The American Board of Anesthesiology (ABA) and ASA have joined forces for a new article series to demonstrate how the two organizations work together to support anesthesiologists throughout each stage of their careers. The first article, “Shared Perspectives: Collective Interests and Respective Roles for Anesthesiologists in the ABA and ASA,” was published in the January 2024 ASA Monitor. This article focuses on Maintenance of Certification in Anesthesiology (MOCA).

I can't tell you how many times someone has come up to me and said, “The MOCA Minute question I had last week helped me with a patient this week!” I have found the same to be true for me, and it speaks to the ABA's MOCA Minute Committee doing a stellar job picking pieces of new medical and anesthesia information that applies directly to patient care. I also like the ABA GO portal dashboard, which shows which MOCA Minute items I have gotten right and wrong so I can remind myself of questions I answered incorrectly. Ironically enough, as much as I like to get all the questions correct, getting questions that I don't know the answer to can make me feel that I am getting more value from MOCA. This is because a wrongly answered question tells me I'm learning something I didn't know before. This growth mindset is something I've tried to incorporate in all aspects of my professional and personal life.

The importance of lifelong learning and a growth mindset is highlighted even further by upcoming changes to the cycle length for board-certified anesthesiologists. To meet the new American Board of Medical Specialties (ABMS) certification standards, the ABA began transitioning our continuing certification cycle from a 10-year cycle to a five-year cycle in 2024. Not all board-certified anesthesiologists will immediately transfer to the five-year cycle. The change will only occur once their current certificate expires. This change was based on feedback ABMS received from patients and the medical community that suggested 10 years was too long to wait to assess whether a clinician's medical knowledge and skills are current. The shorter cycle better reflects how rapidly medicine and anesthesiology change. Newly board-certified residency graduates will start with this five-year cycle, so they won't even know there has been a change.

The good news is the ABA Board of Directors began evolving our program several years ago, which has positioned us well to meet the new standards without significant disruption for our board-certified anesthesiologists. A big feature of the new ABMS standards is a requirement that all medical specialty certifying boards have a longitudinal assessment like MOCA Minute, which the ABA implemented in 2016; many other member boards took longer to implement, using the ABA program as a model. More recently, the ABA created a new standing committee to revamp and strengthen the quality improvement aspect of MOCA.

I have seen firsthand how all ABA directors and staff really are committed to using input from the anesthesiology community to improve MOCA and the continuing certification process. This dedication is consistent with providing lifelong value to all the talented clinicians in the specialty.

For me, the positive impact that I continue to see for our patients has motivated us to further improve at the ABA. As one example, the fact that we can identify our specific clinical practice types within MOCA Minute and receive only questions related to our individual practice mix is something not all the other member boards do. This fact speaks to our attempt to provide individualized learning and assessment for each anesthesiologist.

Why would a “Lifetime” ABA Diplomate volunteer for MOCA? I had just finished my fellowship and had taken my oral board exam a few weeks prior. It was a Thursday in 1997. During my lunch break from the OR, I phoned my wife to catch up on her day and the kids. She told me that I had a letter from the ABA in the mailbox and asked if I wanted her to open it. I told her no because this was something I'd rather do at home, with family to support me if there was bad news inside.

Fortunately, the letter contained a gratifying message – validating years of study, practice, and preparation. I had just become a diplomate of the American Board of Anesthesiology! It took me a while to get used to how they spelled diplomate, but regardless of the spelling, I remember feeling the satisfaction of knowing the certificate would last a “lifetime.” Never again would I need to take a high-stakes exam and wait nervously for my results.

Life was good. Work and family activities were getting very busy. We weathered Y2K in 2000 and 9/11 in 2001. And then I started hearing some talk about “maintenance” of certification. Some medical specialty boards were considering a change to an ongoing testing process, and this would occur probably every 10 years. What happened to my “lifetime” certification?

I felt like I was on top of my game. All my training was a recent memory and seemed crystal clear. I had kept learning and teaching, and I actually conducted some research of my own. Signing up for an additional administrative burden seemed unnecessary to me, and perhaps even a distraction – like volunteering for an additional Joint Commission visit to the hospital.

But at the same time, I understood the concept of lifelong learning. I knew it was unlikely that I would always remember all the details of the profession without regular review. I also appreciated first-hand that new discoveries were coming every month. Committing to a “maintenance” program would be healthy in the same sense that starting a regular exercise program at the gym seemed like a good idea.

I've always aspired to be consistent in my approach to ethics. And in this case, I needed to embody the principles I taught the residents. They no longer had the option for lifetime certification and would be required to participate in MOCA. It was critical for me to not just talk the talk, but walk the walk. So, I voluntarily enrolled in MOCA and have remained in the program since that time.

Engaging in MOCA helped my advocacy efforts, too. When discussing the scope-of-practice and educational distinctions between anesthesiologists and CRNAs, my ongoing commitment to continued learning is evident, benefiting both my patients and communication with legislators. The path to becoming an anesthesiologist is a journey, not just a destination. Realizing my intrinsic motivation made the MOCA experience all the more satisfying.

In retrospect, I was unaware of how much new knowledge would be discovered during my career. Medications, equipment, and techniques have all improved. And the MOCA program itself has improved. ABA's MOCA Minute was a welcome innovation, eliminating the need for a high-stakes exam.

The adult learning model – delivering knowledge in manageable chunks followed by educational snippets – appeals to many, including our residents and those in early career stages. It's an effective method to weave learning into a busy schedule, similar to the ASA CME products that I enjoy, like ACE and SEE.

Moreover, the time and money I invest in this process are minimal compared to other hobbies and pursuits. As I age, maintaining cognitive sharpness is crucial. MOCA serves as an effortless self-assessment to ensure I'm still on the right track.

Alex Macario, MD, MBA, Secretary, American Board of Anesthesiology, Vice Chair for Education, and Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California. @alexmacario

Alex Macario, MD, MBA, Secretary, American Board of Anesthesiology, Vice Chair for Education, and Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California. @alexmacario

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David P. Martin, MD, PhD, FASA, ASA Vice President for Scientific Affairs, and Professor of Anesthesiology, Mayo Clinic, Rochester, Minnesota.

David P. Martin, MD, PhD, FASA, ASA Vice President for Scientific Affairs, and Professor of Anesthesiology, Mayo Clinic, Rochester, Minnesota.

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