By Sahar Pastel-Daneshgar and Richard Wiggins, MD
This article discusses an academic experience, tips and tricks for expanding or getting started with MOC/CC Part 2 credits especially into RSS.
About us. The University of Utah Continuing Medical Education (UUCME) Office is part of the University of Utah School of Medicine. UUCME has Accreditation with Commendation from the ACCME and are ABMS Portfolio Program Sponsors. The UUCME is a decentralized office, meaning we work with planning partners to provide CME credit. We do not provide conference or planning services. Currently, we accredit 150+ RSSs, 100 courses, 100+ enduring materials, and 3-7 PI-CME each year. Since all our physicians must be board-certified, helping our learners maintain/continue their board certifications is important to our office.
MOC/CC Program. We communicate often that all board-certified providers without lifetime certification (or lifetime certified providers that have opted into MOC/CC) are required to participate for MOC/CC to ‘maintain’ or ‘continue’ certification. We find there is often confusion about MOC/CC and try to help clarify for our providers. For more information about ABMS and certification, see https://www.abms.org/board-certification/
We provide MOC/CC Part 2 credit for all boards aligned with ACCME. Each of the boards has additional specific requirements for what their diplomates must do. The ACCME produced a helpful Program Guide that details each of the boards’ requirements, found here: https://www.accme.org/publications/cme-for-moc-program-guide We reference this document often! Additional resources from ACCME are also helpful, here: https://www.accme.org/cme-counts-for-moc
UUCME offers many options for MOC/CC Part 2 through our already approved CME activities. We’ve had great success integrating MOC/CC Part 2 into our Regularly Scheduled Series (RSS), in particular. We have effectively increased the number of RSSs at our institution with MOC/CC Part 2 from 19 (with 2,876 credits) in 2019, to 34 (with 5,124 credits) in 2021.
Lessons for CPD Practice
- Communication. Help providers understand MOC/CC, and that it is required of board-certified providers without lifetime certification. They are already doing most of the work for CME, so why not get those cookies?
We started by identifying activities that were already including the required MOC/CC components in their activity with engagement strategies like case discussion. We wanted to give them credit for the work they were already doing (get those cookies!). Since the self-evaluation engagement piece is already occurring, adding MOC/CC only meant adding a statement and a tracking mechanism. The educational design components, often the most difficult for us to change, were already in place.
We’ve found people are often intimidated by MOC/CC and by talking it through, outside of email or documents, helps show how straightforward it can be. And, where the complexities might lie! We’re also able to chat about what people might already be doing that we can tweak to count for MOC/CC Part 2. Once we were able to demonstrate that we could make it easy for planners and diplomates, with just a few additions into what they are already doing, we started to get planners who wanted to include the credit.
- Ease of use. Use clear templates to reduce work for series and your office. Connect the value of MOC/CC credit to work they are already doing.
After we started with our initial series, we increased our efforts to reach out to various departments that may be interested in adding MOC/CC to their RSS events. We started by surveying all RSS directors of their interest in adding MOC/CC Part 2 into their series with our annual evaluation process. Then we asked the learners. Finally, we followed up with the interested activities. Recently, we’ve begun reaching out one-on-one to departments directly, explaining MOC/CC and why it might be beneficial for planners to include MOC/CC Part 2 in their activities. We targeted specific departments based on the number of diplomates within our system as well as the ease of implementing MOC/CC. We have presented at department faculty meetings using a templated presentation about the importance of MOC/CC and how it can easily be added to current CME-approved RSS events.
Some Boards such as ABA or ABPath, can easily be added to an RSS that is already meeting the requirements for CME credit. We also have many interdisciplinary RSS with multiple areas of care covered in the same activity, sharing expertise across specialties (e.g., surgery and internist or pediatricians and anesthesiologists). If the learners of an activity cross boards, we offer credit for all the applicable boards. Multiple boards can be accredited and submitted to for a single activity and encourage multidisciplinary approaches for improved learning opportunities.
The element of all the board’s requirements that tends to trip up planners the most is providing feedback back to learners from their engagement. We’ve found case discussion, which most of our activities were already including, to be the easiest mechanism for both assessment and feedback, where the feedback is the on-going conversation. Zoom chats can also work, as long as someone is providing feedback during the session. We’ve experimented with polling functions but found our planners soon lost track of writing questions for weekly sessions. With the size of our office and the small number on our team added to our busy planners’ schedules, we couldn’t include things that would require additional work outside of the RSS sessions, like requesting planners to review reflective statements and then provide individual feedback. We were concerned more intense strategies like that wouldn’t get completed in the busy day-to-day of our system. Our strategy has been to focus on what activities are already doing for engagement and feedback of their learners.
- Follow-up. Follow up on adding MOC/CC, especially when it first starts until there is a good rhythm, use follow up to help clarify any issues, questions, or concerns, and to build a relationship with that series.
Once you’ve added MOC/CC Part 2 into a series, follow-up is needed to ensure it takes hold. Just like for CPD providers, MOC/CC can seem daunting at first for the RSS coordinators and directors we work with. But, it will work; and it will become routine. So, we follow-up to be sure they understand what’s needed, check-in often in the beginning, and work to make it as easy as possible for the planners to integrate the additional requirements into their activities. Typically, those additional requirements are adding statements, gaining permission from diplomates and tracking participation in the MOC/CC engagement component.
Wherever possible, we’ve developed quick, easy, and reproducible templates to share across RSS for integration. We’ve created an easy online survey for diplomates to provide their permission and board information. Adding statements has become part of our CME statement block and is checked within our usual CME process.
For tracking completion of participation, we have tried several methods. We had a few series try to do poll engagement with survey questions for each session that learners would complete, and we’d use the read out from that poll as tracking. We have had series track participation via zoom chats, which has worked as long as the presenter could comment to give feedback to learners. By far, though, what we have found most successful is providing a simple spreadsheet for CME coordinators to check off during their session as diplomate learners complete the engagement requirements. The coordinators then send us their “pass tracking” Excel file and we confirm credit has been awarded. This simple approach, completed digitally and emailed, has been the most manageable idea we’ve come up with so far.
For large functions we keep in mind that the number of diplomates is typically much smaller than the full number of participants. For some of our larger in-person courses, that also include MOC, diplomates are asked to sit in one section of the room as a group so ‘tracking’ is easier. We’ve also allowed for self-reported tracking to the CME coordinator, whereby a diplomate who engages during the session checks in with the coordinator on the way out of the learning space and confirms that they did engage in the discussion.
Once a series transitioned to virtual or hybrid formats, we reviewed how to continue offering MOC to series with a large number of attendees at each session. For these RSSs, the speaker is instructed to ask a case-based question related to the presentation and learners respond to each question via the virtual chat feature. The speaker provides a brief moment for learners to respond after the question is posed, and then the speaker will immediately give feedback as to the correct answer and why. The learner’s answer(s)–right or wrong–satisfies the MOC requirement for learner self-evaluation. For this method all physician learners must have their name visible in their profile so they can be matched to their individual response. The entire session chat is saved as the “pass” tracking mechanism by the series coordinator or moderator running the virtual RSS. In turn, the chat is sent to the CME office.
To keep things as easy as possible, we’ve developed several templates to guide us and keep us consistent. Our most used templates include:
Email template for reaching out to offer MOC/CC to RSS
MOC/CC permission collecting survey
MOC/CC passing tracking
Follow-up email template
Organizational MOC/CC Sheet
These templates can be found here:
Overall, we have found the experience of adding MOC/CC Part 2 into RSS to be beneficial for our providers, helpful for our planners, and even a little bit fun! If you are new to the MOC process, our best piece of advice is to just try it. Pick one board and one activity and see how it goes. Then refine and try again. Sound familiar? Plan-do-study-act – just be sure to get to that Do. And share with us what you learn along the way.
Sahar Pastel-Daneshgar is MOC/CC Coordinator and Richard Wiggins, MD is Associate Dean at the University of Utah School of Medicine, Continuing Medical Education Office.