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Maintenance of certification exam preparation and improving quality of primary care: the experiences of internists and family physicians.

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Gray BM, Chesluk B, Lynn L, Lipner RS. — American Board of Internal Medicine

Eden A, Hansen E, Peterson L. — American Board of Family Medicine

Presented: Academy Health Annual Research Meeting, June 2017

Research Objective: Understanding how preparation for Maintenance of Certification (MOC) board exams can impact quality and efficiency of patient care.

Study Design: We conducted semi-structured 45-60 minute interviews with 39 mid-career primary care physicians (19 general internists and 20 family physicians) who had recently completed their respective board's MOC exam. Interview topics included exam preparation method; time and other costs associated with preparation; clinical areas covered; whether studying led to changes in practice; and specific examples of those changes.

Physicians were recruited through an iterative process designed to maximize response rates and construct a sample representative of the population in terms of practice type, gender, age and attitudes about the MOC exam. Each week a sample of 40-60 randomly selected physicians from each board were sent up to four recruitment emails over the following seven days. As the study progressed, the characteristics of physicians sent emails were adjusted to enhance the match between our sample and the eligible physician population.

Interviews were conducted by trained qualitative researchers. Notes, recordings and transcripts were analyzed using a priori categorizations to extract information about exam preparation and impact on practice.

Population Studied: General internists/family physicians who reported spending at least 70% of their practice time in outpatient settings.

Principal Findings: All 39 interviewees devoted significant extra time and resources to studying for their MOC exam, beyond what they would normally do to stay current. Most began studying well before the exam (24 reported studying for at least three months for the exam, with 13 reported studying six months or longer). Interviewees generally used similar study materials, medical knowledge self-assessment programs and/or an exam review course, with some focusing on particular topics.

Did knowledge gained through studying affect quality of care? Thirty-one of 39 interviewees described examples from their practice of how knowledge gained through exam preparation seemed to improve quality and/or efficiency of care, including: improved diagnosis (better-focused criteria for diagnosing deep vein thrombosis); better understanding of guidelines (colon cancer screening, treatment of hyperlipidemia); reduced need for referrals and/or improved communication with consultants (less need to refer patients with some rheumatologic disorders, more thorough workups to accompany referrals); reduced unnecessary testing (fewer routine metabolic panels); changes in prescribing (knowledge about new antibiotics, anticoagulants and anti-depression/anxiety medications); and improved communication with patients (new approaches to communicating with cancer patients).

Specific instances of how studying for the exam changed care include an internist treating an underserved population who reported improved ability to “act as a specialist” for patients who lacked access to specialists, and a family physician whose knowledge gained about guidelines helped her explain to a patient that he did not need a colonoscopy.

Conclusions: Most physicians interviewed expended substantial effort studying for their MOC exam, and recalled numerous examples of how knowledge gained through this process seemed to improve quality and/or efficiency of care. Further research is needed to explore the extent and value of these practice changes across larger physician populations.

Implications for Policy or Practice: MOC exams add value by providing physicians with a stimulus for studying that leads to acquiring knowledge, which benefits their patients.

For more information about this presentation, please contact Research@abim.org.