Wednesday, August 28, 2013

We Love MOCA Simulation Exams. As If We Had A Choice

In 2010, the American Board of Anesthesiologists made yet another change in how anesthesiologists get recertified ten years after getting their initial board certification. After conducting a survey of ASA members in 2006, they claim that greater than 80% of respondents felt a simulation component to MOCA would enhance their skills as anesthesiologists and are interested in trying it out. Thus the simulation portion was instituted.

In the MOCA simulation, the anesthesiologist travels to one of 34 centers around the country that conducts the test. He or she is placed in a team of four to six other test takers. Then scenarios similar to the oral board exams are conducted with each anesthesiologist taking turns being the team leader. Afterwards, each member is supposed to identify three improvements he can make in his practice because of the simulations and submit the plan to the ABA. A few weeks later the ABA will contact the physician to see how his practice has changed because of the simulation. That's it. There is no pass/fail or grading curve.

According to the ABA, follow up surveys of simulation participants showed that 95% would recommend the course to their colleagues while 98% thought it helped them improve their practice. Those are pretty impressive numbers. Almost too impressive if you ask me. I can't think of anything else in American society where 98% of us agree on one thing. Those numbers sound like election results coming out of North Korea or Cuba.

I wonder how honestly the survey participants answered the poll questions. The fact is that anesthesiologists like myself who hold time limited board certificates are completely beholden to the ABA and its policies on MOCA to keep our board certificates and our practices. How many people are going to say on an ABA survey that they thought the simulation was a total waste of time and money. And we're talking big money. These tests cost thousands of dollars and that doesn't even include money for lost wages and travel expenses. Any anesthesiologist who remembers studying for the oral board exam will also recoil with horror the amount of time spent studying for it and the extreme anxiety that comes with preparing for it. After suffering through all that, are survey participants likely to say it was so not worth the effort or will they try to attempt to make the best of the situation by stating that it was a truly glorious and absorbing experience?

Of course the elephant in the room is that only some anesthesiologists are required to go through this hassle to keep their jobs. According to the ABA and ASA, "Physicians are being asked by local, state, and federal agencies to do more to maintain their licensure and medical staff credentials in order to demonstrate their commitment to lifelong learning. Our patients deserve physicians who can deliver the most appropriate evidence-based care and document the quality of their practice." Okay, I'll buy that . We should all commit ourselves to lifelong learning to ensure quality care for our patients. Agree 100%. Then why is it that anybody who got board certified before the year 2000 have a lifetime certificate that never needs to be renewed? They can coast through their entire career with only what they learned in residency two, three, or even four decades ago. If anything, it is the older generation of anesthesiologists who are in most need of simulation exams so they know the most current anesthetic techniques. They shouldn't be hiding behind their yellowing and fading certificates and proclaim board recertification is good for all doctors and patients, except themselves. The ABA should stop this hypocrisy and either admit that MOCA is a sham or make it universal for the good of our patients.

1 comment:

  1. You wrote: "The ABA should stop this hypocrisy and either admit that MOCA is a sham or make it universal for the good of our patients."

    I am sure that the ABA would love to suck MOCA fees out of the grandfathers. They can't. Very simply the agreement with the ABA that the grandfathers signed is different than the one who started the process in 2000 and beyond signed. They would be subject to litigation and would most likely lose. This is not only an issue for anesthesia. It is an isssue for every specialty that provided lifetime certification that now time limits certification.