Zen and the Art of Pediatric MOCcycle

Written by Stuart Silverstein on Tuesday, 15 January 2013. Posted in Pediatric recertification, Pediatric Maintenance of Certification

I recently heard about a pediatrician, who procrastinated as long as he could to put his toe into the uncertain waters of the “MOC” process until the deadline for “enrolling” in the MOC process was less than a month away. That pediatrician was me!  

 I not only had to  put together the book used by so many of our colleagues, but I also have to go through the process myself.  I can tell you the latter is much more difficult.  It is much easier to teach and preach than to perform.

I invite those of you who are and/or will be going through the MOC process in the coming weeks to join me on what I hope will be a humor-laden description of this confusing process which will cover more than merely preparing for an exam.  That isn’t to say that preparing for and taking a proctored exam is an easy task for us working stiffs who spend all day helping patients and then answering to the needs of a family when we get home. Many of us have not taken an exam since Bill Clinton was actually the president, and not a hired gun giving speeches at the DNC.  


For most of you, this process will begin with a good news/bad news letter.  The good news is you have been given 2 more years to prepare for the proctored exam.

The bad news is you will have to enroll in the MOC process, and go through MOC cycles” to maintain your certification.  The proctored exam is just one part of the on the MOC–cycle trip.  The MOC process is not a cheap one and proportionately higher for us pediatricians who cannot compete with our more fortunate procedure reimbursed colleagues. We will cover that in future blogs.


Circling the Cycle:

Part 1: Professional Standing – Also known as having a valid medical license.

Part 2: Knowledge Assessment:  Differentiated into 2 subcategories[1]

  • Knowledge Self Assessment- 200 online questions, which you don’t even have to pass to get credit.
  • Decision Self Assessment – 50 multiple choice questions based on patient cases , this time you have to get a passing grade

Part 3:  Cognitive Expertise:  Also known as the proctored exam, or the big test, the one you had to take every 7 years and now have to take every 10 years while MOC cycling.

Part 4: Performance in Practice:  This is the part that had and still has me as confused as an octogenarian staring at iPod®.   As of this writing I am still not clear on what the heck we are expected to do.  This is not a simple matter of answering questions online or even preparing for and taking an exam. This involves something along the lines or doing a quality improvement study in your practice. 

I began reading this, and flies began landing on my eyes without my noticing while I reviewed the 2 choices for fulfilling this requirement which were:

  • Established Quality Improvement Projects:  Where you collaborate with other groups and practices.  Lots and lots of moving wheels.
  • Web Based Improvement Activities: These seem to be off the shelf activities conducted within your practice and presumes you will want to do this with in conjunction with the other physicians in your practice.


The other day I tried to make sense of this part of the MOC process.  I stared and read it over and over until my mind went blank.  The next thing I remember was sitting at Brazilian Steakhouse  and some guy named Raul was serving me sliced Turkey from a cutting  board at my table.  I guess I was so traumatized that I must have suffered retrograde amnesia. [2]  Therefore I will have to cover this in greater detail when I return to this part of the MOC requirement as I tackle it myself.


Coming Attractions


In the future, patient surveys will be added to the mix. Yes!  Patient surveys handed out to parents who will provide their opinion of communication style and availability.  It is not yet clear if you will have to hand this out randomly, or cherry pick your favorite patients for their input.  As if there aren’t enough challenges, practicing medicine will become American Idol where you will have to perform for a panel of judges. What’s next?  Patients commenting on your doctoring skills on your Facebook® wall and hitting “Like” buttons?


We will keep you posted when and if you will have to face such a tribunal!


For me the process began with what seemed like a bombardment of some 300 email and snail mail letters that I ignored until I realized those ignored letters is not good for my professional standing with the board.  I was also thankful that the ABP has not discovered Facebook® or Twitter® where I would sure to face the electronic equivalent of being placed in the public stocks.


Qualify to Enroll


I had until December last year to “qualify” to enroll in the MOC process, s I finally took the first steps to “qualify” for the enrollment process.  Up until that moment, as the author of “Surfing your Way to Recertification”, I have been receiving calls, emails and, yes, Facebook messages from friends asking about the process.  Much to my shock, when replying to my friends, I found myself stammering and changing the topic to the weather or local traffic reports. Until then I couldn’t give first hand advice and guidance.


In order to qualify I had to get through Parts 2 and 4.  Part 1, providing proof that I had a medical license which was easy enough.  Then again, if you don’t have a medical license why would you be going through all of this torture?


Over the coming weeks, we will muck through the MOC process together.  Unlike the ABP, we actually are familiar with Facebook ® and Twitter®, and I invite you to “like” us on Facebook and “follow our Tweets” on Twitter®.  We also want to note that this blog and our materials will help you get through and demystify the process.[3]

[1] Which makes this all even more convoluted and confusing, since they are 2 activities why not just assign them each an independent number. ?

[2] Folks, this was inserted the sake of humor,  it didn’t really happen so please do not write us to let us know that you had the same experience, as you might be better served seeking psychiatric assistance if that is the case.  

[3] We are not here to provide inside information on questions asked on the exam, answers to the questions, or otherwise reveal any other part of the MOC process, or the exact areas of knowledge that will be tested. We do welcome general feedback and shared experiences going through the process, but are not looking for nor will we be accepting such exam specific information.   

About the Author

Stuart Silverstein

Stuart Silverstein

Founded by Stu Silverstein, MD, in addition to being a Board Certified Pediatrician, Dr. Silverstein is anything but“Certified Bored”!

During and following his residency training San Francisco, Dr. Stu Silverstein was a critically acclaimed Standup Comedian, booked regularly at popular clubs in the San Francisco Bay Area, where he shared the stage with nationally known comedians including Dave Feldman (Staff writer for Dennis Miller), Rob Shneider , as well as Robin Williams at the famed Holy City Zoo. During that time he was featured in dozens of local and national newspapers and magazine articles. He appeared on local and nationally televised shows culminating in a feature story on World News Tonight,.

Peter Jennings said, “In the latter part of the Century, Sir William Osler was one of the very first to recognize the importance of bedside manner, including the healing power of humor. I suspect he would approve of Dr. Stu Silverstein.”

Requests to give humorous presentations at Medical Society Meetings and Conferences across the country came in. Dr. Silverstein has been giving his “Humor in Medicine??? You Must Be Joking!” presentation as requests continue to pour in this day.

The “Laughing Your Way to Passing the Pediatric Boards”® , is the culmination of Dr. Silverstein’s mission to combine his well honed Standup Comedy skills with making board preparation more enjoyable and less of a chore.

Dr. Silverstein has been on faculty with the Osler Institute Board Review Course as well as the UCLA Pediatric Board Review course. Currently, Dr. Silverstein is concentrating on future study aids and new materials to help you, our medical students, prepare for your board exams.

Dr. Silverstein conceived and founded Firefly After Hours Pediatrics in Stamford, CT, where is currently serves as Medical Director. Dr. Silverstein is an Assitant Clinical Professor of Emergency Medicine at the New York Medical College when he isn’t writing study guides for Medhumor Medical Publications and assisting fellow physicians and medical student in pursuing their preparation for exams while enjoying the process.

Comments (4)

  • Neftali


    12 January 2013 at 22:59 |
    Went through parts 2 and 4 a year ago and still confused. From what I understand there are 2 cycles, a 60 month cycle for parts 2 and 4 but a 10 year cycle for testing. Please correct me if I have this wrong. Thanks


    • Super User

      Super User

      05 February 2013 at 21:44 |
      Dear Neftali,

      Thanks for posting your question. First you are not the only one who is confused by this process, we have heard from lots of pediatricans out there pulling their hair out trying to figure this out. This is most unfortunate since in some cases they are actually pulling out expensively placed hair transplants, that cost almost as much as the cost of taking the exam

      Having said that, where in the process are you ? Have you enrolled in the "MOC process" already or are you preparing to enroll. This is an important question since you must qualify to enroll by getting past a preliminary version of Parts 2 and 4. This of course only adds another layer to the confusion to the Pediatric Recertification (MOC) process.

      There actually are 2 cycles you must complete for each proctored exam also known as Part 3, of the Moc process.. and after taking out my handy calculator (actually the one on my computer): 60 months divided by 12 months/year = 5 years

      However, at this point it is likely that you will have to only complete one cycle before you sit for Part 3

      Therefore it will help to know where in the cycle you are to help us demystify this for you

      BTW as I noted I am going through the process myself and as I get deeper into the process and am forced to clarify this for myself, I will share what I discover about the requirements as I check them off my list.

      I am here to help so let me know! Good luck!

      Stu Silverstein


  • L Dev

    L Dev

    27 March 2013 at 03:38 |
    Dr. Silverstein
    Great article. Looking forward to keeping up as I THINK my certification is coming up in the next couple of years. Here are my questions/dilemmas. I still don't get what to do if MDs see a few or no patients. I'm in child abuse pediatrics. None of my parents are going to be happy w the process! I took a break and worked for a medical compliance company. No patients there to evaluate me. And what about QI. Doesn't seem like any of those topics fit if you are the only MD in a practice like child abuse, or if you work in the business aspect of medicine.

    It seems after all the info we have gotten over the years it would be explained much easier on the site yet it ISN'T!

    And there are no costs explained (for MOC 2&4) unless you go thru the registration process but what if we don't need to register yet but just want to know how much it costs?

    And all this we do on our vast amounts of free time!


  • Super User

    Super User

    22 April 2013 at 20:19 |
    Dear Doctor,

    I am glad that you found the article helpful. We will be providing more and more of these as I go through this convoluted process myself. Regarding the fees, you are correct, this doesn't seem to be noted in the FAQ's on the ABP website until you actually enroll. I enrolled over a year ago and believe the fee then was around $1200 so assume it is in that range. This probably sets you up for 10 years, or 2 MOC cycles, but I will soon find out myself and include it in my blog series.

    Regarding the Part 4 , this is the most confusing part and to tell you the truth I am not clear on it myself, but will be soon enough. I am fairly certain that there ARE modules available for physicians who are not actively practicing. I have seen this before but the easiest thing for you to do would be to call the ABP directly and explain your situation.

    Regarding patient direct feedback of your performance, I do not believe this portion has been implemented. But certainly if you are working for the child protection agency and/or the prosecutors side, I would imagine your feedback from the parents wouldn't be favorable.

    I appreciate your posting this on our blog. The pediatric MOC process is a confusing one and even more confusing with special cases such as yours which is rare but certainly not unique.


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