Moving the Goalposts

“Please stop moving the goalposts.” That was the request of a colleague who attended the ABO’s Learning Lounge session on Maintenance of Certification (MOC) at the American Academy of Ophthalmology annual meeting in Chicago this past October. There is no denying that much has changed at the ABO during the past couple of years – and that much change is afoot. And there is no doubt that change sometimes can be uncomfortable and annoying. So, please allow me to explain why moving the ABO goalposts is both appropriate and desirable.

First, a quick review, starting with this forum: Diplomate Digest. We hope that you find this blog helpful in keeping you abreast of board-related news relevant to your practice. Suggestions for improvement, such as topics you would like to see covered, are welcome.

Although the ABO’s primary mission is not education per se, but rather to verify competence via assessments of knowledge, judgment, and skills, we are partnering with the Academy’s EyeNet magazine to feature periodic case studies on patient safety and with the American Ophthalmological Society to conduct an annual symposium at the AAO meeting featuring “must-read” articles from the recently published scientific literature.

Speaking of assessment, approximately 90% of our diplomates who have opined prefer the new Quarterly Questions program for MOC over the DOCK examination, which will be phased out at the end of this month. As with any new venture, the 1.0 version launched in early 2017 was not perfect and we are working hard to improve the product with each quarterly installment. Your suggestions have been greatly appreciated and your collaboration will be critical to ensure the program’s long-term success.

Many of you have told us that the Improvement in Medical Practice component of MOC has been challenging, time-consuming, and oftentimes not relevant to your everyday practice. To respond to your concerns we are expanding the menu of activities that you can pursue, and in some cases hope to be able to recognize and reward quality improvement activities in which you already are engaged. Through a collaboration between the ABO and the Academy, we applaud those of you who have been able to leverage the IRIS Registry to receive MIPS credit while simultaneously meeting MOC activities and enhancing the care you deliver to your patients.

The ABO is committed to being inclusive and representative of the diplomate community. To that end, there now is a certification pathway for internationally trained ophthalmologists if they have practiced in the United States for at least five years, achieve passing scores on the ABO written and oral examinations, and complete MOC requirements. As regards the ABO reflecting the diplomates we represent, 44% of the candidates who sat for the 2018 Written Qualifying Examination were women, and in about five years, if current trends continue, more women than men will be entering our specialty. The ABO leadership mirrors these changes; in 2019 seven of our 16 Directors will be women. As the diversity of the ophthalmic community increases, the ABO strives to represent its constituency accordingly.

Another goal to which we are committed is to steward our finances with transparency and integrity. The ABO recently achieved a platinum rating from GuideStar as a demonstration of this aim. Furthermore, to decrease operational costs, the ABO has transitioned from the physical office where its staff has worked since 1980 to a “virtual office” model in which staff work from their homes. We plan to pass on achieved savings to candidates and diplomates by maintaining our fees as low as possible.

What’s next? One major change in progress is to compress the timeline between residency graduation and achieving board certification. Currently, approximately half of newly graduated residents can become certified in 15 months whereas the other half cannot sit for the Oral Examination until almost two years after completing residency. Over the next two years we will transition the schedule such that a graduating resident will be able to take the Written Qualifying Examination just three months later and, if successful, undertake the Oral Examination the following March, less than nine months after finishing residency. Additionally, after decades of conducting the Oral Examination in hotel rooms, starting in March 2020 we will be moving to a venue where the examination can take place in a more professional, office-like setting.

So what about those goalposts? One thing’s for sure – not a single person with whom I’ve spoken, once s/he has become certified, wants the bar lowered or the distance between the uprights widened. Understandably, everyone wants the credential, once earned, to have value. By making changes in the certification process, the ABO is trying to keep standards appropriately high while improving the conditions in which candidates and diplomates pursue the goal. Our goal is for everyone to succeed.

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