The American Board of Urology (ABU) recognizes that after initial certification, many diplomates find the maintenance of certification (MOC) program to be onerous, burdensome, and not relevant to their practice. The trustees, chair of MOC (Michael Ritchey, MD), and executive secretary of the ABU (Gerald Jordan, MD) have carefully evaluated the MOC process, have listened to diplomates’ concerns, and have instituted what we are referring to as a life-long learning (LLL) program rather than MOC. More detail on the history of MOC and the ABU evolution of an LLL program is available in a newsletter and video presentation on the ABU website (www.abu.org).
The ABU believes that urologists strive to keep abreast of our rapidly changing field after initial certification. The LLL program is designed to help diplomates achieve that goal by assessing their performance as their practice changes over time. The ABU views the LLL program as a partnership with diplomates to assist them in identifying potential areas of weakness and to then provide them with the feedback to remediate those areas to achieve practice improvement.
Last year we made the decision to revert to a modular examination, recognizing that many urologists “self” specialize as their practice evolves after training. The current examination will consist of a core general urology module required by all (40 questions), and one of four modules (35 questions) in a specific area of practice (oncology, andrology, female urology/voiding dysfunction, calculi/obstruction/laparoscopy). A large percentage of questions come from the AUA self-assessment study program exam and are based on AUA guidelines that should be familiar to our diplomates.
An additional change is in the method of scoring that in the past could result in “failure.” The ABU believes that an LLL program consists of many components and is more than a single examination. Beginning this year, the ABU will use the knowledge assessment exam given in October to identify those diplomates who have knowledge gaps and direct them to focused CME in areas that need attention. The ABU is able to make this change because of multiple sources of information provided by our diplomates, including submission of billing logs.
Although billing logs are time consuming for all involved (diplomate, ABU staff, and trustees), they provide insight into diplomates’ practice and assessment of their practice standards. These will now be used to verify that our diplomates are taking the modular exam that best fits their clinical practice, allowing an improved assessment of the knowledge base required for their individual practice. In addition, the practice logs allow the trustees to be certain that diplomates have a sufficient case load to maintain their skills.
Most importantly, we have the opportunity to provide feedback to the diplomate. In the very near future, the ABU will launch a web portal individualized for the diplomate, informing them of where they stand in the LLL process and easing the process of log submission.
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Another major change incorporated in our LLL program will be the frequency of assessments during a 10-year cycle. In the past, we have required completion of some element of the process every 2 years. In the near future, this will change to a total of two assessments over a decade. These assessments will occur at years 4 and 7-9, and will decrease the time required to participate in LLL.
The ABU recognizes that the practice of medicine is changing rapidly. These changes require continuous learning on the part of those who practice and continuous evolution of the process for assessing the knowledge, judgment, and skills of the practicing physician. The ABU is committed to evolving an LLL program that diplomates find relevant and less burdensome. We will always welcome diplomates’ feedback regarding this evolving program.
H Ballentine Carter, MD
President, American Board of Urology
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