ABMS Approves Article-Based Alternative to 10-Year Exam

The American Board of Medical Specialties (ABMS) last month approved the American Board of Psychiatry and Neurology’s (ABPN) Article Assessment Pathway as a permanent alternative to the secure, proctored 10-year Continuing Certification examination.

The alternative assessment will be modeled on a pilot project, launched in 2019, in which eligible candidates who chose to participate in the pilot were required to read a minimum of 30 articles but no more than 40 articles. They then had to answer four out of five questions correctly on the first attempt on a mini-exam for each of the journal articles they had chosen.

Diplomates choose from a library of articles selected for the test by test-writing committees. These committees include nominated members from the ABPN, APA, the American Academy of Child and Adolescent Psychiatry, the American Academy of Neurology, and the Child Neurology Society.

Developing an alternative to the 10-year exam has been an APA priority in negotiations with the ABPN because of member dissatisfaction with the Maintenance of Certification (MOC, which the ABPN is now calling “Continuing Certification”).

“Psychiatrists will now have an alternative to the 10-year MOC exam,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “It provides more flexibility by allowing diplomates to select articles that are relevant to their practice and to read the articles and complete the tests at their own pace. The pilot project using the article format has met with approval among psychiatrists who have participated in the project, and the 10-year exam will still be available to those who prefer it.”

Under the pilot project, only general psychiatrists and child and adolescent psychiatrists were eligible to participate. ABPN President Larry Faulkner, M.D., told Psychiatric News that in 2022 the new format will also be open to candidates in geriatric psychiatry, addiction psychiatry, forensic psychiatry, and consultation-liaison psychiatry.

“We believe that our article-based approach is more consistent with strategies that have been shown to promote enduring lifelong learning,” Faulkner told Psychiatric News. “It is also consistent with the manner in which many, if not most, ABPN diplomates maintain their knowledge to provide quality patient care. Most important, it is gratifying to see that most diplomates who participated in our pilot project reported that they were satisfied with the process and that reading the required articles was helpful to their practices.”

Articles are accessed online through an ABPN portal, and diplomates may refer to the articles when answering questions. Once a mini-exam is opened, diplomates must answer all questions before they can access subsequent mini-exams. Mini-exams can be completed in multiple sittings.

Candidates can access any articles at no cost that are from APA journals, and APA provides CME credit—American Journal of Psychiatry, Focus, and Psychiatric Services.

Diplomates enrolled in the journal-based alternative to the 10-year exam must still meet all other Continuing Certification requirements to maintain their certification.

For all ABMS specialties, MOC involves a four-part process that has been the source of wide discontent among physicians. They say that the requirements are burdensome, costly, and not relevant to their clinical practice. These are the four components:

• Part I: Professionalism and Professional Standing

• Part II: Lifelong Learning (CME), Self-Assessment, and Patient Safety

• Part III: Assessment of Knowledge, Judgment, and Skills

• Part IV: Improvement in Medical Practice (also known as Performance in Practice, or PIP)

Comprehensive information about MOC and the activities that can fulfill requirements for each of the four parts is posted on APA’s website at psychiatry.org/moc.

Ranga Ram, M.D., chair of the APA Caucus on MOC, said caucus members agree that the creation of an alternative to the 10-year test is a “step in the right direction.” He added that there is a diversity of opinion among caucus members and that some do prefer the 10-year exam.

But Ram said he and other caucus members believe the entire four-part process is flawed, citing the cost and complexity of the process as principal complaints. He said that the cumulative cost of the new Part III Article Assessment Pathway, which needs to be repeated every three years, will still be burdensome to members, particularly if they have to purchase articles from publishers who have them behind a paywall.

“We are pleased that there is an alternative to the 10-year proctored exam, but ultimately we would like to see APA take over the role of monitoring and assessing lifelong learning,” he said. “It is research published in APA journals that produces the knowledge by which lifelong learning should be assessed. The ABPN can still be the certifying body and charge a reasonable fee, but we would like to see our own organization doing the assessments.”

At a meeting in July with APA leaders (including Ram), Faulkner said the ABPN would consider a proposal for an alternative to the current continuing certification process but was noncommittal about approving it. “If the ABPN does receive a proposal, it will be given due consideration at that time,” Faulkner said (see Psychiatric News).

Tristan Gorrindo, M.D., chief of APA’s Division of Education, urged members to visit the APA website for information about Continuing Certification and to contact APA with questions about the new Article Assessment Pathway.

“We think this is a great first step, and we will continue to work with the ABPN to ensure that those who have subspecialty certification can access this program and to simplify the process for those who are double or triple boarded,” he said. ■