Beginning with the January 2008 issue of Plastic and Reconstructive Surgery, Maintenance of Certification ™ in Plastic Surgery (MOC-PS) learning modules are available online through the Journal’s Web site (www.PRSJournal.com). The MOC-PS program represents a cooperative effort of the American Board of Plastic Surgery and the American Society of Plastic Surgeons. On behalf of the Society, Plastic and Reconstructive Surgery is proud to offer its MOC-PS continuing medical education articles. Modules offered by the Journal represent only a small part of the overall MOC-PS program offered by the Society. The Society provides numerous components of the MOC-PS program to its members, including a wide variety of MOC-PS–specific educational courses, documentation and record keeping of certification, additional MOC-PS–specific logistical assistance, and MOC-PS–specific consulting and other assistance.
MOC-PS learning modules will look familiar to Journal readers. They look similar to the regular continuing medical education articles in that they have learning objectives and multiple-choice questions. Each MOC-PS article, derived from the MOC-PS tracer module outlines, is meant to be a clearly defined, succinct overview of a specific topic. A total of 20 MOC-PS articles will be offered in the online Journal in 2008: 10 in January and an additional 10 in April. Four specific subject areas are covered by these articles: comprehensive plastic surgery, craniomaxillofacial surgery, hand/peripheral nerve surgery, and cosmetic surgery.
Each of the four subject areas will have a total of five articles. The articles are very heavily clinically oriented and are not meant to be exhaustive or comprehensive topic reviews. The intended audience is the practitioner of 10 or more years. Successfully completing one of the MOC-PS online courses will satisfy the education component for part IV (performance in practice) and the continuing medical education credit will be applied to part II (lifelong learning and practice) of the MOC-PS program; successfully taking the Plastic and Reconstructive Surgery Maintenance of Certification ™ continuing medical education test will satisfy the PAC-PS continuing medical education requirement. Instead of taking a teaching course, Maintenance of Certification ™ participants can get their PAC-PS continuing medical education credit through these Journal articles, making the process easier and less expensive.
Every Maintenance of Certification ™ module article is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. Articles are prepared to accompany practice-based assessment of perioperative assessment, anesthesia, surgical treatment plans, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment and outcomes and complications with authoritative, information-based references. This information base is then used for self-assessment and bench marking in parts II and IV of the Maintenance of Certification ™ process of the American Board of Plastic Surgery. Articles are not intended to be exhaustive treatises on any subject; rather, they are designed to serve as reference points for further in-depth study by review of the reference articles presented.
HISTORY OF CERTIFICATION
Medical progress prior to the twentieth century was the domain of the generalist. Anatomy, surgery, pharmacology, basic science, human development—all were considered important and necessary subjects that needed to be “mastered” by medical doctors. Even today, medical schools provide a broad-based education to future doctors; mastery of a vast base of knowledge is necessary for the aspiring doctor, no matter his or her eventual specialty. Built on the foundation of a general biomedical knowledge is a superstructure of specialization. In the history of medical specialization, a seminal moment came in 1745 with the division of the barbers from the surgeons in England. The two guilds split into separate entities, with the Royal College of Surgeons receiving its Royal Charter in 1800. Throughout the eighteenth and nineteenth centuries, European systems of medical education remained pre-eminent; because of inconsistencies and educational deficiencies in their home countries, doctors from around the world would travel to Europe for advanced training.
In response to the weaknesses of medical education in the United States, the American Medical Association asked the Carnegie Foundation for the Advancement of Teaching to evaluate medical education in the United States in the early twentieth century. Abraham Flexner, educated at Harvard College and the University of Berlin, spent 2 years visiting every medical school in the United States to evaluate ways to improve the American medical education system. His widely influential report, Medical Education in the United States and Canada, published in 1910, provided impetus in developing the current system of medical education in the United States.1
Medical specialization began in earnest with advances in the basic sciences, medical technological advances, and growing numbers of physicians in urban settings; physicians were more able to specialize in distinct areas of medicine, and specialty societies developed.2 In 1916, the American Board of Ophthalmic Examinations was founded and offered its first board certification the next year. Soon, more medical specialty certification boards followed, including the American Board of Otolaryngology, the American Board of Obstetrics and Gynecology, and the American Board of Dermatology.
In 1933, the American Board of Medical Specialties was formed to help provide advice and oversight, and to help stimulate improvement in postgraduate medical education to the other board. Specialization in medicine led to specialization in certification, development of specialty boards, and specialty-specific competencies and certification schedules.
THE AMERICAN BOARD OF PLASTIC SURGERY, INC.
The American Board of Plastic Surgery, Inc. was organized in June of 1937 by representatives of various groups interested in this type of surgery, and it received recognition as a subsidiary of the American Board of Surgery in May of 1938. The American Board of Plastic Surgery, Inc. was given the status of a major specialty board in May of 1941 by action of the Advisory Board for Medical Specialties as approved by the Council on Medical Education of the American Medical Association, which has designated certain specialty fields as being suitable to be represented by specialty boards.3 The essential purposes of the Board are as follows:
- To establish requirements for the qualifications of applicants who request a certificate of their ability in the field of plastic surgery in its broadest sense.
- To conduct examinations of approved candidates who seek certification by the Board.
- To issue certificates to those who meet the Board’s requirements and pass the respective examinations.
- To do and engage in any and all lawful activities that may be incidental or reasonably related to any of the foregoing purposes.3
As with other specialty medical certification boards, the American Board of Plastic Surgery is not an educational institution, and certificates issued by the Board are not to be considered degrees. It is, rather, a certifying body, an entity that promotes uniform standards for plastic surgeons in the United States, serving both the patient and the plastic surgeon. The process for initial certification, whether in a specialty or subspecialty, involves a rigorous process of testing and peer evaluation that is designed and administered by specialists in that specific area of medicine. Successful candidates are awarded certification.4 Board certification serves patients in that it provides them with confidence in their surgeon; patients nationwide and worldwide know that board-certified plastic surgeons have undergone specific training, have continued in their education, and are up to date with the latest in their specialty. For the surgeon, certification by an American Board of Medical Specialties member board is widely recognized by physicians, healthcare institutions, insurers, and patients themselves as an essential tool to judge that a physician has the knowledge, experience, and skills for providing quality healthcare within a given specialty. It is considered the accepted standard because of its unique physician-directed approach for assessing qualifications.4
THE NEED FOR MAINTENANCE OF CERTIFICATION ™: THE DEVELOPMENT OF MOC-PS
Previously, achieving certification required successful completion of a single examination process in a particular specialty. Once completed, a physician could consider himself or herself as a “diplomate” or “board certified” in that specialty for the remainder of his or her career.5 When the process of certification was begun, physicians were awarded certificates that were not time-limited and therefore did not have to be renewed. In recognition of the pace of change in medical knowledge, a program of recertification through a periodic process (every 10 years) of continuing education in the specialty, credential review, and further examination was established by the American Board of Plastic Surgery in 2003 for those with time-limited certificates first issued in 1995. Realizing that this process cannot assess how a physician is evolving his or her knowledge and skills after the initial certificate or recertification is awarded, the Maintenance of Certification ™ program was created as the new accepted standard. Maintenance of Certification ™ requires proof of continuing education and experience in between testing for recertification.4 In other words, the measure of physician specialists is not merely that they have been certified but also how well they keep up to date in their specialty. That is why the American Board of Medical Specialties and the member boards developed a program involving continuous professional development called Maintenance of Certification ™ as a formal means of measuring a physician’s continued competency in his or her certified specialty and/or subspecialty, rather than merely passing an examination once every 6 to 10 years. Maintenance of Certification ™ is a response to the rapid pace of research and technological changes in the medical field and the drive toward improving the overall care and safety of patients.5
MOC-PS, THE PLASTIC SURGEON, AND PLASTIC AND RECONSTRUCTIVE SURGERY
The American Board of Plastic Surgery, in conjunction with the American Board of Medical Specialties, developed the MOC-PS with four components: professionalism, lifelong learning and practice assessment in plastic surgery, evaluation of knowledge, and performance in practice.
Each of these components has various assessment methods, each with its own documentation and timelines over the course of 10 years. The complete set of MOC-PS components, assessments, and frequency is available on the American Board of Plastic Surgery Web site (www.apblsurg.org) in the diplomate and then the MOC-PS program sections of the site. Although there are numerous components to the MOC-PS program, it is designed as a comprehensive and ongoing process. When the MOC-PS program is followed, there are no periods of “cramming” for an examination or a need to “hurry up” to get continuing medical education credits, because the necessary credits, study hours, self-assessments, and patient documentation have been conducted all along. The MOC-PS integrates self-assessment, practice self-scrutiny, and ongoing medical education into a lifelong process; the plastic surgeon is kept constantly up to date by following the MOC-PS program guidelines.
Plastic and Reconstructive Surgery serves as an essential requirement of the MOC-PS program by providing an assessment method under the lifelong learning and practice assessment component (part II) and the performance in practice educational component (part IV). This assessment method involves the plastic surgeon linking to an article for one Web-based performance in practice module (in years 3, 6, and 9 of the 10-year MOC-PS cycle), located at the Plastic and Reconstructive Surgery Web site (www.PRSJournal.com). As mentioned previously, these modules resemble the Journal’s traditional continuing medical education articles.
PLASTIC AND RECONSTRUCTIVE SURGERY’S MOC-PS CONTINUING MEDICAL EDUCATION MODULES
Plastic and Reconstructive Surgery serves as a provider of MOC-PS continuing medical education articles, all of which have undergone a series of quality-oriented steps to ensure their ultimate value to the plastic surgeon following the MOC-PS program. There are 20 separate module topics, aligned with the initial 20 tracer procedures offered by the American Board of Plastic Surgery. Authors for each topic were also recruited by the Board. Furthermore, the MOC-PS continuing medical education articles have a very specific outline (again, developed by the Board and its advisory councils), which guided the authors in the writing of the articles.
Plastic and Reconstructive Surgery solicited the specific MOC-PS articles. All MOC-PS articles have undergone rigorous peer review and revision. Upon resubmission of revised MOC-PS articles, each revision was re-reviewed. After acceptance, MOC-PS continuing medical education articles received a final review by members of the Journal’s MOC-PS committee. This MOC-PS Plastic and Reconstructive Surgery subcommittee, in many cases, requested further revision of MOC-PS articles. Lastly, as with all other continuing medical education articles published by the Journal, the MOC-PS test questions were submitted to the American Board of Plastic Surgery for quality assurance and validation; the MOC-PS questions are subjected to a validation process similar to that used for the regular continuing medical education questions.
MOC-PS articles are available on the Plastic and Reconstructive Surgery Web site (www.PRSJournal.com). As mentioned earlier, a total of 10 are available with the January 2008 issue; an additional 10 will be available with the April 2008 issue. All 20 MOC-PS continuing medical education articles will remain on the Journal Web site for 3 years. Plastic surgeons wishing to utilize these specialized articles to fulfill part of their MOC-PS (performance in practice MOC-PS, part IV) practice assessment module requirement will be able to access, read, and take the test online for a fee of $100/module. This price represents an inexpensive method for obtaining this requirement; using the Journal’s Web site-based MOC-PS continuing medical education program has the following benefits:
- No travel is required.
- No meeting or course registration is required.
- There is no practice downtime or time missed to take the assessment module.
- It is inexpensive.
- Immediate test results are given and test recording is sent to the American Society of Plastic Surgeons and the American Board of Plastic Surgery.
- Various choices of articles are available within each subject area.
We know that they represent the typically high-quality article that our readers have come to expect from the Journal, and we are pleased to offer them in a convenient, inexpensive, and technologically sophisticated way. We look forward to promoting the MOC-PS program to Journal readers in the future. We hope you find the Journal’s MOC-PS modules informative and useful in your ongoing learning activities.
The authors are grateful for the thoughtful contributions to this editorial made by R. Barrett Noone, M.D., Terri Cullison, R.N., M.S.N., and especially April Handley and Dan Sullivan.
1. Flexner, A. Medical Education in the United States and Canada.
Carnegie Foundation for the Advancement off Teaching, Bulletin no. 4, 1910.
2. Schrock, J. W., and Cydulka, R. K. Lifelong learning. Emerg. Med. Clin. North Am.
24: 785, 2006.
3. American Board of Plastic Surgery, Inc. Available at www.abplsurg.org
. Accessed August 7, 2007.
4. American Board of Medical Specialties. What board certification means. Available at www.abms.org/about_board_certification/means.aspx
. Accessed August 7, 2007.
5. American Board of Medical Specialties. Maintenance of Certification (MOC). Available at www.abms.org/about_board_certification/MOC.aspx
. Accessed August 7, 2007.