The most significant new issue facing the American Board of Anesthesiology (ABA) and its diplomates is the transition under way by all American Board of Medical Specialties (ABMS) member boards to move from static, one-time certification to ongoing maintenance of certification with a defined cycle length. The newly inaugurated program for Maintenance of Certification in Anesthesiology (MOCA) is designed to be easy to enter with simple requirements often already being done by the diplomate. It is Web-based and requires little paperwork. The MOCA program elements and the examination are clinically oriented, and MOCA meets ABMS and other regulatory body requirements.

Maintenance of Certification
Since 2000 ABA has awarded only a time-limited certificate (TLC) that expires in 10 years. In January 2004, ABA launched MOCA so TLC diplomates can maintain their certification status. MOCA is a 10-year process consisting of lifelong learning and self-assessment (LL-SA), ongoing assessment of professional standing, periodic assessments of practice performance and passing an examination of current knowledge. These four activities taken together are designed to provide assessments of the six general competencies for physicians, which are espoused for medical school, residency and postgraduate competency. The six general competencies are: 1) patient care, 2) medical knowledge, 3) practice-based learning and improvement, 4) interpersonal and communication skills, 5) professionalism and 6) systems-based practice.

To maintain uninterrupted certification status, TLC diplomates must register for MOCA within the year following either their initial certification or their completion of a prior MOCA cycle. Registration is available online through the ABA Web site <www.abanes.org> as is the reporting of the 350 credits for LL-SA, 250 credits of which must be Accreditation Council for Continuing Medical Education category 1. Up to 100 LL-SA credits may be for activities for which category 1 credit is not awarded. Diplomates are encouraged to complete some LL-SA activities in each of the six general competencies for physicians. LL-SA credits are subject to audit by ABA.

Professional standing will be assessed by the collaboration of the Federation of State Medical Boards with ABMS to provide ABMS member boards with monthly status updates of any final actions regarding diplomates’ state medical licenses. In addition all ABA diplomates now have the affirmative obligation to advise ABA of any and all restrictions placed on any of their medical licenses and to provide ABA with complete information concerning such restrictions within 60 days after their imposition. Diplomates discovered not to have made disclosure may be subject to sanctions on their diplomate status.

Practice performance will be assessed periodically during each MOCA cycle by obtaining attestations from persons in the diplomate’s professional environment who can confirm that the diplomate meets the minimum clinical activity requirements as well as attest to evidence of practice evaluations at the local level. Attention also is given to patient safety and practice improvement. Satisfactory professional standing and practice performance and completion of 200 of the 350 LL-SA credits are prerequisites to assessing cognitive expertise by passing an ABA examination administered via computer under secure, standardized testing conditions. The examination may be taken no earlier than the seventh year of the 10-year MOCA cycle.

It is the responsibility of every MOCA registrant to assure that ABA receives all required information and payments in a timely manner to facilitate their maintenance of certification status.

MOCA for TLC Diplomates Certified Between 2000-03
Diplomates issued TLCs from 2000 through 2003 will have less than 10 years to complete MOCA before their certificates expire. The LL-SA credits required both prior to taking the examination and to completing MOCA are prorated for them. Diplomates with TLCs issued from 2000 through 2003 may consult the ABA Web site and click “MOCA Program Frequently Asked Questions” for specific information on the prorating schedule.

Diplomates With Non-Time-Limited Certificates
ABA diplomates certified prior to the year 2000 received certificates without an expiry date. Externally imposed federal, state and local initiatives, however, may require documentation of updated qualifications. The voluntary recertification program established by ABA in 1993 to provide non-TLC diplomates with documentation of updated qualifications will not be offered after 2009. Until 2009 non-TLC diplomates may enter either the voluntary recertification program or the MOCA program. After 2009 MOCA will be the only option for documenting updated qualifications.

Because MOCA is a 10-year cycle, non-TLC diplomates who do not voluntarily recertify before 2009 could be left without an expeditious way to meet an externally imposed requirement for updated qualifications. Thus a one-time expedited program has been developed and is only available to non-TLC diplomates, permitting them to complete their first MOCA cycle in as short a time as 12 months after registration for MOCA. This expedited process for non-TLC diplomates requires reporting of 350 LL-SA credits in the immediate prior 10 years, satisfactory professional standing and practice assessments and passing of the secure examination after those three requirements are met. Delay in passing the examination may result in the requirement for additional updating of LL-SA activities and additional professional standing and practice assessments. After completing the one-time expedited MOCA cycle, the non-TLC diplomate could immediately register to enter a subsequent standard 10-year MOCA cycle in order to maintain documentation of updated qualifications without lapse into the future.

Updating Qualifications in Critical Care and Pain
MOCA programs do not yet exist for the anesthesiology subspecialties of critical care medicine and pain medicine. Holders of TLC certificates in critical care medicine and pain medicine should continue to register for and pass the recertification examinations in critical care and pain medicine prior to the expiry dates of their subspecialty certificates in order to maintain their certification status without lapse. While application for initial anesthesiology subspecialty certification in critical care and pain medicine requires current certification in anesthesiology, application for recertification in critical care medicine and pain medicine does not require current primary certification in anesthesiology; for example, if the applicant is limiting his/her practice to critical care or pain medicine. In addition, beginning in 2004, the recertification examinations in critical care medicine and pain medicine will be given on a separate day from initial subspecialty certification and will permit the recertification applicant to eliminate 25 percent of the questions without penalty in recognition of the particulars of ongoing practice profiles.

Other Matters
Fee separation for initial certification. In response to inquiries by the ASA Resident Component as well as the ASA Committee on Residents and Medical Students, ABA is inaugurating a separation of the fees for the written and oral components of ABA certification, beginning with those who register to initially enter the examination system for the written examination, which will be administered in 2005. Information about the fee structure and submission deadlines will be available in the ABA “Booklet of Information” published in spring 2004 and made available on the ABA Web site at that time.

Misrepresentation of ABA status. Unfortunately a very few non-ABA-certified individuals have misrepresented their status with respect to certification by way of falsified documents with the ABA trademark ABA has and will aggressively defend the integrity of its trademarks, which may include but not be limited to available legal and financial remedies, restrictions upon subsequent entrance into its examination system and notification of any state medical licensure boards known by it to have licensed the individual.

Patricia A. Kapur, M.D., is Professor and Chair, Department of Anesthesiology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California.