Christopher E. Wolfla MD
Former Annual Meeting Chair, 2005 CNS Annual Meeting
Former Chair, CNS Education Committee
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| With the ever-increasing emphasis on quality in health-care delivery, the concept of
Maintenance of Certification (MOC) has become important to all practitioners. All Board
Certifications granted by the American Board of Medical Specialties, including
Neurological Surgery, are now time-limited. Continued certification requires that
all practitioners now participate in a regular recertification process to remain Board
Certified. While this process has implications on the state (through the Federation of
State Medical Boards) and local (hospital credentials committees) levels, the largest
component of MOC is being addressed by the American Board of Neurological Surgeons (ABNS).
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| The ABNS has identified four primary components of neurological surgery MOC.
These include evidence of Professional Standing, Lifelong Learning and Self-Assessment,
Cognitive Knowledge, and Performance in Practice. This information was sent to all Diplomates
in the Fall of 2004. The Lifelong Learning and Self-Assessment component is comprised of
two elements: Self-Assessment in Neurosurgery (SANS) and Continuing Medical Education (CME).
The relationship of CME to MOC is depicted in Figure 1.
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Figure 1 |
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| SANS was designed to help Neurosurgeons maintain and improve proficiency in surgical
decision making, stay abreast of the latest advances in the field, and prepare for
certification/recertification. SANS has been endorsed by the ABNS as a valuable
tool to help fulfill the Self-Assessment portion of the Lifelong Learning and
Self-Assessment component of MOC. Successful completion of the SANS program
also qualifies the neurosurgeon for Category 1 CME credit. Additionally, a
substantial portion of the content of the planned ABNS Recertification/Maintenance of
Certification Cognitive Examinations will be derived directly from SANS questions.
Participation in the SANS program, therefore, will be of substantial benefit to
individual neurosurgeons in their preparations for Recertification/MOC examinations.
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| CME has been defined by the American Medical Association (AMA) in the following manner:
“CME consists of educational activities that serve to maintain, develop, or increase the knowledge,
skills, and professional performance and relationships a physician uses to provide services for
patients, the public, or the profession. CME represents that body of knowledge and skills
generally recognized and accepted by the profession as within the basic medical sciences,
the discipline of clinical medicine, and the provision of health care to the public.”
This definition is essentially identical to the definition of CME adopted by the Accreditation
Council for Continuing Medical Education (ACCME), the accreditation body for CME providers. |
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| CME activities have been divided into two groups, Category 1 and Category 2. The ABNS has
proposed a CME requirement for MOC of 150 hours of CME every three years. Of this 150 hours,
60 hours must be Category 1 and up to 90 hours may be Category 2. At least 80% must be
“specialty-specific” (i.e. related to the practice of neurological surgery). These requirements, while
not currently finalized by the ABNS, serve to underscore the importance of CME to MOC.
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| Category 1 CME must be sponsored by an organization that is accredited by the
ACCME (such as the Congress of Neurological Surgeons [CNS]) and must be designated as
AMA PRA Category 1 education by that organization. Category 1 CME may take a number of
forms, though the most relevant for practicing neurosurgeons are live or attendance-based
activities and enduring materials. Live or attendance-based activities are CME activities that
physicians must attend in order to receive credit. They may range from national conferences
(such as the CNS Annual Meeting) to local workshops, seminars, grand rounds, or departmental
scientific meetings. Enduring materials are printed, recorded, audio, video, and electronic
activities that may be used over time at various locations, and that in themselves constitute a planned
CME activity. The SANS program is an excellent example of such an activity. Upon completion of a
Category 1 CME activity, the participant can expect to receive notification of credit earned from the
sponsoring organization.
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| Category 2 CME, in contrast, has been defined as all educational activities not designated
Category 1, that have improved the care that a physician provides for his or her patients. This
definition includes a surprising number of activities that neurosurgeons, especially those in an
academic setting, engage in on an every day basis. Some of these activities include:
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- Consultation with peers and medical experts,
- Developing and reviewing quality assessment data (Morbidity and Mortality),
- Use of electronic databases in patient care,
- Use of enduring materials (reading medical books, periodicals, and web sites),
- Small group discussions,
- Self-assessment activities,
- Journal club activities not designated Category 1,
- Teaching health professionals (medical students, residents, physicians, nurses, and allied health),
- Medical writing (abstracts, journal articles, book chapters),
- Teleconferences,
- Preceptorships, and
- Lectures, seminars, and workshops not designated Category 1 (poster viewing at the CNS Annual Meeting).
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| Many times participation in these activities cannot be documented. Therefore, an important
difference between Category 1 and Category 2 CME is that Category 2 CME is not awarded by an
ACCME accredited sponsoring institution. Instead, it is self-reported and self-designated by the
individual physician. Sponsors are not required to and usually do not record and maintain
participation/attendance information for Category 2 CME.
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| Given the increasing importance of CME and, particularly Category 2 CME, the CNS Education
Committee recommends keeping careful records of participation in all of the activities listed above.
Figure 2 shows a sample spreadsheet that could be used to log this type of information. Click on Figure 2
to download the sample spreadsheet.
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Figure 2 |
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