Zen and the Art of Pediatric MOC cycle : Don't Tailgate!

Zen and the Art of Pediatric MOC cycle : Don't Tailgate!

Posted by Stu Silverstein, MD, FAAP on Mar 28th 2021

I recently heard about a pediatrician, who procrastinated as long as he could to put his toe into the uncertain waters of the “MOC” process until the deadline for “enrolling” in the MOC process was less than a month away. That pediatrician was me!

Peds MOC deadline

I not only had to put together the book used by so many of our colleagues, but I also have to go through the process myself. I can tell you the latter is much more difficult. It is much easier to teach and preach than to perform.

I invite those of you who are and/or will be going through the MOC process in the coming weeks to join me on what I hope will be a humor-laden description of this confusing process which will cover more than merely preparing for an exam. That isn’t to say that preparing for and taking a proctored exam is an easy task for us working stiffs who spend all day helping patients and then answering to the needs of a family when we get home. Many of us have not taken an exam since Bill Clinton was actually the president, and not a hired gun giving speeches at the DNC.

For most of you, this process will begin with a good news/bad news letter. The good news is you have been given 2 more years to prepare for the proctored exam.

The bad news is you will have to enroll in the MOC process, and go through MOC cycles” to maintain your certification. The proctored exam is just one part of the on the MOC–cycle trip. The MOC process is not a cheap one and proportionately higher for us pediatricians who cannot compete with our more fortunate procedure reimbursed colleagues. We will cover that in future blogs.

Circling the Cycle:

Part 1: Professional Standing – Also known as having a valid medical license.

Part 2: Knowledge Assessment: Differentiated into 2 subcategories[1]

  • Knowledge Self Assessment – 200 online questions, which you don’t even have to pass to get credit.
  • Decision Self Assessment – 50 multiple choice questions based on patient cases , this time you have to get a passing grade

Part 3: Cognitive Expertise: Also known as the proctored exam, or the big test, the one you had to take every 7 years and now have to take every 10 years while MOC cycling.

UPDATE: Most candidates are now selecting the Peds MOCA process a quarterly timed, open source exam. 

Part 4: Performance in Practice: This is the part that had and still has me as confused as an octogenarian staring at iPod®. As of this writing I am still not clear on what the heck we are expected to do. This is not a simple matter of answering questions online or even preparing for and taking an exam. This involves something along the lines or doing a quality improvement study in your practice.

I began reading this, and flies began landing on my eyes without my noticing while I reviewed the 2 choices for fulfilling this requirement which were:

  • Established Quality Improvement Projects: Where you collaborate with other groups and practices. Lots and lots of moving wheels.
  • Web Based Improvement Activities: These seem to be off the shelf activities conducted within your practice and presumes you will want to do this with in conjunction with the other physicians in your practice.

The other day I tried to make sense of this part of the MOC process. I stared and read it over and over until my mind went blank. The next thing I remember was sitting at Brazilian Steakhouse and some guy named Raul was serving me sliced Turkey from a cutting board at my table. I guess I was so traumatized that I must have suffered retrograde amnesia. [2] Therefore I will have to cover this in greater detail when I return to this part of the MOC requirement as I tackle it myself.

Coming Attractions

In the future, patient surveys will be added to the mix. Yes! Patient surveys handed out to parents who will provide their opinion of communication style and availability. It is not yet clear if you will have to hand this out randomly, or cherry pick your favorite patients for their input. As if there aren’t enough challenges, practicing medicine will become American Idol where you will have to perform for a panel of judges. What’s next? Patients commenting on your doctoring skills on your Facebook® wall and hitting “Like” buttons?

We will keep you posted when and if you will have to face such a tribunal!

For me the process began with what seemed like a bombardment of some 300 email and snail mail letters that I ignored until I realized those ignored letters is not good for my professional standing with the board. I was also thankful that the ABP has not discovered Facebook® or Twitter® where I would sure to face the electronic equivalent of being placed in the public stocks.

Qualify to Enroll

I had until December last year to “qualify” to enroll in the MOC process, s I finally took the first steps to “qualify” for the enrollment process. Up until that moment, as the author of “Surfing your Way to Recertification”, I have been receiving calls, emails and, yes, Facebook messages from friends asking about the process. Much to my shock, when replying to my friends, I found myself stammering and changing the topic to the weather or local traffic reports. Until then I couldn’t give first hand advice and guidance.

In order to qualify I had to get through Parts 2 and 4. Part 1, providing proof that I had a medical license which was easy enough. Then again, if you don’t have a medical license why would you be going through all of this torture?

Over the coming weeks, we will muck through the MOC process together. Unlike the ABP, we actually are familiar with Facebook ® and Twitter®, and I invite you to “like” us on Facebook and “follow our Tweets” on Twitter®. We also want to note that this blog and our materials will help you get through and demystify the process. [3]

[1] Which makes this all even more convoluted and confusing, since they are 2 activities why not just assign them each an independent number. ?

[2] Folks, this was inserted the sake of humor, it didn’t really happen so please do not write us to let us know that you had the same experience, as you might be better served seeking psychiatric assistance if that is the case.

[3] We are not here to provide inside information on questions asked on the exam, answers to the questions, or otherwise reveal any other part of the MOC process, or the exact areas of knowledge that will be tested. We do welcome general feedback and shared experiences going through the process, but are not looking for nor will we be accepting such exam specific information.