Wednesday, December 1, 2010

MOC, SAMs, and CME, Oh My!

Maintenance of Certification is a veritable alphabet soup.

I vowed not to blog for a couple of weeks, because I have lots of SAMs to catch up on at night by December 31st. Self-assessment modules, that is. You see, in the age of MOC, it is not enough just to go to conferences and perform the CME (Continuing Medical Education) that has been required by pathologists throughout the ages. I was part of the lucky class to be the first group required to participate in MOC. Maybe in other fields MOC has already been in place, but in pathology it just started four years ago. So now, as a part of CME, we have to find and purchase activities that mandate a pre and post test. Not only that, but we also have to get peer reviews and prove that we are part of a QA/QC (quality assurance and control) activity at our hospital. I haven't figured out exactly how to do that yet, but as the head of microbiology I do attend the QA/QC meetings once a month so I am hoping that will do.

Luckily, SAMs were waived for the first three years, because they were not well set up or readily available. I spent about three hours on the computer last week searching for, and paying for SAMs activities. I have to read 10 journal articles from a respected path journal and pay (did I already mention the pay?) to take pre and post tests.

I was sharing my finds with my co-hort who is a year behind me today, and lamenting over the fact that each module took at least half, if not all of the hour of credit that I received at the end of the testing. Aside from conferences, I am used to these CME activities that my group participates in taking a mere fraction of the time rewards doled out. You know - 20-30 minutes for 5 hours. Another one takes about an hour for 10 hour credits. Now I need to spend about an hour a night to get all caught up by the deadline. Don't get me wrong - I think keeping up with one's field is paramount to being a good professional, I just resent being forced to do it someone else's way and document it meticulously. For me, it takes the fun out of it.

I am currently collecting documents for Phase 2 of reporting. I completed Phase 1 a couple of years after passing my general boards. I had a heart-stopping moment this summer when I received a call from the American Board of Pathology. It was August - I had just sold my house, had six weeks to find another, and was facing the same time frame until my divorce trial. The intercom went off in my office.

"Dr. Shyder, you have a call from someone from the American Board of Pathology. Do you want me to put them through?"

"What? The American Board of Pathology?" At first I thought surely it is a hoax to get me to talk to some salesman. But if it was a trick, it was a new one. I asked her to put them through.

"Dr. Shyder, this is so-and-so from the American Board of Pathology. You were supposed to report MOC for your fellowship at the end of January. We have been trying to get in touch with you by e-mail for months."

"Oh my gosh! I've had a rough year. I'm usually really good at keeping up with these things, I promise. What does this mean? Is my fellowship license in jeopardy?"

She seemed amused, but reassuring. "No, we just need to update your professional e-mail address." I had accidentally given them .edu instead of .org. "Then you have to fill out a form requesting combined MOC reporting for your fellowship and your general boards, fax it to us, and nothing will be due until the end of the year."


Anyone else have any MOC headaches to share? I'm not looking forward to the board-like exam in six years to continue my AP/CP (anatomic and clinical pathology) board certification. Luckily I do it all at my job - I can't imagine how hard it would be if I had settled into a national lab job reading only GI biopsies or pap smears. But still - combined boards was hard enough when I had just completed my residency and was used to stuffing massive quantities of numerical and graphic facts into my brain like what platelet aggregation patterns flag Von Willebrand's disease vs. aspirin effect and the numerical likelihood of a unit of blood containing different transmissible diseases. Now, if asked to interpret these tests or dole out this information, I can just look that stuff up - I've got it at my fingertips. I sure hope the MOC boards are open book.


  1. "You know - 20-30 minutes for 5 hours."

    Payback for spending 4 hours a week in lecture and 6 hours in lab for organic and only getting 4 credit hours out of it.

  2. Aaaack! I am studiously trying to ignore the fact that my first 3-year MOC cycle is coming due at the end of the month. I haven't lifted a finger yet.

    What a huge hassle, and what a huge scam. The whole certification process is built around money. All this, on top of everything we have to do every day and all the CME requirements. Not to mention the meetings we have to attend to keep up our professional memberships. It just plain makes me mad.

    I'm all for staying current (as I've pointed out in a recent post), but like you, Gizabeth, I resent having to jump through these hoops. Time-consuming, expensive hoops!

    I'm convinced that the people who came up with this crap are the same ones who came up with the new and "improved" surgical time-out. I hope you are reading this, whoever you are, in your suit and clipboard...

    Maybe the NEJM will publish a study about the effectiveness of MOC that will show it has no effect on surgeon performance and patient outcomes, just like the new study showing all the "patient safety" measures have made... NO difference in patient safety!

    Aaahhhhh. That felt good.

  3. I am knee deep in MOC as well and it is tough. I found myself taking at least 10 minutes each question just to get to the reference they cited for the question so I could find the ridiculously detailed answer that they wanted that NO ONE IN THE WORLD could possibly know without looking up. So far, I have completed 30 questions out of 50. And that is just one module. Yikes

    The good news is that my job picks up the tab for the MOC, so I started early. But the cost is ridiculous as well!

  4. Don't even get me started. Family Medicine has been doing this MOC nonsense for several years, and not only is it a pain in the posterior, it also sucks money out of our CME budgets. I've done two of the miserable things plus one 'Practice Improvement" module and it hasn't made me one bit better. It's just made me mad, like gcs15. We've had regular recertification exams ever since I've been boarded, which were waste of time and money as well. I think our board, being not content to steal my money every 7 years uses MOC (which was invented by a bunch of ivory tower types/government wh-excuse me, prostitutes who haven't touched a patient in years) to steal my money every year. And all in the name of "improvement."Great gig if you can get it.

  5. Michael - that's a great way of looking at it! And makes me feel a little less guilty.

    gcs15 - Thank YOU! For the anger. I feel so isolated in my struggle right now - there is no one around me going through it - and I hesitated in being overly pissy about the whole thing. I am really frustrated. I'll be waiting for that study - kind of like the one that blew Vitamin D supplementation out of the water today? Gotta love that. Maybe in a few years . . .

    Carrie - My group takes care of it too, but it comes out of my own CME fund, so I still resent it. I agree - the one SAM I did asked the craziest questions that had me scouring the article after I had already read it and gotten all the important points, looking for answers. Ridiculous, I agree!!

    mamadoc - love, love, love the comment. I am imagining a giant troll who spent a few years sucking off of others to publish research and be an academic superstar, only to retire in a cush administrative job and invent MOC torture for all of us out there in the trenches. Laughing and flying all over the world for free, supported by our MOC $$$. OK, I'm being a little crazy, but to echo gcs15 - Ahhhh. That felt good.

  6. We do need to be lifelong learners, and are also accountable to the public to demonstrate this. Learning in practice from the clinical questions that arise everyday is something we can "get credit" for nowadays (free sometimes, too, for 0.5 hours of internet point of care credit).

    How do you stay current and plan your learning?

    Also, see


    for a debate in internal medicine.

  7. Thanks, T - I read both of your links regarding ABIM MOCs and feel like they overall supported my current opinion and that of my colleagues above. If this MOC process is here to stay, it definitely needs refinement.

    I overwhelmingly agree with your first statement - that we should be accountable to the public for our continuing medical education. I think that as gcs15 above said - all the hours of CME logged in to maintain our boards and professional memberships support this. The MOC and SAMs, at least from my standpoint in pathology so far, seem to be micromanagement at its worst.

    I would be interested to know if I can get CME from my clinical practice - that would be fabulous. I am doubtful with my specialty.

  8. Not being in practice, I have no intention of dealing with this. Plus, I think I'm grandfathered (mothered?).

    But I have watched hubby go through this every 7 years. Ack.

  9. I get CME from UpToDate, the conferences that I already attend, etc. These are *generally* enough to meet my state licensing requirements.

    However I also have to read 10 ABEM-chosen articles each year and answer their crazy questions... plus do all the QI/QA assurance stuff (can't even remember the acronyms for that, it's a new requirement)... plus take the every-10-year board recert exam. At least there are no more oral boards (at least, not yet, give it time).

    I agree with all of you. I consider myself very uptodate on the literature; I work in academics, am 50% research, subscribe to 3 EM journals + 2 non-EM medical journals (and read them!). So all of this feels like just additional crap to add on my plate.

    (Oh, did I mention the risk-management-specific stuff I have to do to maintain certification at my hospital? And it can't be *any* risk management CME - it has to be "approved" AHEAD OF TIME by my hospital admin - !! Ugh.)

    I wish this were my area of research. I'd love to prove how useless it all is.

  10. The Mother - yes, you are grandmothered, as are all my pals a year ahead of me and beyond. Jealous! Looks like most grandparents are sneezing at the suggestion to voluntarily join MOC.

    MLR - You should see the risk management web based readings/tests I take to get discounts on my malpractice insurance. So hilariously not applicable to me. I love learning how to be a more effective (i.e. less litigated against) hospitalist, etc. - so very interesting!

  11. Ugh, this does not sound fun. More fun than organic chem lab perhaps, but not by much. ;)

  12. What a timely post. I am going though EXACTLY what you are going through. I just got by 10 SAMS completed and now look forward to spending time getting the paperwork ready for the ABP. Booo!!! This is such a pain.

    Anyway... I found out that the ASCP has has pretty decent tool on their website to keep track of all your CME and SAMS. With your yearly membership, you get a couple of CMEs that you can use for SAMS ( i think the number is 7).

  13. That remember.moc? I started doing that. I've got 6 under my belt. I'm glad I'm not the only one - good luck! Love your name. Gaucher's?

  14. Thanks.. seen in CML.Hemepath by trade and mother of 3.

  15. Oh yeah, Gaucher's is crumpled tissue paper histiocytes. I think I was thinking of one of those other storage diseases. Maybe Niemann-Pick? Oh, no, those board questions are escaping me . . . since I use that stuff so often.

    And of course, CML! I'm not certified in hemepath, but I do a lot, and it scares me to death, still.


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