Continuing Urologic Certification Moving Forward

By: David B. Joseph, MD, FACS, FAAP, Chair Lifelong Learning, American Board of Urology; J. Stuart Wolf, MD, FACS, President, American Board of Urology; J. Brantley Thrasher, MD, FACS, Executive Director, American Board of Urology | Posted on: 19 Jan 2024

Background

Continuing Urologic Certification (CUC) was presented to the American Board of Medical Specialties (ABMS) in 2020 as a pilot for certified urologists creating a continuous longitudinal learning opportunity as an alternative to the current Lifelong Learning (LLL) Program for maintenance of certification. CUC is completing its third pilot year and has gained outstanding support and important critiques from the approximately 1000 participating diplomates. The positive response led the American Board of Urology (ABU) to request adoption of the CUC by the ABMS in late October 2023. Approval will allow all diplomates to transition to CUC.

Since 1985, all certified ABU diplomates hold a 10-year time-limited certificate requiring recertification. Recertification has transitioned through Maintenance of Certification, LLL, and now CUC. Recertification will continually evolve as the needs of our diplomates change and improvements in patient care advance. Diplomates have made it clear that the LLL 10-year secure knowledge assessment exam is outdated, burdensome, and disruptive to their clinical practice and personal lifestyle. Equally important, the ABMS has established new standards that support public health care and requires continuous longitudinal assessment of a diplomate’s ability every 5 years due to the exponential expansion of medical knowledge. CUC was specifically developed to maintain the highest level of urologic patient care utilizing contemporary technology and educational opportunities.

Learning Elements of CUC

The ABU previously moved from a pass/fail 10-year exam to Continuing Medical Education (CME) remediation of knowledge gaps. CUC maintains that principle and takes the next step advancing a contemporary learning environment in 5-year cycles. Knowledge gaps are identified and diplomates are directed to individualized CME opportunities. CUC establishes a unique learning experience, eliminating the 10-year secure exam while maintaining all other requirements in LLL. Activities are assigned to a specific year, facilitating continuous participation of the diplomate (Table).

Table. Continuing Urologic Certification Pilot 5-Year Cycles A, B

CUC learning activity	Year	Cycle A	Cycle B
Knowledge Exposure 8 Articles 40 Questions ≥80%^a	1	Peer review	Peer review
Knowledge Reinforcement 40 Questions ∼65%^a	2	Practice assessment protocol Professionalism and ethics module	Practice assessment protocol Pt safety module
Knowledge Exposure 8 Articles 40 Questions ≥80%^a	3	CME (90/30 category 1)	CME (90/30 category 1)
Knowledge Reinforcement 40 Questions ∼65%^a	4	QI attestation	Complication/mortality narratives Practice log
Knowledge Assessment 90 Questions	5	KA (bye option) ≤2 SEM^b 1-3 CME activities	KA (bye option) ≤2 SEM 1-3 CME activities
Abbreviations: CME, Continuing Medical Education; CUC, Continuing Urologic Certification; KA, Knowledge Assessment; Pt, patient; QI, quality improvement; SEM, standard error of measurement. Reproduced with permission from David Joseph, MD, copyright holder. ^aKnowledge Assessment optional if knowledge thresholds noted above are achieved. ^bAll diplomates complete complication/mortality narratives and a practice log year 4B. Diplomates falling below the second standard error of measurement on the knowledge assessment year 5A may be required to complete complication/mortality narratives and practice log.

CUC capitalizes on 3 learning elements: Knowledge Reinforcement (KR), Knowledge Exposure (KE), and Knowledge Assessment (KA). These learning activities were developed to prevent fatigue of a repetitive process while enhancing everyday knowledge, exposing advancements in care, and identifying individualized knowledge gaps that benefit from additional learning.

KR

KR serves as a memory challenge strengthening past knowledge in common urologic care. KR occurs every other year. Forty questions (20 core urology and 20 in a selected module) are accessed via the internet in a home or work environment. The diplomate has 14 weeks to complete all questions and chooses how many questions are completed at one time. Maximal educational benefit is achieved with 1 question/day. All resources are available except for discussing questions with others. An average threshold of ∼65% correct responses on 2 successive KR cycles allows the diplomate the opportunity to opt out of the KA exam given every 5 years. Sixty percent is based on the minimal knowledge the ABU expects the average urologist to maintain; this is reset periodically as the criterion standard changes.

KE

Exposing the diplomate to advancements in the management, care, and treatment of urologic disorders allows them to remain up to date. The ABU has partnered with the AUA, identifying the most relevant advances highlighted within The Journal of Urology®, Urology Practice®, and AUA guidelines. KE occurs every other year; 8 articles or guidelines are required, 4 related to core material and 4 in any module. Each reading activity is associated with 5 questions; a correct response rate of ≥ 80% is required to claim CME credit and also to opt out of the KA. (CME credit requires a nominal additional fee.)

KA

KA identifies gaps in knowledge. A 90-question exam will have the same structure and psychometric rigor as the current 10-year secure exam. The difference is that the KA is open to all resources and taken in the home or work environment. The exam is completed in 1 day with no time restriction per question. Questions cannot be discussed with others. A threshold of minimal knowledge has been identified for each module. Diplomates will be assigned CME activities in their weak content areas and have 1 year to complete the required CME (Figure).

Figure. Continuing Medical Education (CME) is assigned based on individual knowledge gaps. Alternative CME activity in lieu of American Board of Urology recommendation will be considered by the Board on a case-by-case basis when submitted in writing by the diplomate. SEM indicates standard error of measurement. Reproduced with permission from David Joseph, MD, copyright holder.

CUC Participation Feedback

Performance on the KR parallels that of the 10-year secure exam. This supports continued open use of all available resources. The questions are not intended to be hard, but rather to be thought-provoking, encouraging further review and enhancing knowledge.

Access to the KR was considered easy, having clear instructions. Seventy percent of the participants completed all questions within 2 weeks. While no module duplicates a diplomate’s practice, 75% felt questions were relevant and enhanced learning. Ninety-five percent of diplomates preferred the KR over the traditional secure 10-year exam.

Questions for the KE are written to confirm comprehension of the reading material. The 80% threshold has been achieved by > 95% of pilot participants. Ninety-seven percent agreed that KE meets the learning objectives, and 89% reported the overall quality of the material was very good or excellent.

Moving Forward

CUC has shown distinct advantages over the existing LLL program. The ABU Trustees and staff have decided to rapidly transition all diplomates into CUC at one time and are preparing for transition spring of 2024 pending approval by the ABMS. The staff has worked tirelessly developing this transition to allow all diplomates to gain from the improved learning experience and eliminate the burden of the secure exam. With transition to CUC, there will no longer be an expiration date on ABU certificates. (Certificates with an expiration date will be replaced in the year requiring recertification.) Diplomates who remain active in all aspects of CUC will be continuously certified.

Diplomate Responsibility

Diplomates should periodically visit their ABU portal. Important information and Board initiatives will be posted along with an individualized overview of current status and pending requirements. Diplomates will be placed into the corresponding year of CUC that minimizes duplication of any activity completed in LLL.

CUC is a major step forward and not expected to be the last step. The ABU thanks all pilot participants for contributing to the successful evolution of continuous certification and acknowledges the dedication and commitment of the AUA Office of Education with development of the KE.