Self-Assessment Lifelong Learning Assessment of Performance in

Self-Assessment, Lifelong Learning, & Assessment of Performance in Practice: Maintenance of Certification for Family Physicians Parts II &IV David Price, MD Colorado Permanente Medical Group Associate Professor Family Medicine UCSHC Chair-elect, American Board of Family Medicine Med. Biquitous April 2007

MOC l l Response of ABMS & member boards to quality concerns & gaps Multiple stakeholders (patients, FSMB, AMA, ACCME, physicians, etc. )

Components of MOC (MC-FP) Professionalism Periodic self-assessment (SAM*) I. II. • • • Knowledge assessments (KA*) Clinical Simulations (Clin. Sim*) CME Cognitive expertise (Examination) Practice-based learning & improvement III. IV. • • PPM MIMM Pt-Clinician Communication Pt Safety module

Extend Certification From 7 to 7+3 Years l l Old: 6 SAMs + 1 PPM then exam year 7 NOW: Diplomates engaged/remaining in MCFP process can extend certificate to 10 years by completing MC-FP requirements in 3 blocks: l l 2 SAMs + 1 PPM per 3 year block x 3 blocks with exam in 10 th year.

Part II (SAMs + Simulations) l l l 2004: DM, HTN 2005: CAD, Asthma 2006: Depression, Heart Failure 2007: Well child care, Pain management 2008: Health behavior change, Maternity care Eventual choice from about 20 modules

SAM: Diabetes Mellitus Diagnosis 5 quest. Recognition/mgmnt. macrovasc. Compl. 10 quest. Recognition/mgmnt. microvasc. Compl. 10 quest. Non-pharmacologic mgmnt 5 quest. Pharmacologic mgmnt 15 quest. DKA/HONK mgmnt 5 quest. Clin. Impl. Insulin resistance 5 quest. Prevention 5 quest.

ABFM Self-Assessment Modules: Completion Time

Changes Resulting from Diplomate Input l l Questions printable for initial completion off line (“pre-test”) Only incorrectly answered questions appear upon completion On-line full text references for questions Direct link to references from questions

CME Process vs. QI cycle Price D. Continuing medical education, quality improvement, and transfer of practice. Medical Teacher 2005; 27(3): 259 -268. l Needs assessment l Objectives l Implementation l Evaluation l Follow-up l Plan l Do l Study l Act

Part IV l Patient-based, physician controlled improvement model (HTN, DM, CAD, asthma, depression, HF) l l l 6 or more quality indicators per condition Practice audit 10 charts/patients Feedback vs. peers & benchmarks Select area(s) for improvement Develop QI plan (from a “QI wizard”) Re-audit (PDSA) 10 charts/patients

I hope this has been an eye opening experience