Explore the history of rheumatology certification to understand the events that have led to today's discussion.
1971: ABIM Introduces Rheumatology Subspecialty: The first ABIM Rheumatology examination is administered.
1990: ABIM Introduces Time-limited Certificates: All new rheumatology certificates issued during or after 1990 are time-limited, requiring a MOC exam every ten years. Certificates issued prior to 1990 remain lifetime certifications.
1990 – 2013: ABIM MOC Program Continues to Evolve: ABIM introduces MOC points, practice assessment, and approves MOC points for society-developed medical knowledge and quality improvement activities. ACR develops MOC educational activities to ensure rheumatologists have opportunities to earn MOC points while participating in activities that reflect a rheumatologist’s scope of work.
2014: ABIM Introduces a More Continuous MOC Program requiring all physicians with time-limited certificates to complete 100 MOC points every five years, as opposed to the previous ten-year timeline. Additionally, these physicians will have to earn some of their activity points at least once every two years. ABIM announces they will begin to publically report whether or not physicians are “Meeting MOC Requirements” in place of awarding the current 10-year, time-limited certificates. Patient feedback and patient safety modules are also introduced and the ABIM fee structure is increased.
2014: ACR Begins to Advocate for MOC Reform: Based on concern expressed by ACR members ACR joins with ACP and 13 other internal medical subspecialty societies to outline collective concerns about the MOC program to ABIM. See an update on ACR's 2014 ABIM MOC advocacy efforts.
February 2015: ABIM Releases “We Got It Wrong. We’re Sorry” message: The ACR is encouraged by the reflective tone of the ABIM's announcement to modify its MOC program and in a letter to the ACR membership stated “the immediate suspension of the Practice Assessment, Patient Voice, and Patient Safety requirements for at least two years is a step in the right direction. However, there is still much work to be done.” See a message from ACR on ABIM MOC changes.
August 2015: ACR Releases MOC Position Statement based on Membership Survey: In a collaboration between ACR leadership and its members the ACR releases a position statement outlining areas ACR members believed should be considered as a part of MOC reform including: (1) allowing physicians to develop and implement a continuing professional development plan relevant to his/her professional roles and responsibilities; (2) eliminating the secure, closed-book, high stakes MOC examination, because it is not an appropriate means of assessing clinical knowledge or decision-making for the purpose of recertification; (3) eliminating Practice Assessment, Patient Voice, and Patient Safety requirements as they are redundant with existing requirements. The statement also addressed the redundancy of physicians being required to obtain both CME and MOC medical knowledge credits, the need to reduce program costs, and desire for evidence that the program is improving physician competence. See a press release on ACR's Physician-Driven Position Statement on ABIM’s Maintenance of Certification Requirements.
September 2015 – September 2016: ACR Continues to Advocate for MOC Reform: ACR leadership meets with ABIM leadership, ABMS leadership, and internal medicine societies and responds to ABIM’s Assessment 2020 Taskforce Report. ABIM announces they will further suspend the Practice Assessment, Patient Voice, and Patient Safety requirements in its MOC program through December 31, 2018 and gives top priority to changing the MOC exam. A revised ABIM Rheumatology MOC blueprint is released. See ACR's MOC Response.
September 2016: ABIM Announces Possible Changes to the 10-year MOC examination: ABIM sought the community’s feedback on an additional option to the 10-year secure ABIM MOC examination. ABIM proposed a new assessment consisting of either a 2-year pathway or a 5-year pathway that would be launched in 2018, alongside the current 10-year secure MOC examination.
September 2016: ACR Surveys Membership about ABIMs Proposed Changes: Overall, of the ACR members who responded to the ACR survey, most were not supportive of either a 2-year pathway or a 5-year pathway as proposed. Comments included: (1) proposed ABIM modifications represented minimal change; (2) did not reflect the current practice of medicine; (3) no opportunities for education of knowledge gaps and learning. See ACR Letter to ABIM.
September 2016: ACR Representatives Provide Feedback to ABIM: During an ABIM Liaison Committee on Certification and Recertification meeting 26 societies presented their preference for the two ABIM proposed models. Consistent with direct feedback obtained from the membership survey, the ACR stated neither model was adequate, which was similarly expressed by a total of 17 societies. The main concern was that the two proposed ABIM models were not different enough from the current model, and it appeared that the ABIM had taken the 10-year exam and proposed to offer it every 2 or 5 years. Those societies that selected the 2-year or 5-year pathway stated the need for additional information before confirming their choice, e.g., information on cost, decision on open-book, and reassurance that “more frequent” would not be more burdensome. See ACR Letter to ABIM on Assessment Models.
November 2016: Dr. Baron, ABIM President and CEO, Attends ACR Board of Directors Meeting: ACR expressed extreme concern that the medical societies’ feedback and the ABIM’s actions are disparate. The ACR advocated for seven key issues including that ABIM consider recommendations to approve meaningful open-book access, introduce unobtrusive security features for assessments completed at home, offer immediate remediation, provide detailed feedback reports that allow physicians to recognize and address knowledge gaps, and transparent pricing with the new assessment. See ACR Letter to ABIM on Assessment Models.
December 2016: ABIM Announces Plans to Release the 2-year Knowledge Check-in Assessment Option: The 2-year Knowledge Check-in option will be available for internal medicine and nephrology in June 2018 alongside the current 10-year secure MOC examination. In addition, ABIM announced both the 10-year and 2-year options for internal medicine and nephrology will offer “open-book” access meaning physicians will have access to certain UpToDate® resources during the exams. The 2-year knowledge check-in option for rheumatology, with limited access to UpToDate®, is scheduled to be released in 2019. See ABIM's MOC FAQs.
December 2016: ACR Expresses Concern that ABIM’s 2-year Knowledge Check-in is Not Different Enough from the 10-year Exam: In an effort to support rheumatologists in their commitment to lifelong learning ACR continues to meet with ABIM and other internal medicine societies to expedite more meaningful MOC change. ACR establishes an MOC taskforce to examine all options. See ACR Letter on Knowledge Check-in.
January 2017 – August 2017: ACR MOC Taskforce Actions: In response to the ABIM’s changes and concern expressed by ACR members, the ACR MOC taskforce begins to further analyze the impact of the changes on rheumatologists and their patients as well as the approach to MOC being taken by other member boards within the American Board of Medical Specialties (ABMS). A shared interest in immunologically mediated disease led the ACR taskforce to contact the American Board of Allergy and Immunology (ABAI) to learn more about their MOC program. Of specific interest to the taskforce was the continuous assessment program being launched by ABAI in 2018 that is a longitudinal summative assessment based on recently published medical literature and general knowledge questions. This program appears to address many of the learning goals directly expressed by ACR members while also providing a meaningful model for rheumatologists to demonstrate continual professional development with the application of evidence-based standards.
September 2017: ACR and ABIM Leadership Meeting: ACR leadership discusses the feasibility of piloting a program similar to ABAI model. ABIM responded that summative assessment based on recently published medical literature and general knowledge questions does not align with ABIM’s MOC principles.
November 2017: ACR’s Board of Directors Meeting: Based on taskforce recommendations and discussion with ABAI and ABIM the ACR Board of Directors determine the goals that are at the core of the ABIM principles of physician certification are meritorious. However, the fact that ABAI and other ABMS member boards have developed alternative certification approaches suggests that there are other ways to align with the principles and the ABMS standards.
In an effort to address membership concerns about MOC, ACR Board of Directors requested ACR representatives begin to have more detailed discussions with the ABAI. Discussions have included the feasibility, advantages, and disadvantages of moving rheumatology to ABAI and forming a new combined board of Allergy, Immunology, and Rheumatology. As initial certification and MOC cannot be offered by separate boards, the conversation has expanded beyond MOC to include the initial rheumatology certification.
February 2018: ABAI Representatives Meet with ACR Board of Directors: Based on taskforce recommendations and further discussion with both ABAI and ABIM, the ACR Board of Directors determined that the next appropriate step was to engage the rheumatology community in a discussion related to the future of rheumatology certification (which would include both initial certification and MOC). This information would then be used to decide whether a proposal should be submitted to the ABMS to request that rheumatology certification be moved from ABIM to ABAI with the formation of a new combined board of Allergy, Immunology, and Rheumatology.
June 2018: ACR Initiates Discussion: Rheumatology Board Certification: Exploring Change
June 2018: ACR Releases Survey to Rheumatology Community
January 2019: ABIM Rolls Out Knowledge Check-In: In response to physician requests for a more flexible, lower-stakes Maintenance of Certification (MOC) assessment option, ABIM rolls out the Knowledge Check-In (KCI) in eight disciplines, including rheumatology. This alternative assessment to the traditional 10-year MOC exam allows rheumatologists to take a shorter exam from their home, office or test center if they choose, along with access to UpToDate as an external resource.
January 2022: ABIM Launches the Longitudinal Knowledge Assessment: ABIM launches the Longitudinal Knowledge Assessment (LKA™), which builds on many of the most well-received features of the KCI. Rheumatologists participating in the LKA can take questions without needing to go a to a test center, can use all their personal resources, and receive immediate feedback for most questions. The traditional, 10-year MOC exam remains an option for rheumatologists who prefer it.