FAQ IV: Questions About Diagnostic Radiology
What are the requirements?
As a time-limited certificate holder, what do I have to do for MOC? When did the MOC requirements "clock start ticking?" Is maintenance of cognitive expertise in all 11 ABR categories really viable for a practicing radiologist? What is the basic structure of the MOC program and requirements? What are the licensure requirements related to the first component, Professional Standing? What are the CME and SAM requirements related to the second component, Lifelong Learning and Self-assessment? What are the exam requirements related to the third component, Cognitive Expertise? What are the project requirements related to the fourth component, Practice Quality Improvement? If I am chosen for a random audit, must I achieve a compliance status before my certificate can be renewed? What if I am living and practicing in Canada, and participate in the Canadian Continuing Professional Development Program?
Responses
As a time-limited certificate holder, what do I have to do for MOC?
You are automatically enrolled in the program. To view your requirements, please visit the Timelines & Fees page of your area.
- Establish your Personal Data Base (PDB) page on the ABR's interactive web site. In order to do so, you need to have your ABR identification number and a confirmation code which you may obtain by contacting MOC division staff at the ABR office by phone, 1-520-519-2152, or by email at abrmoc@theabr.org.
- Keep your state license (if applicable) and personal contact information (mailing, phone number, email address) up to date - you may do this on your PDB.
- Begin accumulating CME and SAMs credits and start on your Practice Quality Improvement project.
- Frequently check the ABR web site for MOC information, SAMs availability, etc.
When did the MOC requirements "clock start ticking?"
Each diplomate's cycle began the day he or she earned a time-limited certificate. However, since the MOC program is being phased-in, the diplomates in this transition period will have prorated MOC requirements in lifelong learning and self-assessment, and in practice quality improvement; they must, however, fully satisfy the components of professional standing and cognitive expertise. Fees are likewise prorated.
Full lifelong learning and self-assessment (CME and SAM) requirements began in 2007, although credits earned earlier in a diplomate's cycle may also be counted. For lifetime certificate holders, credits earned up to one year before enrollment may be applied to MOC requirements. The number of credits required for a cycle ending in 2015 or earlier is calculated by multiplying the per-year recommended number of credits by the number of years from 2007 to the end of the cycle.
Practice quality improvement (PQI) requirements also begin in 2007. The steps to be performed each year are posted on the web site under "Requirements" for Part 4. Again, for cycles ending in 2015 or earlier, the requirements are prorated, and the diplomate is only required to do as many steps as there are years from 2007 to the end of his or her cycle.
Is maintenance of cognitive expertise in all 11 ABR categories really viable for a practicing radiologist?
In most instances, no. Diplomates achieve knowledge and skills as a prerequisite to their initial certification, and pass all categories and requirements of the board. MOC is designed to reflect the diplomate's unique practice and foster continuous professional development and improvement in patient care. Thus, the program has major self-directed and educational planning features to be developed by the diplomate around his/her practice profile and local needs assessment.
If a diplomate's practice is, for example, limited to two or three of the ABR categories, that person selects clinical SAMs in those practice areas. The computer-based examination will reflect that practice profile as well. The "practice-profiled" exam will consist of one noninterpretive skills content module (patient safety, life support, ethics, principles of image quality, etc.), and four clinical modules, selected to reflect the diplomate's self-reported practice profile. For example, a diplomate practicing 50 percent GI and 50 percent GU radiology would have two modules of each on his or her practice-profiled exam.
What is the basic structure of the MOC program and requirements?
MOC requires that each diplomate provide evidence of maintaining the essential competencies involved in delivery of quality care, which extends beyond medical knowledge. It is designed to evaluate, on a continuous basis, the maintenance of the six essential competencies via a four component structure. The six ACGME/ABMS MOC competencies:
- Medical knowledge
- Patient care
- Interpersonal and communication skills
- Professionalism
- Practice-based learning and improvement
- Systems-based practice
The four MOC Components:
- Professional Standing
- PLifelong Learning and Periodic Self-assessment
- Cognitive Expertise
- Practice Performance
A task force of the ABMS and the Accreditation Council for Graduate Medical Education (ACGME) developed generic principles - the six competencies - relevant to resident and fellow education for all medical specialties. All 24 ABMS member boards have accepted and endorsed this model. The four components of MOC were developed by the ABMS after several years of consideration, and all four must be present in every member board's MOC program. The ABR has interpreted the ABMS guidelines in developing the requirements in a manner relevant to diagnostic radiology and its subspecialties.
What are the licensure requirements related to the first component, Professional Standing?
This part requires valid, unrestricted licensure to practice medicine in all states in which the diplomate holds active license. If any disciplinary action is taken against any of a diplomate's state medical licenses, the diplomate has an obligation to inform the ABR of the action within 60 days. The ABR checks reports of disciplinary action from the Federation of State Medical Boards on an ongoing basis.
If I have a restriction applied to my license/certificate to practice, what must I do?
You must notify the ABR immediately and provide details about the restriction. Diplomates have the affirmative obligation to notify the ABR of any and all restrictions placed on any of their medical licenses, and to provide the ABR with complete information concerning such restrictions within 60 days after their imposition. The ABR will also receive notification from the Federation of State Medical Boards. Revocation, suspension, surrender (or retirement) in lieu of further state investigation/action, are considered by the ABR to be serious actions and sufficient grounds for revocation or suspension of the ABR certificate. State actions including probation and restricted licensure are also of concern to the ABR, and may be followed up by the ABR in terms of potential consequences for certification. Please refer to the Professional Standing Policy for details.
What are the CME and SAM requirements related to the second component, Lifelong Learning and Self-assessment?
A minimum of 250 ACCME-approved Category 1 CME credits is required over the 10-year cycle. A minimum of 70% of the 250 hours must be in specialty-specific (i.e., diagnostic radiology) or related areas (e.g., pediatrics for a pediatric radiologist, urology for a genitourinary radiologist, etc). The remaining 30% may be in additional credits in these clinically related areas, or in relevant topics such as risk assessment, ethics, statistics, the processes of continuous quality improvement, methodologies of outcomes measurement, etc.
Self-assessment is accomplished through a series of 20 self-assessment modules ( SAMs) over the 10-year cycle. SAMs carry Category 1 CME credit as well as "SAM credit," and may be counted to meet both the lifelong learning credit hours and the self-assessment requirement. To count toward MOC, the SAM must be qualified by the ABR. The requirements are as follows:
- Four noninterpretive skills SAMs (e.g., in patient safety, basic life support, professionalism/ethics, principles of image quality).
- Sixteen "clinical content" SAMs related to your practice, within the broad area of diagnostic radiology. If you have a subspecialty certificate, click here for specific requirements .
I am a busy, practicing radiologist and have difficulty getting away for meetings. How can I satisfy my MOC lifelong learning and self-assessment requirement?
Category 1 CME may be obtained through many distributed sources, including hospital/department Category 1 CME, and CME offered in journals and on-line. Many states require CME Category 1 credit for licensure. These credits can be counted as the Category 1 CME requirement for MOC.
What are noninterpretive skills SAMs?
Noninterpretive skills represent those areas of radiology practice that are not necessarily direct clinical care, but have a significant impact on practice. These areas affect our practices; thus, all diagnostic radiology and subspecialty certificate holders are required to have knowledge about them. These SAMs are practice-based and include, but are not limited to, categories such as:
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- Patient safety and radiation protection
- Professionalism/ethics
- Principles of image quality
- Life Support Principles
They may also include topics related to the competencies such as communication and interpersonal skills, practice-based learning and improvement, and systems-based practice.
What documentation must I provide to the ABR?
All of your progress in fulfilling MOC requirements should be entered into your Personal Data Base (PDB) page on the interactive web site provided by the ABR for MOC diplomates. For component 1, you will enter your state medical license information and keep it current. For component 2, you will enter your category 1 CME and SAM credit (or, it may be entered automatically if you participate in the CME Gateway and authorize your society credits to be transmitted to the ABR).
What are the exam requirements related to the third component, Cognitive Expertise?
This component requires passing a proctored, secure, computer-based examination within the last three years of the MOC cycle (in the case of a multiple-certificate diplomate, in the last three years of the governing cycle). The examination for maintenance of the initial certificate in diagnostic radiology will be available in 2010 and will consist of general and clinical content related to the diplomate's practice profile. Questions from SAMs in the category may be incorporated into examinations. To reflect actual practice to the greatest extent possible, the exam will be case-based and image-rich. In order to register for your exam, you must be current with your CME, SAM and PQI requirements, e.g., if you register for your exam in year eight of your cycles, you must have completed seven years of these requirements. You must also be current with your annual fees.
Non-interpretive skills will account for 20% of the exam. The clinical content (80% of the exam) will be proportional to the categories in which the diplomate practices. The clinical portion will be divided into four modules. The configuration of each diplomate's four modules will depend on the practice profile of the diplomate, as self-reported to the ABR at the time of registration for the exam. Modules will be available in the following categories: breast, musculoskeletal, thoracic, cardiac, gastrointestinal, genitourinary, neuroradiology, pediatric radiology, vascular and interventional radiology, ultrasound, and nuclear radiology. A diplomate who practices 100% in a category will have four modules in that category; a diplomate who practices 50% in each of two categories will have 2 modules from each of those categories, etc.
What should I do to study or prepare for my exam?
There is a study guide posted for each subspecialty on the ABR website. The areas in the study guide in which you practice on a regular basis should not require much additional study; areas in which you practice less frequently or not at all would be focus for study through appropriate books, journals, and refresher or other courses.
Will the exam facility accommodate an individual who has a physical disability that makes sitting for several hours difficult?
The Americans with Disabilities Act requires that all testing organizations have policies dealing with reasonable accommodations for disabilities. Please notify the board of your needs at the time of registration for the exam.
How many opportunities will I have to pass the exam?
The exam is offered twice each year. A diplomate who takes the first exam available in the 8th year of his/her MOC cycle would have five additional opportunities to pass before the end of the cycle. There may be a retake fee assessed.
Why doesn't the ABR provide a web-based exam? The inconvenience and incidental costs of having to travel to take an exam are significant.
From the earliest planning of the ABR-MOC program, the trustees wanted to provide a web-based examination. However, a major unresolved concern of the medical specialty boards comprising ABMS is that of diplomate identification. Each board must positively verify the identity of every examinee and assure that the examinee is responding unaided. Although retinal scanners and electronic fingerprint technology exist, they are expensive and not generally available on home PCs. Even with the technology, a system of proctoring would still be required to guarantee that the specified diplomate is truly the one taking the examination.
ABR has seriously considered the computerized exam centers. However, one critical aspect of ABR examinations that does not affect other boards to the same degree is our dependence on high-quality images. This single, overriding requirement has thus far precluded widespread administration in standard commercial exam centers that are operating throughout the country. We are continuing to investigate this option.
As a near-term alternative, the ABR has begun to partner with radiology societies to offer examinations in conjunction with their annual meetings. This allows convenience while maintaining the necessary quality and standardization of the exam experience, although it is demands significant time and resources from the participating societies and the ABR.
When will I receive my exam results? Since the exam is computerized, will I receive them on-site?
Currently, results are mailed to diplomates two weeks or less after the examination. Certain internal processes are necessary to ascertain that all questions are performing to standards, and that the passing point has been accurately applied. These are performed as quickly as possible, following which results are mailed out. The ABR is committed to reducing the time for releasing results whenever this can be done without compromise to accuracy; for example, in the future, it may be possible to avoid the time taken for postal mail by making results available electronically.
What are the project requirements related to the fourth component, Practice Quality Improvement?
The ABR's Practice Quality Improvement - "PQI" - program addresses Part IV requirements. For diagnostic radiology, five categories of PQI projects have been defined: 1) patient safety, 2) accuracy of interpretation, 3) report turnaround time, 4) practice guidelines and technical standards, and 5) referring physician surveys. Each diagnostic radiologist decides on a project in one of these categories, working as an individual, within a department or practice group, or associated with a national society. Below are the steps necessary after selecting a project:
PQI Milestones and Timeline Tracking
| Year of Cycle | What to do each year of the 10-year MOC cycle | Attestation |
| 1 | Learn about PQI process |
Yes |
| 2 | Select project and metric(s) Collect baseline data |
Yes |
| 3 | Analyze the data Work on improvement plan |
Yes |
| 4 | Collect data, compare with initial data, summarize results |
Yes |
| 5 | Modify improvement plan Implement plan |
Yes |
| 6 | Collect improvement plan data Analyze and summarize data If goals achieved, select additional PQI project |
Yes |
| 7 | Refine improvement plan Implement plan |
Yes |
| 8 | Collect improvement plan data |
Yes |
| 9 | Complete collection of improvement plan data Analyze data Summarize data |
Yes |
| 10 | Prepare a final report of results and conclusions Maintain the gain of 1st cycle Select topic for next cycle |
Yes |
Notes:
- Projects may be done as part of a practice group, department, institution, or society. Projects may also be done by individuals
- Outliers in terms of participation may be contacted to produce documentation of participation.
- Diplomates may change project topic if data analysis shows that time may be better spent in improving another area.
- Annually submit attestation via the Personal Data Base
Download the printable chart in .pdf format
If I am chosen for a random audit, must I achieve a compliance status before my certificate can be renewed?
Yes, you must achieve a compliance status before your certificate can be renewed.
The ABR will randomly select a number of diplomates annually for audit of their MOC progress. An audit is the process of requesting from the diplomate, and reviewing, documentation of records of CME, SAM, and PQI activity not conveyed to the ABR electronically from the awarding societies/organizations. The documentation will be examined by the ABR, and a determination made as to the validity of the activities with respect to each MOC component. The ABR review will result in:
- Declaration of which claimed activities accurately reflect the data, and
- Evaluation of the extent to which the diplomate is compliant in making continuous progress toward fulfillment of all MOC requirements within the MOC cycle
The results will be communicated only to the diplomate. If a diplomate is chosen for a random audit, he/she must achieve a compliance status before his/her certificate can be renewed.
PROCESS: A letter, and e-mail or telephone call, notifies diplomate of selection for random audit and asks him/her to provide within sixty (60) days the following documentation:
- COMPONENT ONE: PROFESSIONAL STANDING
Evidence of active, current, valid, and unrestricted licenses relevant to all locations of practice. - COMPONENT TWO: LIFELONG LEARNING
Copies of certificates from all ACCME-approved Category 1 CME and ABR-qualified SAMs for which the credit was not conveyed directly to ABR from a society/Gateway; for RP, copies of the recording forms for all SDEPs claimed. (Note that in many circumstances, additional CME credits will be those provided by one or more institutions through which ACCME-approved credits have been obtained. - COMPONENT FOUR: PQI
Copies of supporting documentation for each essential element completed up to the point of the audit, e.g., project title, baseline measurements, analysis, action plan, ect. If applicable, copy of PQI certificate of satisfactory completion from society.
What if I am living and practicing in Canada, and participate in the Canadian Continuing Professional Development Program?
The ABR's policy is that ABR diplomates who are participating in the Canadian Continuing Professional Development program may fulfill the four MOC components in the following ways:
- Professional Standing: continuous possession of a current and unrestricted medical license in a Canadian province(s) (or U.S. state).
- Lifelong Learning: documentation of satisfactory participation in the Canadian Continuing Professional Development program from the Royal College of Physicians and Surgeons of Canada.
- Cognitive Expertise: successful examination through the ABR MOC exam in the last three years of his/her MOC cycle.
- Evaluation of Performance in Practice: documentation of satisfactory participation in the Canadian Continuing Professional Development program from the Royal College of Physicians and Surgeons of Canada.
A diplomate fulfilling requirements for components 2 and 4 through participation in the Canadian CPD program must send his/her participation record to the ABR annually. Other participation information and fee payment must be entered through the Personal Data Base (PDB).
