Continuous Certification ensures better quality care

Last year, the American Board of Surgery (ABS) and the American Board of Medical Specialties (ABMS) introduced a Continuous Certification initiative for surgeons and physicians seeking to maintain board certification. Panelists during a session Tuesday morning explored why Continuous Certification is relevant to surgeons who want to provide safe, effective care.

According to Mark A. Malangoni, a former Regent of the American College of Surgeons (ACS) who played an instrumental role in implementing Maintenance of Certification (MOC) during his tenure as associate executive director, ABS, Philadelphia, PA, the board certification movement started in 1916 with American Board of Ophthalmology. “The ABS began issuing time-limited certificates in 1975,” and now surgeons must recertify periodically, he said. “More than 95 percent of ABS diplomats participate in MOC/Continuous Certification.”

Board certification and recertification are important because they represent national standards for evaluating surgeons’ knowledge and competence as defined by the surgical community, Dr. Malangoni said. MOC requires physicians to demonstrate their professional status through licensure; hospital/surgical center privileges, if in active practice; professional references; ongoing participation in a local, regional, or national outcomes registry or quality assessment program; and Continuing Medical Education (CME) and self-assessment. Surgeons also must take a recertification exam.

Studies have shown that surgeons who maintain board certification have reduced mortality and morbidity rates, Dr. Malangoni said. Moreover, surgeons who participate in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) have reduced mortality, morbidity, and surgical site infection rates. There also is association between board certification and maintenance of licensure, he noted.

“More than 80 percent of the states require certification for licensure,” said J. Patrick Walker, MD, FACS, professor of surgery, University of Texas (UT) Medical Branch, Galveston. The goal of Continuous Certification is to assure the public that surgeons maintain their professional identity, update their knowledge, and improve patient care, Dr. Walker said. Furthermore, Continuous Certification “is associated with decreased growth in costs related to laboratory tests, imaging, and specialty visits.”

The ABS has developed a new recertification examination, said Dr. Walker, noting that the response to the new exam has been very favorable. “Don’t fear it,” he said.

Board certification is meaningful to the hospitals where surgeons practice, as well as the patients they treat, according to Julie A. Freischlag, MD, FACS, FRCSEd(Hon), chief executive officer, Wake Forest Baptist Medical Center, and dean, Wake Forest School of Medicine, Winston-Salem, NC. “I would never hire someone who isn’t board certified, and I would never keep someone on staff who isn’t recertified,” she said.

“Our patients really want us to be professional and up-to-date,” Dr. Freischlag added. “Patients today are consumers and are shopping for care.” One criterion they use in selecting their providers is outcomes. “Higher MOC scores are associated with better performance on overall chronic care and preventive services composites,” she said. “It is a marker of someone who wants to be the best they can be.”

“There’s always something you can learn” while preparing for a recertification exam, she added. “Maintenance of certification should not be onerous.”

Ronald M. Stewart, MD, FACS, Medical Director, ACS Trauma Programs, and professor and chair, UT Health School of Medicine, San Antonio, TX, described the special issues related to Continuous Certification, particularly for aging surgeons. “Have things changed since you graduated from residency? Medical knowledge advances at a rapid rate,” and the MOC process can help surgeons ensure they are staying current, he said.

While IQ tends to decline with age, skills and performance of complex psychomotor activities may actually improve as surgeons gain more experience, Dr. Stewart said, drawing an analogy to driving a car. Young people are more likely to be involved in automobile crashes than people ages 30 to 70 years old. After age 70, the collision rate goes back up, he said.

“We can compensate [for the loss of cognitive ability], but this requires effort,” including study and independent assessment, Dr. Stewart said. Surgeons must commit to lifelong learning because information and technology change rapidly, he added.

Karen J. Brasel, MD, MPH, FACS, professor of surgery, division of trauma, critical care, and acute care surgery, Oregon Health and Science University School of Medicine, Portland, explained the benefits of CME and ongoing assessment. She specifically focused on the recertification exam and what it evaluates. She noted that exam questions tend to follow a hierarchy. Lowest on the ladder are tests that assess recall of information. Moving up the ladder are the ability to understand, apply, analyze, evaluate, and create.

According to Dr. Brasel, who is a senior director for the ABS, “70 percent of the questions we ask are on the low part of the ladder.” She suggested that professional exams should “interleaf” questions. In other words, questions should vary, shifting from topic to topic—not a series of queries centered on one subject.

“Essay/short answer tests are better than multiple choice” for assessing areas that are higher on the hierarchy, such as analysis, evaluation, and creativity, she added.