After I passed my maintenance exam (American Board of Pediatrics -Pediatric Gastroenterology Subspecialty), I thought I would publish a few criticisms.

1. The test has not kept up with the digital age. In daily practice, it is a good idea to look up information and research difficult cases.  Knowing how to use these resources is more important than memorizing a lot of rare facts for an exam.

2. Why should any of the questions ask me to interpret radiographs or histology slides?  In daily practice, I would rely on my colleagues in radiology and pathology.  One of my surgical colleagues years ago used to say, “when I order a CT it should be like ordering a pizza.  Don’t ask me why I want it.  Ask me what I want on it.”  In the case of the maintenance exam, ask which test I want.  There are excellent radiologists and pathologists who are the experts at interpreting the results.

3. How is the MOC evidence-based? The popular buzz word of quality care is “evidence-based.”  Where is the data that taking the test & keeping up with the MOC (maintenance of certification) process improves physician performance?   From my discussions, it is apparent that physicians do not believe that the test “weeds” out underperforming physicians.

4. If the MOC process is so important, how come there are so many physicians who were “grandfathered” out of the requirements?  While the official line to this question is that the “diplomates” at that time who were board-certified were not time-limited, an honest answer is that it was the only politically feasible way to get enough physician support.

As a whole, these criticisms indicate the difficulty in designing a test to assess whether a physician has the necessary competencies.  As alluded to in a previous post (Training Not Meeting Procedure Thresholds for Fellows …), it is crucial that physicians gain the necessary experience/knnowledge in their training.

The MOC has lofty goals of assuring that physicians acquire and maintain their skills.  Yet, the current approach does not meet these goals.  Ultimately, the burden on a physician, like in other career pathways, on keeping up his knowledge and clinical skills relies mainly on the conscientious individual.  Those interested in taking shortcuts will do this and the current system is merely a nuisance.