Richard G. Ellenbogen, MD, FACS
Professor and Chairman, Department of Neurological Surgery, University of Washington Medicine
Director, American Board of Neurological Surgery
Specialty boards, such as the American Board of Neurological Surgery (ABNS), were created as entities independent of the government and medical specialty societies to establish criteria and a process of establishing the competence of a specialist physician, known as “board certification.” During the 1990s, patients, insurers and many physicians challenged the concept of lifelong certification leading to the establishment of Maintenance of Certification (MOC) programs. While the 
goals of these programs are laudable, like many regulatory requirements, the cost and burden were often excessive with limited proven benefit. Organized neurosurgery, however, is leading the way with an innovative MOC program that shows how governmental regulatory criteria can be a win-win for neurosurgeons and patients they serve.
The goal of the ABNS Maintenance of Certification (MOC) program, is to foster excellence in patient care and thus improve the public health of the communities we serve. The ABNS directors built MOC on three principles:
- To ensure patient safety;
- To provide useful, evidence-based educational strategies for our diplomats; and
- To deliver these MOC products in a respectful, convenient and cost-effective manner to our busy diplomates.
The ABNS MOC program reflects the realities of today’s spectrum of neurosurgical practices. We have listened to the constructive suggestions of our ABNS diplomates and patients, making modifications that will benefit both.
The ABNS has designed a program that both supports continuing education that is tailored to the specific focused practice of our diplomates and one that effortlessly delivers updated “core” neurological surgery evidence-based knowledge in a yearly/continuous format. There are four parts of MOC as defined by the American Board of Medical Specialties (ABMS) and included in the ABNS MOC process.
- Part I: MOC reflects the ABNS’ dedication to professionalism in its diplomates. It provides a rigorous format to ensure public safety by documenting that all ABNS certified neurosurgeons have maintained hospital privileges and a state license, in good standing. The ABNS will contact the hospital chief of staff to establish this documentation directly, relieving this administrative burden from our diplomates.
- Part II: Fosters our diplomate’s dedication to lifelong learning and self-assessment. Each diplomate is required to earn 20 Category I CME credits/year of education tailored to their practice. We respect that each of our neurosurgeons learns differently and will wisely choose specific educational programs that benefit their practice and patients. There will be no prescribed or required CME component, as in the past.
- Part III: A novel way of assessing knowledge, skills and judgment. The key change in Part III is that the 2017 exam format is changing from a once a decade “all or nothing exam” to an annual “adaptive learning tool.” The “adaptive learning tool” will provide the new evidence-based information pertinent to the practice of neurosurgery in a user-friendly format. The new exam/tool can be engaged anytime during the year and will consist of multiple-choice questions accessible via the internet from the Diplomate’s computer 24/7/365. The exercise is tailored to update all ABNS diplomates’ “core” neurological surgery knowledge by focusing on new evidence-based concepts most critical to providing emergency, urgent or critical care for patients with neurosurgery conditions. The diplomate must master each concept provided before moving to the next one. Each correct and wrong answer will be explained with the adaptive learning tool, also providing the original peer-reviewed articles (primarily, Level I and II evidence). This ensures individualized education and skill mastery without the need for any preparatory courses or inefficient study.
- Part IV: Concerns the diplomates implementing improvement in medical practice. Completion of this component can be secured through participation in a regular institutional quality improvement conference. These programs provide the neurosurgeon critical analysis on how to provide safer patient care. In addition, the safety module required by each diplomate’s hospital will be completed as part of the ABNS MOC process, thus satisfying two requirements simultaneously.
The new ABNS MOC is a more workable solution to our current governmental regulatory guidelines. There’s no question that it’s of greater benefit to neurosurgery’s public safety mission, consists of more time efficient educational opportunities for our diplomats and it will help elevate our specialty to serve our patients better.
Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #RegRelief.
