throughout the debate and discussion about MOC,one thing has become very clear to the ABR: MOCcan succeed in delivering improved healthcare, basedon the standards we set, only if those standards areimplemented by our practicing diplomates. Therefore,in addition to protecting the public, MOC must deliversufficient value to the diplomates themselves.With this in mind, the ABR and ABMS have been workingto align MOC requirements with all other aspects ofpractice life, including other requirements, incentives,medical licensure, and routine workflow. Key examples(not all-inclusive) are listed below:• The Physician Quality Reporting System (PQRS) MOCProgram Incentive• Development of practice performance measures forPQRS reporting and Part IV of MOC• Alignment with Maintenance of Licensure (MOL)• Focused practice recognition within MOC• Group participation in MOC for large community andacademic practices• MOC Part IV portfolio sponsor recognition/approvalFurther details on these initiatives can be found in theMOC section of this report (see Page 12).5