Neurologists and psychiatrists who take the recertification examination in 2007 will face new requirements under the maintenance of certification process.
Starting next year, physicians taking the exam will need to have completed 30 hours of specialty- or subspecialty-specific category 1 continuing medical education credits. Over the next 10 years, that requirement will grow to 300 hours of CME over a 10-year period.
Other new requirements will be phased in over the next few years, according to Katie DiOrio, a spokesperson for the American Board of Psychiatry and Neurology (ABPN).
The American Board of Medical Specialties began developing the maintenance of certification process several years ago, and the basic requirements—evidence of professional standing, self-assessment, and lifelong learning; demonstration of cognitive expertise; and evaluation of performance in practice—apply to all 24 medical specialty boards. The ABPN is still working out the details of the self-assessment activities and performance-in-practice modules, including how to provide the tools for ABPN diplomates to fulfill these components. “Maintenance of certification implementation is really in its infancy,” Ms. DiOrio said.
Among other requirements, starting with the 2010 examination year (applications for which are due in 2009), diplomates will be required to have completed at least one major self-assessment activity during the 10-year cycle.
Neurologists already have some approved options in this area. For example, they can complete the postreading questions from the American Academy of Neurology's Continuum or complete the program modules from AAN's Quintessentials.
The self-assessment requirement was originally scheduled to go into effect next year but was postponed. ABPN officials also wanted more time to approve additional programs for diplomates to use in fulfilling the component, said Ms. DiOrio.
In an effort to gather information about how many physicians have started using self-assessment tools, board officials are asking physicians to note on their maintenance of certification applications any self-assessment activities that they have completed, she said.
The other new requirement being phased in as part of the new maintenance of certification process is a performance-in-practice component, which is aimed at evaluating whether a physician has participated in performance improvement activities over the 10-year cycle. Beginning in the 2013 examination year, neurologists and psychiatrists will need to complete one module in this area. Three modules will be required by the 2017 cycle.
Each module will include chart review of five cases from a specific diagnostic category, along with feedback from either five peers or five patients seen in the past 3 years. To complete each module, physicians also will be required to compare clinical case data with published practice guidelines or with their peers and obtain feedback on their performance and on how to improve the efficiency or effectiveness of their practice. Physicians will also need to develop a plan to improve their performance.
Within 24 months of the original assessment, physicians will be asked to reassess their practice using five different cases in the same diagnostic category and to get feedback from either at least five peers or at least five patients.
The performance-in-practice component is likely the least understood of the maintenance of certification requirements, said Dr. Ralph F. Józefowicz, chair of the AAN's education committee and a professor of neurology and medicine at the University of Rochester (N.Y.).
So far much of the feedback from physicians about the process has been negative, Dr. Józefowicz said. While the aim of this and other components of the maintenance of certification process is to improve quality, physicians understand that there is no guarantee that following the requirements will translate into better care, he said. “It's really a very big unknown.”
As a result, officials at AAN are focusing on trying to develop tools that will make the requirements as helpful and painless as possible for physicians. AAN is currently working to develop a Web-based tool for the performance-in-practice component that would allow neurologists to plug in their chart information and evaluate their care against AAN guidelines.
AAN officials plan to pilot test the online tool in 2008 and have it available to physicians in 2010. The academy is also developing a Web-based tool to aid neurologists in completing the new self-assessment requirements.
That tool is expected to be available for physician use next spring, said Dr. Józefowicz, who will become one of eight neurology directors on the ABPN in January.
In addition to the new requirements under maintenance of certification, physicians will continue to be required to pass a cognitive recertification examination every 10 years and hold an unrestricted medical license in at least one state.
More information on maintenance of certification in neurology is available at www.abpn.com.
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