The ABR MOC Part IV:

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The ABR MOC Part IV: Practice Quality Improvement (PQI) Stephen R. Thomas, Ph.D ABR Associate Executive Director Radiologic Physics (RP)

The ABR Radiologic Physics Trustees Richard L. Morin, Ph.D. Diagnostic Radiologic Physics Assistant Executive Director RP IC G. Donald Frey, Ph.D. Medical Nuclear Physics Assistant Executive Director RP MOC Geoffrey S. Ibbott,, Ph.D. Therapeutic Radiologic Physics

The ABR MOC Program ABR Headquarters Building Tucson, Arizona URL: http://theabr.org On home page one finds: MOC Radiologic Physics

ABR Home page: http://theabr.org theabr.org

Personal Data Base (PDB)

PDB: Web-based based Process Available for ABR diplomates Web-based based application password protected Step by step process for MOC Easy to use with effective tools Maintain files Receive data (CME s, SAMs) Review status Submit documents

American Board of Medical Specialties (ABMS) Established 1933: Now composed of 24 member boards: Past-President President (2001) - James Youker,, MD (ABR) Mission (in part): To maintain and improve the quality of medical care by assisting the member boards in their efforts to develop and utilize professional and educational standards for the evaluation and certification of physician specialists. 1973/1993: Formal policy regarding recertification. March 2000: Agreed that existing or planned programs of recertification would evolve into programs of: Maintenance of Certification (MOC). Committee on Oversight and Monitoring of MOC (COMMOC) SR Thomas: Elected member

ABMS: Six Competencies (Specific to Radiologic Physics) Medical Knowledge: Understand and apply appropriate radiologic physics techniques to meet the needs of patients, health care providers, and the health care system. Engage in continuous learning. Patient Care: Interpersonal & Communication Skills: Professionalism: Practice Based Learning & Improvement: Systems Based Practice: Realize that radiologic physics is one part of a continuum of patient care. Work towards integration and continuous improvement.

ABMS: Four Components of MOC Component 1: Professional Standing - Physicians; Unrestricted license - Physicists; Unrestricted license or practice involvement documentation (Letters of Attestation) Component 2: Lifelong Learning and Self-Assessment - The requirement to keep current in the field. Renewing & expanding knowledge, skills, competence, and performance for the purpose of improving the quality of patient care. Component 3: Cognitive Expertise - Examination process. Component 4: Practice Performance Improvement - Assessment regarding support of patient care.

RP PQI References 1.) Med Phys 34: 4158 4163; Nov 2007 2.) ABR website URLs: - http://theabr.org/rp_moc_req.htm theabr.org/rp_moc_req.htm - http://theabr.org/rp_moc_pqi.htm theabr.org/rp_moc_pqi.htm

The ABR s s MOC Initiatives: Summit Meetings with Stakeholder Organizations 2005: Summit meeting on issues concerning Self Assessment Modules (SAMs) 2006: Summit meeting on Part IV: Practice Performance Improvement (PPI) 2007: MOC Part IV: Practice Quality Improvement (PQI) 2008 (in planning stages with RP Trustees as the prime organizers): PQI Patient Radiation Safety

AAPM TG 127: MOC Task Group Chairs: Michael V. Yester & Per H. Halvorsen Charge: - Act as a resource to the ABR Trustees and AAPM members concerning MOC - Provide information/suggestions on activities that meet MOC requirements - Ensure that educational activities are available to members

Part 4: Practice Quality Improvement (PQI) Objective of MOC: Improve the quality of health care through diplomate initiated learning and quality improvement. PQI projects provide evidence of critical evaluation of the individual s s performance in practice. Expectation that the diplomate will participate continuously in PQI over the 10-year cycle.

Part 4: Practice Quality Improvement (PQI) Five areas established for PQI projects: - Safety for patients, employees, public - Accuracy of analyses & calculations - Report turnaround time & communication issues - Practice guidelines & technical standards - Surveys (including peer review of self- assessment reports)

Part 4: Practice Quality Improvement (PQI) First year: PQI concepts training Selection of one project to be carried out over the 10-year cycle. Projects may be developed by individuals, group practices, institutions, societies. ABR will review and qualify national programs developed by professional societies.

Part 4: Practice Quality Improvement (PQI) Metrics Improvement plan Remeasurement Evaluation

RP PQI Examples on ABR Website: Diagnostic Radiologic Physics Safety: Monitoring of dose indices for lumbar spine radiography Safety: Women s s CT dose Report Turnaround Time: Determine report turnaround time and quality of consultation following medical physics equipment evaluation

Metrics Metrics 1. 1. Develop Develop software software to to extract extract Dose Dose Indices Indices from from DICOM DICOM Headers Headers 2. 2. Using Using archived archived examinations, examinations, establish establish the the mean mean and and standard standard deviation deviation for for these these indices indices over over the the last last two two years years PQI Example: Diagnostic RP PQI Example: Diagnostic RP

RP PQI Examples on ABR Website: Therapeutic Radiologic Physics Accuracy of Analyses/Calculations: HDR graphical optimization Safety: Standardizing physics chart checks Practice Guidelines and standards: Standardizing dose constancy testing

PQI Example: Therapeutic RP PQI Example: Therapeutic RP Metrics Metrics 1. 1. Collect Collect dose dose constancy constancy data data for for 12 12 months. months. 2. 2. Determine Determine the the overall overall standard standard deviation deviation for for all all data data along along with with the the standard standard deviation deviation for for each each physicist. physicist.

Surveys : Peer review of self-assessment reports AAPM Task Group 103 report on peer review in clinical radiation oncology physics. Journal of Applied Clinical Medical Physics, Vol. 6, Issue 4 (Fall 2005); 50pp.

RP PQI Examples on ABR Website: Medical Nuclear Physics Safety: Radiation badge monitoring Practice Guidelines and Standards: PET SUV Accuracy and stability Surveys: Survey of satisfaction of physicians

1. For radiologic physicists in the ABR MOC program, the first year activity for Part IV: Practice Quality Improvement (PQI) involves. 6% 1. collecting baseline data 13% 2. creating and implementing an improvement plan 3% 3. reporting the selected project to the ABR 77% 4. engaging in education and training on PQI 0% 5. analyzing the PQI data acquired

1. For radiologic physicists in the ABR MOC program, the first year activity for Part IV: Practice Quality Improvement (PQI) involves. D. engaging in education and training on PQI References: Med Phys 34: 4158 4163; Nov 2007 ABR website URLs: - http://theabr.org/rp_moc_req.htm theabr.org/rp_moc_req.htm - http://theabr.org/rp_moc_pqi.htm theabr.org/rp_moc_pqi.htm

18% 2. For radiologic physicists in the ABR MOC program, peer review of self-assessment reports would be included under which one of the following PQI project categories? 25% 1. Safety for patients, employees, and the public 25% 2. Accuracy of analyses and calculations 5% 3. Report turnaround time and communication issues 28% 4. Practice guidelines and technical standards 5. Surveys

2. For radiologic physicists in the ABR MOC program, peer review of self-assessment reports would be included under which one of the following PQI project categories? E. Surveys References: Med Phys 34: 4158 4163; Nov 2007 ABR website URLs: - http://theabr.org/rp_moc_req.htm theabr.org/rp_moc_req.htm - http://theabr.org/rp_moc_pqi.htm theabr.org/rp_moc_pqi.htm

Thank you for your attention! Now it s s time for your Questions

Part 3: Cognitive Expertise Expected to maintain the essentials of core knowledge fundamental to the practice of Radiologic Physics, and to remain up-to date on evolving technologies, protocols, procedures and techniques involving applications of physics in medicine. Fulfillment of these expectations will occur by evaluation of cognitive expertise utilizing a multiple-choice examination in a secure testing center.

Philosophy of the Cognitive Exam ABR Point of View Configured as an instrument that promotes the theme of continuous learning, thus Designed as an integral part of the continuous learning process and not as an unpleasant hurdle to overcome Constructed so that it is relevant to practice Degree of difficulty to be set at a realistic level with the expectation that the pass rate will be relatively high Guidance will be provided to the diplomates to assist in preparation

Cognitive Expertise The examination format will be 100 un-weighted multiple-choice questions with content based on 1) core knowledge (approximately 30%), 2) current evolving technologies (approximately 70%). Necessary reference material will be embedded in the questions. Newly formatted cognitive exam will be available on a yearly basis. A diplomate who fails an exam will have the opportunity to retake the examination, offered in the next year. The exam should be taken during the eighth, ninth or tenth year. Multiple certificate holders must take an exam in each.

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