Primary certification

The ABA, a member board of the American Board of Medical Specialties (ABMS), has established threshold criteria and the training and education requirements, as well as the knowledge and skills, that anesthesiologists must have so that the ABA can certify (and recertify) an anesthesiologist as meeting these criteria. Certification by an ABMS-member board, such as the ABA, has been shown to correlate with medical school evaluations and grades, the duration and type of residency training, and faculty assessment of procedural skills. Interestingly, personal characteristics such as trait-anxiety (the tendency to respond to a wide range of situations as dangerous or threatening) and the ability to maintain focused attention (vigilance) and process information quickly are also associated with clinical competence, but certification by an ABMS-member board is more widely and readily accepted by the public.

Because the knowledge and skill sets that a physician has decline over time, and because of the continuing advances in technology and science, ABMS-member boards are increasingly recertifying physicians. The results of these recertification processes correlate positively with the number of patients anesthetized and with the severity of illness that these patients have; certification correlates with better clinical outcomes.

Physicians who successfully complete the requirements for residency training (the Continuum of Education) in an Accreditation Council for Graduate Medical Education (ACGME)-accredited anesthesiology residency program may qualify to enter the examination process for primary certification by the ABA if they meet the threshold requirements for primary certification in anesthesiology (Box 248-1).

The duration of candidate status to be eligible for the Part 1 examination is limited to one opportunity per calendar year for 3 years. Candidates completing residency training after January 1, 2012, must complete all certification requirements within 7 years of the last day of the year in which residency training was completed. All candidates must complete the Part 2 examination within 3 years of the date of the first Part 2 examination for which they become eligible.

Trainees beginning the clinical base year (CBY) in 2012 or later will be required to complete three stages of ABA examinations. The first stage (Basic examination) is administered following successful completion of the first clinical anesthesia (CA) year. The second stage (Advanced examination) is administered following successful completion of residency training. The oral examination (Applied examination) may be taken following successful completion of both Basic and Advanced written examinations.

Continuum of education in anesthesiology

The ABA Continuum of Education in Anesthesiology consists of 4 years of full-time training after a medical or osteopathic degree has been conferred. This continuum includes 1 year of clinical base training and 3 years of training in clinical anesthesiology (CA-1, CA-2, and CA-3 years). The CBY must be completed in a transitional year or primary specialty training program that is accredited by the ACGME or the American Osteopathic Association. Training outside the United States and its territories must be conducted in a program affiliated with a medical school that is approved by the Liaison Committee on Medical Education.

The 3-year clinical anesthesia curriculum includes basic anesthesia training, subspecialty anesthesia training, and advanced anesthesia training during which residents provide care for progressively more complex patients and progressively more difficult procedures. Basic anesthesia training focuses on fundamental aspects of anesthesia. Subspecialty anesthesia training is focused on the subdisciplines of anesthesiology, such as obstetric anesthesia, pediatric anesthesia, cardiothoracic anesthesia, neuroanesthesia, anesthesia for outpatient surgery, the postanesthesia care unit, perioperative evaluation, regional anesthesia, critical care medicine, and pain medicine. Advanced anesthesia training occurs in the CA-3 year. Training in the CA-3 year must be distinctly different from that obtained during the CA-1 and CA-2 years and is characterized by increasing independence to prepare residents for the unsupervised practice of anesthesiology after residency completion. Additional details about the specific requirements for completion of the Continuum of Education in Anesthesiology is available in the ABA Booklet of Information accessible on the ABA website.

Clinical anesthesia training (CA-1 through CA-3 years) must be conducted in no more than two ACGME-accredited programs with at least 3 months of uninterrupted training in each. The 6-month period of clinical anesthesia training in any one program must end with receipt of a satisfactory Certificate of Clinical Competence for this training to receive credit toward requirements to complete the Continuum. Part-time training is assessed on an individual basis by the ABA Credentials Committee and must be approved prospectively. Total absence from training must not exceed 60 working days during the CA-1 through CA-3 years. Absences beyond this limit require extension of total training time based on the duration of the absence. After a prolonged absence from training (>6 months), the ABA Credentials Committee will determine the number of months of training after the absence that are required.

Subspecialty certification

The ABA also offers subspecialty certification in critical care medicine, pain medicine, hospice and palliative care medicine, sleep medicine, and pediatric anesthesiology (Box 248-2). Subspecialty recertification is offered through successful completion of a written examination. A transition from subspecialty recertification examination programs to Maintenance of Certification in Anesthesiology for Subspecialties (MOCA-SUBS) began January 1, 2010. The last subspecialty recertification examinations will be conducted in 2016 and the first MOCA-SUBS examinations will be conducted in 2017. The MOCA-SUBS program is the only option for holders of ABA subspecialty certification or recertification awarded after January 1, 2010. After 2016, the MOCA-SUBS program is the only option to maintain subspecialty certification.

Maintenance of certification

Maintenance of Certification in Anesthesiology (MOCA) is required for ongoing certification of anesthesiologists who achieved primary certification in anesthesiology during or after 2000. The MOCA process is completed in 10-year cycles intended to assure the public of a diplomate’s continuing competence in the practice of anesthesiology. MOCA requirements are divided into four parts: professional standing, lifelong learning and self-assessment, cognitive examination, and practice performance assessment and improvement. MOCA requirements are summarized in Table 248-1.

3 Cognitive examination during years 7-10 of the 10-year accreditation cycle:
 200 multiple-choice questions, 50 of which address anesthesiology subspecialties 4 During the 10-year cycle, participate in two evaluations—one during years 1-5 and one in years 6-10
Case
 A four-step process to assess practice and implement changes that improve outcomes
Simulation
 A contextual learning opportunity to assess and improve practice conducted in an ASA-endorsed center
 Confirmation of a diplomate’s clinical practice and ongoing practice assessment and performance improvement activities through attestations

Summary

Board certification and MOCA are critical achievements that may impact medical licensure (and maintenance of licensure), hospital privileges, and employment. The requirements for certification and MOCA are detailed and numerous. This chapter provides an overview of current primary certification, subspecialty certification, and MOCA requirements. However, it is important for candidates and diplomates to periodically review current requirements on the ABA website to be aware of the specific requirements.