Revised October 9, 2017
What is Maintenance of Certification (MOC)?
In 2001, the American Board of Medical Specialties (ABMS) voted unanimously to expand recertification programs with Maintenance of Certification (MOC) – a more comprehensive program to assess the ongoing competence of physician specialists and their ability to provide quality health care in six general competencies:
- Medical knowledge
- Patient care
- Interpersonal and communication skills
- Practice-based learning and improvements
- System-based practice
Certification requires successful completion of an Accreditation Council for Graduate Medical Education (ACGME) approved nuclear medicine residency program or other approved pathway, an unrestricted medical license, and passing a certification examination. Diplomates certified since 1992 are issued time-limited certificates, which expire after 10 years. Diplomates who pass a re-certification (MOC) examination are issued another time-limited certificate. Since 2007, ABNM diplomates can no longer simply take an examination; instead they must meet all MOC standards.
The American Board of Nuclear Medicine (ABNM) MOC program provides documentation that a nuclear medicine physician maintains the necessary competencies to provide quality patient care in nuclear medicine throughout his/her career.
Definitions of Physician Status Regarding ABNM Certification
In keeping with ABNM principles and definitions, and to effect harmonization with ABMS recommendations, the following classifications will be applied to ABNM diplomates. Note that no individual may be classified in more than a single category at any one time. A physician is Certified, meaning they have met and continue to meet all ABNM standards, or Not Certified, meaning they currently fail to meet at least one required standard for ABNM certification.
This designation applies to all physicians who have met initial training and experience requirements, have passed the ABNM certification examination, and continue to meet requirements of certification. All other physicians are designated as Not Certified by the ABNM. Certified physicians are also classified according to participation in MOC, as follows:
- Participating in MOC: This designation applies to both time-limited and non-time-limited ABNM certified physicians who meet ABNM MOC standards
- Not Participating in MOC: This designation applies only to time-limited ABNM certified physicians who do not meet ABNM MOC standards.
- Not Required to Participate in MOC: This designation applies only to non-time-limited ABNM certified physicians who do not meet ABNM MOC standards. The ABNM expects all diplomates to participate in MOC, but diplomates with non-time-limited certificates will not lose their certification if they do not meet MOC standards.
Not ABNM Certified
This designation applies to all physicians who are not currently certified by the ABNM, which includes diplomates whose certificates are suspended, revoked, or expired.
MOC Components and Requirements
MOC is an ongoing, continuous process. Diplomates are expected to maintain a pace that accomplishes steady progress toward fulfillment of the standards.
There are four parts of MOC. To meet MOC standards, nuclear medicine physicians must pay a fee, and annually update their contact information and professional profile including medical licensure (Part 1). They should annually update information regarding continuing medical education (Part 2) and Improvement in Medical Practice (Part 4). They must also demonstrate knowledge, judgment and skill (Part 3) by taking an MOC examination every 10 years, or by participating in a longitudinal assessment program (CertLink™).
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- Professionalism and Professional Standing
The requirements of professionalism and professional standing include having an unrestricted medical license in all jurisdictions where a diplomate is licensed. The ABNM policy on licensure may be reviewed by clicking here.
- Lifelong Learning and Self-Assessment
There should be a commitment to lifelong learning and involvement in a periodic self-assessment process to guide continuing learning. The ABNM requires each diplomate to maintain:
- A minimum 5-year average of 25 CME AMA category 1 creditsper year,
- which include a minimum average of 5 credits related to Nuclear Medicine,
- which in turn include a minimum average of 8 self-assessment creditsper year.
Since correlative imaging is an essential part of Nuclear Medicine, any correlative imaging credits are considered to be related to Nuclear Medicine. In addition, other credits that are relevant to a diplomate’s Nuclear Medicine practice (e.g. the staging of lung or thyroid cancer) are considered to be related to Nuclear Medicine.
Self-assessment credits are awarded for both self-assessment modules (SAM) and self-assessment CME (SA-CME).
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has developed SAM activities that allow nuclear medicine physicians to meet the self-assessment requirement. The ABNM also accepts self-assessment modules (SAM) qualified by any member board of the American Board of Medical Specialties (ABMS). To view a current list of modules available from the SNMMI, RSNA, and ACR, click on the following links:
Self-assessment credits are awarded for both self-assessment modules (SAM) and self-assessment CME (SA-CME). Self-assessment CME (SA-CME) includes two of the seven types of AMA PRA Category 1 Credit™, types 2 (enduring materials) and 3 (journal-based articles). Since these two types of CME must include self-assessment, the ABNM counts them toward the self-assessment requirement. SA-CME credits are approved by organizations accredited by the Accreditation Council for Continuing Medical Education (ACCME).
For diplomates who register with the CME-gateway, SAM, SA-CME, and other CME credits will be recorded automatically in your profile on the ABNM website. All diplomates have the option of attesting to meeting the standards without providing specific information unless required by random audit.
- Assessment of Knowledge, Judgment and Skills
Diplomates may demonstrate knowledge, judgment, and skills in one of two ways:
- A secure, computer-based, psychometrically valid examination. The MOC examination is composed of multiple-choice questions on fundamental knowledge, up-to-date practice-related knowledge, and other issues such as ethics and professionalism. The current exam cycle is ten years. A diplomate may take the MOC exam up to two years before the required time without affecting the required date for the subsequent exam.
- Longitudinal Assessment Pilot Program (CertLink™). CertLink™ periodically delivers Nuclear Medicine questions with detailed explanations and references directly to diplomates. Based on adult learning theory, CertLink™ questions and explanations provide repeated exposure to relevant information as a way to test and expand knowledge.
- Improvement in Medical Practice
Improvement in Medical Practice demonstrates commitment to patient centered care that improves quality. Physicians can meet this standard in one of three ways:
- Attestation that diplomates participate in quality improvement activities as part of routine clinical practice, such as participation in a peer review process, attendance at tumor boards, or membership on a radiation safety committee. The list of approved activities can be viewed by clicking here.
- Participation in a Practice Survey. Each year the ABNM releases a practice survey related to approved clinical guidelines. The survey has several questions based on review of actual cases. Diplomates receive a summary of the answers provided by other physicians that allows them to compare their practice to peers. The practice survey can be accessed by clicking here.
- Improvement in medical practice projects designed by diplomates, or provided by professional groups such as the SNMMI. Project areas may include medical care provided for common/major health conditions, physician behaviors, such as communication and professionalism, as they relate to patient care, and many others. The projects typically follow the model of Plan, Do, Study, Act. The ABNM has developed a few IMP modules for the SNMMI, Alternatively, diplomates may design their own project.
Diplomates must complete one of the three requirements each year. Diplomates with no clinical responsibility can write to the ABNM, firstname.lastname@example.org, and request a waiver of the Part 4 requirement.
Participation in MOC
The ABNM expects all of its diplomates, including those with lifetime certificates, to participate in MOC. The ABMS displays information on whether diplomates are participating in MOC on a public ABMS website (www.certificationmatters.org).
Three-year Grace Period
At the beginning of each calendar year, the current year requirements are added to each diplomate’s record. By the end of the year, the ABNM expects each diplomate to meet the standards. However, there is a three-year grace period before a diplomate is considered to be not participating in MOC. At the end of the year, a diplomate who is more than three years behind in payment of fees, or meeting the standards of Parts 1, 2, and 4, is not participating in MOC. If a diplomate is not participating in CertLink, or the MOC exam is not taken in the year required (Part 3), the diplomate is also not participating in MOC.
Diplomates who are not participating in MOC at the end of a calendar year will no longer be listed as “Participating in MOC” on the ABMS website. Diplomates with time-limited certificates will be listed as Not participating in MOC”. Diplomates with non-time-limited certificates will be listed as “Participation not required.”
CertLink™ and MOC Examination Eligibility
Diplomates must meet all MOC standards to be eligible for CertLink™ or the MOC Exam:
- Annual MOC fee, including past due amount, must be paid.
- Diplomates must be current with all MOC standards.
Re-entry to Certification
Diplomates with expired time-limited certificates must meet all MOC standards, and take the MOC examination within 5 years of expiration. After 5 years, the diplomate must meet all MOC standards and pass the certification examination instead of the MOC examination.
After re-entry to certification the diplomate must continue to meet MOC standards.