It is said that time is perhaps the most treasured asset we have. If you are a practicing oncologist, everyone wants more and more of your time, and I’m not referring to patients. Rather, there is an increasing proliferation of folks who want to make sure we’re doing a good job, and they are imposing external oversight and mandatory training. External groups are measuring and requiring a great many things, and expanding “regulatory” tasks consume more of our time than ever before. Training required by institutional review boards, hospital-based infection control and safety modules, continuing medical education (CME) requirements from the state, and more are layered on our workday seemingly without anyone counting the hours necessary to do these things.
What I really want is continued meaningful education that will make me a better oncology physician, teacher, team player, and administrator. Like many physicians, I think of myself as a self-starter, motivated to keep learning both because it is necessary to keep up and because it also can be fun. But over time I have realized it is more and more difficult to sort out the best literature and to develop what might be the most useful personal curriculum.
It is also clear that to provide optimal oncologic care in the future, I will need to learn more about how best to shape my work setting for efficiency and patient-centeredness. Oncology care is a team event, and communication pathways, group function, and the handling of increasing amounts of clinical data will be as important as how much I remember about the results of the latest phase III clinical trial. Systems-based practice skills will be as important as my traditional medical expertise.
Two types of documents—my state medical license and certificates from the American Board of Internal Medicine (ABIM) for Internal Medicine and Medical Oncology—serve as validation for the public, my affiliated hospital, my employer, and health insurance companies, confirming that I am qualified to work as an oncologist, at least as defined by those review mechanisms. To maintain my state license, I must complete a certain amount of CME activities with appropriate documentation on a regular basis. I can collect CME credits by attending my department’s weekly Medicine Grand Rounds, and I do so, though oncology topics are uncommon and I attend in large part for “citizenship” reasons, ie, to support the department and serve as a role model for house staff.
More attractive are the developing systems for maintenance of certification (MOC) in my own specialty. In recent years, there has been vigorous debate in the literature regarding the state of maintenance of certification, with concerns about relevance, financial cost, time cost, and the effort needed to maintain certification from the American Board of Internal Medicine. A few articles summarize well the issues in this conversation and are worth reviewing to understand the history and issues.1-5
Key elements required for the ABIM-based maintenance of certification in both Internal Medicine and Medical Oncology include licensure, self-assessment and CME, cognitive expertise, and performance in practice.6 For many of us, doing something related to assessment or improvement in our practice can be the most cumbersome. Practice settings are more “corporate” than ever, and making changes that influence the overall business can be difficult.
There is general agreement that we need some kind of system offering guided, structured, lifelong learning; that the system be highly relevant to what we do in our professional lives; and that it be built and controlled by oncologists rather than outside agencies. A consistent concern in the maintenance of certification debate relates to how meaningful and relevant the assessment and testing tools are to the practicing oncologist. With this in mind, I think we are fortunate in having available the tools being developed by ASCO to enhance maintenance of certification in medical oncology. I refer specifically to the components of ASCO University and the Quality Oncology Practice Initiative (QOPI®).
Lisa Johnson, MHS, MT(ASCP)SC, Director of the Department of Integrated Media & Technology at ASCO, describes ASCO University as an oncology e-Learning site and online educational home. The MOC Overview (university.asco.org/ascouniv-MOC) is a great place to start when planning your maintenance of certification schedule. It is a resource that has grown and improved dramatically over the past 2 years and is now a preferred resource, not only for fellow training but also for those out of training at any age. Disease-oriented content continues to expand, and ease of website navigation is steadily improving in response to ASCO membership suggestions. A variety of educational modules are available online, including some specifically geared toward maintenance of certification (eg, breast cancer, lung cancer, and ethics).
Through the QOPI program, ASCO also continues to develop meaningful and highly relevant measures of practice quality.7 It is important to remember that the practice performance assessment can be one of the more intimidating and challenging elements of maintenance of certification. QOPI is ideal for this activity as the only oncology-specific program approved by the ABIM as a data source for practice performance. I have worked with QOPI with two fellowships and two attending groups, and I can confirm that its potential as an educational and practice improvement tool is outstanding.
Our Baystate multispecialty clinical practice group of nearly 500 physicians is piloting innovative division-oriented incentive plans. Our cancer program is QOPI-certified, and our Hematology-Oncology Division has successfully convinced senior leadership we should use elements of QOPI to incentivize our group financially in one of the pilot programs. QOPI will be a natural mechanism for assessing practice success and creation of improvements.
Maintenance of certification is in a transition-and-development phase in all medical areas, and as oncologists we are well positioned, with ASCO ahead of the game in having developed an exciting e-based resource (ASCO University) and a growing practice assessment and improvement structure (QOPI). ASCO is also well situated to develop navigator tools to assist us in creating maintenance of certification timetables, guide us to the right resources, and enhance our lifelong learning. We all need to learn better how to budget time for these activities. As our maintenance of certification “concierge,” ASCO can be a great help in this effort. ■
Disclosure: Dr. Stewart reported no potential conflicts of interest.
Dr. Stewart is a medical oncologist at Baystate Medical Center in Springfield, Massachusetts.
1. Cassell CK, Reuben DB: Specialization, subspecialization, and subsubspecialization in internal medicine. N Engl J Med 364:1169-1173, 2011.
2. Levinson W, King TE: Enroll in the MOC program as currently configured. N Engl J Med 362:949-950, 2010.
3. Goldman L, Coroll AH, Kessler B: Do not enroll in the current MOC program. N Engl J Med 362:50-52, 2010.
4. Steinbrook R: Renewing board certification. N Engl J Med 353:1994-1997, 2005.
5. Johnson DH: Maintenance of certification: Confession of a grandfather. J Oncol Pract 8:203-204, 2012.
6. American Board of Internal Medicine: Maintenance and recertification guide. Available at www.abim.org/moc/default.aspx. Accessed April 18, 2012.
7. McNiff KK, Bonelli KR, Jacobson JO: Quality Oncology Practice Initiative Certification program: Overview, measure scoring methodology, and site assessment standards. J Oncol Pract 5:270-276, 2009.