Certification has been a topic of discussion throughout medicine — including radiology as a critical component of “professional self-regulation.”¹ Certification in radiology administered by the ABR has a long history under the auspices of the American Board of Medical Specialties (ABMS). However, changes in certification have led to concerns by ACR members. Responding to such concerns early in 2019, around the same time the ABMS Vision Commission issued its recommendations (available at bit.ly/Vision_Commission), the ACR leadership established the Task Force on Certification in Radiology. The Task Force was charged with researching the history of certification; examining best practices for certification; determining ACR members’ opinions on certification; and formulating recommendations on how certification might further advance continuous learning, support the profession, and improve patient care.

In November, the Task Force released a report (available at acr. org/Certification-Report) to aid discussions on continuing certification (formerly called maintenance of certification, or MOC) improvement. The Bulletin spoke with Madelene C. Lewis, MD, professor of radiology at the Medical University of South Carolina and chair of the Task Force, to learn how ACR leaders will collaborate with the ABR to move these suggestions forward.

How does this new report address opportunities for improvement in radiology certification?
The mission of the ABR is to certify that diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients. The organization is accountable to both the public and to the medical profession. One opportunity for collaboration between the ACR and ABR is sponsoring independent research to assess the validity of certification methods in measuring competence and improving patient care. Currently, there is a paucity of scientific evidence demonstrating the value of continuing certification including improved patient outcomes. Successful certification programs undertake early and independent research of assessment tools prior to implementation. This is an important step to ensure the accurate assessment of both learner competence and patient outcomes. We should not be limited by legacy methodology. Our specialty has the opportunity to lead in this area.

What are some of the opportunities for collaboration and improvement that align with the ABMS Vision Commission’s recommendations?
The ABMS acknowledged concerns raised by diplomates regarding MOC programs, including the burden, cost, and lack of relevance to everyday practice. In addition, some ABMS boards’ MOC programs had not adequately adapted to the degree of sub-specialization in practice that was occurring — nor did MOC programs sufficiently integrate advances in education and assessment science or offer alternative methods for assessment to foster learning. Recognizing that an overhaul to the current continuing certification process was required, ABMS decided to review both the framework and purpose of continuing certification of physicians and launched a process called Continuing Board Certification: Vision for the Future (also known as the Vision Initiative). Here are a few of the Vision Commission’s recommendations that align with the ACR Task Force’s recommendations:

• The ABMS and ABMS boards must demonstrate value to diplomates, including supporting their learning and helping them be better doctors in service to patients — while reducing the burden associated with fulfilling continuing certification requirements.
• The boards must regularly communicate with their diplomates about the standards for the specialty and encourage feedback about the program. Communication should be open and bidirectional — promoting engagement between the boards and the diplomates.
• The boards must facilitate and encourage independent research to build on the existing evidence based on the value of continuing certification. • The boards must comply with all ABMS certification and organization standards, including financial stewardship. ABMS boards need to be efficient in the conduct of their operations and fully transparent with their diplomates about financial matters.
• The boards should collaborate with specialty societies, the CME/continuing professional development (CPD) community, and other expert stakeholders to develop the infrastructure to support learning activities that produce data-driven advances in clinical practice.
• Finally, the boards must collaborate with professional and/or CME/CPD organizations to share data and information to support diplomate engagement in continuing certification. These results and trends will assist in optimizing education and assessment to advance the specialties.

How will the ACR collaborate with the ABR to help affect reform?
The ACR has been in dialog with the ABR for some time regarding certification but there are now regularly scheduled standing meetings with ABR leadership. These meetings, along with the work of the Task Force and the Vision Commission recommendations, will serve as a starting point toward making improvements in the certification process for our specialties. The ACR is committed to representing its members in a collaborative effort and working with the ABR as it continues to work toward implementation of the Vision Commission’s recommendation.