What is Maintenance of Certification (MOC)?
In 2001 the American Board of Medical Specialties (ABMS) voted unanimously to expand on and replace recertification programs with Maintenance of Certification (MOC) programs – more comprehensive programs 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
In the past, the certification process required successful completion of an Accreditation Council for Graduate Medical Education (ACGME) approved nuclear medicine residency educational program, an unrestricted medical license as evidence of professional standing, and passing the certification examination. Diplomates certified since 1992 have been required to recertification every at a regular interval. Since 2007, nuclear medicine professionals can no longer simply take an exam; instead they must participate in all of the components of MOC.
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 Eligibility and Certification
In keeping with ABNM principles and definitions, and to effect harmonization with ABMS recommendations, the following classifications will be applied to nuclear medicine practitioners. 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 required 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 additional requirements of their certification. All other practitioners are Not Certified by the ABNM. The categories of Certified practitioners are based on status and activity in Maintenance of Certification (MOC) including:
- Participating in MOC: This designation applies to both time-limited and non-time-limited ABNM Certified practitioners who meet the current ABNM standards for active MOC participation.
- Not Required to Participate in MOC: This designation applies to non-time-limited ABNM Certified practitioners who do not meet the current ABNM standards for active MOC participation. The ABNM expects all diplomates to participate in MOC.
Not ABNM Certified
This designation applies to all practitioners who are not actively Certified. Time-limited diplomates who are not participating in MOC are not certified. The “Not ABNM certified” includes:
- Board Eligible: This designation applies to a practitioner who has not previously achieved ABNM certification, who has completed the required training and experience in nuclear medicine within the prior 7 years, who has not failed the Certification Examination 3 times, and who has been recommended for examination to ABNM by an ACGME accredited nuclear medicine training Program Director.
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 requirements.
There are four components of MOC. To participate in maintenance of certification, nuclear medicine physicians should annually update their contact information, their professional profile, progress on Parts 1, 2, & 4, and pay the MOC fee. In addition they must periodically pass a secure exam, Part 3.
1. Professionalism and Professional Standing (formerly, Professional Standing)
ABNM’s Policy on professionalism is described in a separate document. Currently, professional standing is documented by an unrestricted medical license.
2. 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 credits per year,
- which include a minimum average of 17.5 credits related to Nuclear Medicine,
- which in turn include a minimum average of 8 self-assessment credits per year.
Since correlative imaging is an essential part of Nuclear Medicine, any correlative imaging credits are considered to be Nuclear Medicine specific. 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 Nuclear Medicine specific.
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 a Lifelong Learning & Self-Assessment Program (LLSAP) that allows 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 SNM, 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 opt-in to the CME-gateway, SAM, SA-CME, and other CME credits will be recorded automatically in your profile in the ABNM website.
3. Assessment of Knowledge, Judgment and Skills (formerly, Cognitive Expertise)
Knowledge, judgment, and skills are measured on a secure, computer-based, psychometrically valid ABNM MOC examination. The MOC exam 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.
4. Improvement in Medical Practice (formerly, Practice Performance Assessment, PPA)
Improvement in medical practice projects should be chosen to assess and improve the physician’s own practice. 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. ABNM documentation of participation in Improvement in Medical Practice (IMP) began in 2011. The SNMMI has developed a few IMP modules, and is actively developing additional modules.
Projects are divided into three “activities”:
- Select, and measure
- Analyze, plan, and improve
- Re-measure, and analyze
These activities correspond to Stages A, B, and C of type 6 (Performance Improvement Continuing Medical Education, PI-CME) of the AMA PRA Category 1 Credit™. The ABNM requirement is to complete one activity each year. The first year after certification, this requirement may be fulfilled by a special activity, learning about quality improvement.
Improvement in medical practice can be documented by participation in IMP (formerly PPA) modules that have been approved by any ABMS board. A list of IMP modules approved by the ABR can be found on the ACR website listed above. Note: The ABR calls IMP projects PQI projects. Alternately, a diplomate may design his/her own project.
Diplomates with no clinical responsibility can write to the ABNM, ABNM@ABNM, and request a waiver for the Part 4 requirement.
More detail on PPA projects and resources for projects is provided in Guidelines for PPA Projects.
Participation in MOC
The ABNM expects all of its diplomates, including those with lifetime certificates, to participate in MOC programs. Participation in MOC will likely have increasing importance to state medical licensing boards, credentialing committees and payers in the future. The ABMS began publicly displaying information on whether diplomates were participating in MOC on the ABMS website (www.certificationmatters.org) in August 2011.
Starting dates for MOC participation are:
- Contact information: 2006 or the year of certification
- Practice profile: 2006 or the 1st year after certification
- Part 1, Professional Standing: 2006 or the year of certification
- Part 2, Lifelong Learning and Self-assessment: 2007 or the 1st year after certification
- Part 3, Cognitive Expertise: the 1st MOC exam is
- Non-time-limited diplomates (certified 1972-1976): 2015
- Non-time-limited diplomates (certified 1977-1986): 2016
- Non-time-limited diplomates (certified 1986-1991): 2017
- Time-limited diplomates (certified 1992 -): 1 exam cycle after certification
- Part 4: 2011 or the 1st year after certification
- Annual MOC fee: 2006 or the 2nd year after certification (there is no fee during the 1st year of certification)
The Parts 2 and 4 requirements are cumulative over a five-year period. The annual MOC fee is cumulative from the start of the fee requirements.
Three-year Grace Period
At the beginning of each calendar year, the new year’s requirements are added to each diplomate’s required credits. By the end of the year, the ABNM expects each diplomate to have eliminated any gap between required and achieved credits. However, there is a three-year grace period before the diplomate is considered to be not participating in MOC. A diplomate who is more than three years behind in contact information, professional profile, Parts 1, 2, and 4, or fee at the end of the year is not participating in MOC. If the MOC exam (Part 3) is not taken the year required, the diplomate is 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.
MOC Examination Eligibility
To be eligible for the MOC Exam:
- the diplomate must be participating in MOC
- contact information and practice profile must have been updated within the past twelve months
- Part 1 must be up-to-date the year of the exam
- all annual MOC fee must be paid.
Diplomates, who have met the MOC requirements but have not documented them on the ABNM website, re-enter certification by updating the ABNM website.
Diplomates with time-limited certificates who do not pass the MOC exam by the required time are no longer listed as certified. After 5 years, the diplomate diplomate must pass the certifying exam instead of the MOC exam.
Re-entry to certification
- Diplomates who are not certified for 5 or fewer years can have their certification re-instated by passing the MOC exam. Except for current certification, the MOC exam eligibility is as described above.
- Diplomates who have not been certified for greater than 5 years must take the Certifying Exam instead of the MOC exam. The requirements to take the Certifying Exam are the same as for taking the MOC exam except for the MOC fee. The reentry exam fee equal to the MOC fees over one exam-cycle, less any fees paid during the cycle.
After re-entry to certification the diplomate must participate in MOC. The next MOC exam will be scheduled for one exam-cycle after the re-entry exam.