Niels F. Jensen, M.D.

Dr. Jensen Board PREP




MOCA:  Proactive or Reactive?


Recertification is here.  A review of strategy is reasonable. 


The ABA is replacing Recertification in Anesthesiology with MOCA (Maintenance of Certification in Anesthesiology).  Currently, either program is available to those certified before January 1, 2000.  However, Recertification will close in 2009 and only MOCA will be offered as a path to recertification. 


Those certified after January 1, 2000, have time-limited certifications valid for 10 years.  Anesthesiologists in this group need to complete MOCA before their time-limited certificates expire in order to maintain their diplomat status. 


The same test is administered to those in the Recertification pathway and the MOCA pathway; the Recertification exam and the MOCA exam are the same set of questions generated from the same key words. 


For those certified after January 1, 2000 there’s no choice about taking the MOCA-Recert exam if one wants to maintain certification.  While letting one’s diplomat status elapse would not constitute professional suicide, it probably isn’t the right approach, either.  Given the time, trouble, and difficulty of becoming certified and given the growing importance of certification, I doubt very much that many will choose to let their Board certification expire.


Those certified prior to January 1, 2000 currently have an option of not recertifying.   Among this group, one of the most common questions I receive is, “Why recertify?  I don’t want to, unless I have to.” 


One problem with a “head-in-the sand” strategy is that the Board has a history of changing its mind about such things and if and when they do other factors can also change, namely and most importantly pass rates. 


Recall when recertification first came along there was considerable resistance and, in fact, the stated position of the Board until two or three years before the test was instituted was that we were NEVER going to have recertification in our specialty.  After less than a year of “full discussion and debate” it was decided that recertification does in fact have merit and would proceed on a voluntary basis only.


Another year or two passed and recertification went from never, to voluntary (for some), to mandatory (for all).  To avoid full-scale revolt among its membership, the Board decided mandatory recertification would only apply to some of us, namely our junior colleagues (those certified after January 1, 2000).  One can speculate about how and why this date was chosen, but the arrival of a new millennium does not change the fact that this has an appearance to many (especially those affected) of being arbitrary and capricious.   


With all due respect, the Board has a history of changing its mind in this arena and this is precisely why it’s probably best to complete recertification while it is fairly straightforward and before additional stipulations, rule-changes, and scoring modifications.  By getting it done, one moves beyond the controversy and flip-flops which are have characterized the recertification process.


In the final analysis, as usual, perhaps Churchill says it best:  “Very fine arguments are always given for doing nothing.”  While doing nothing is an option for many at the present time, this will likely change.  I believe that the impetus for such change will come from our junior colleagues and, objectively, they have a strong argument.  Specifically, they question why recertification is required for them but not for their more senior peers who, it could be argued, are in just as much need of it (if such a need exists at all). 


In the years ahead, this argument will be advanced with more force, more vigor, by more people in increasingly powerful positions and will eventually carry the day.  To do otherwise, raises the specter of the very sort of double standards, for example in passing percentages, which the Board has always vigorously denied.  It seems very unlikely that anesthesiology will be one of the few Boards which rejects recertification.  What seems more likely is that everyone who has not recertified will be required to.  


Perhaps to blunt criticism, at least for the time being, the solution seems to be frequent rules, eligibility, and even name changes (“Continued Demonstration of Qualifications” became “Recertification” only to became “MOCA”) while maintaining high pass rates on the recertification exam.  The problem, as all of us instinctively know, is that if the janitor, with all due respect, can take and pass the examination how much validity does the entire process have?  This, in my view, will not forever be lost upon the ABA nor upon the American Board of Medical Specialties, which governs the ABA, and more changes are inevitable.  Specifically, this exam is bound to get tougher so it can legitimately be called a valid, reputable examination.      


Given these considerations, what is the best approach to recertification?  To meet the challenge we know is there, I recommend and personally followed the very same strategy we embrace every day in our daily lives to get through massive work and meet major responsibilities:  “get in, get it done right, get out, and go home.”  (I took this examination, I took it as soon as I could, I have no regrets, and I’m proud to hold Recertification Certificate #00191.)  


If this is your strategy, to proceed, your best bet for MOCA-Recertification preparation is MOCA Blue and a course.  MOCA Blue is derived from Big Blue and is adapted to the MOCA examination.  Specifically, MOCA Blue is key word correlated to the MOCA examination.  These key words are reviewed within the text of MOCA Blue and the pertinent information is covered.  


Many have worked with Big Blue, and there is clear overlap.  In fact, Big Blue served as the core basis, the foundation, for MOCA Blue.  However, there are also significant differences and MOCA Blue is much more tailored for this particular test.  Further, it’s often been several years since I worked with many of you for the Written and important things have changed—for example CPR standards, to name just one example.  There are many other important changes and important differences.  Perhaps many of you share my sentiment:  if I’m going to do something, I’d just as soon do it right.


Doing it right also probably entails coming to course, if possible.  The Written review course is excellent for the MOCA-Recertification exam and this will apply to all but those taking the January examination.  For those taking the MOCA-Recertification test in January a special course will likely be necessary.  The dates will be posted on the site. 


Being proactive rather than reactive, aggressive rather than passive, and changing before being forced to change are strategies we have always employed.  These strategies may be old and they may seem tired (wasn’t this what our parents always preached?), but they are central to our success and therefore to who we are.  Most importantly, they work. 


I therefore urge you to be proactive and don’t fight battles which cannot be won.    Rather, embrace the MOCA-Recertification process as a way to refresh and renew your knowledge base and as a point of pride.  How this has come about and some of the rules surrounding it are wrong but the concept of on-going education is not wrong and this concept will ultimately prevail.  By embracing rather than fighting it, you will be enthusiastic and energetic and be more fun to teach and interact with.  More importantly you will learn more and therefore take what you derive where it counts most—to the operating room and to the care your patients. 


In this spirit and specifically with regard to the MOCA-Recertification examination, “Onward to Victory!”



Niels F. Jensen, M.D.