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Medical Education  |   June 2013
Osteopathic Continuous Certification: It's Here—Are You Prepared?
Author Notes
  • From the New Jersey Institute for Successful Aging in Stratford (Dr Scheinthal) and the American Osteopathic Association's Department of Education (Ms Gross) 
  • Address correspondence to Cheryl Gross, MA, CAE, Department of Education, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864. E-mail: cgross@osteopathic.org  
Article Information
Imaging / Medical Education / Professional Issues
Medical Education   |   June 2013
Osteopathic Continuous Certification: It's Here—Are You Prepared?
The Journal of the American Osteopathic Association, June 2013, Vol. 113, 479-483. doi:10.7556/jaoa.2013.113.6.479
The Journal of the American Osteopathic Association, June 2013, Vol. 113, 479-483. doi:10.7556/jaoa.2013.113.6.479
Web of Science® Times Cited: 33
Abstract

The authors explain Osteopathic Continuous Certification (OCC) as mandated by the American Osteopathic Association Board of Trustees. Implemented on January 1, 2013, OCC is the process wherein osteopathic physicians certify their training and expertise in their chosen specialty and maintain the standard of excellence begun with the initial American Osteopathic Association certification. In contrast to one-time examinations, OCC is intended to be an ongoing, lifelong process for osteopathic physicians.

As of January 1, 2013, osteopathic physicians (ie, DOs) who are board certified by the American Osteopathic Association (AOA) and who have time-limited certifications (ie, certifications with expiration dates) are required to participate in Osteopathic Continuous Certification (OCC) to maintain their certification. In the current article, we outline the AOA's OCC standards, including the components that the 18 AOA specialty certifying boards require of all diplomates. 
What Is OCC?
The AOA is committed to ensuring that the DOs it certifies remain current in their chosen field and maintain the standard of excellence they have pledged to meet at the time of their initial AOA certification. In contrast to the previous recertification process for AOA diplomates with time-limited certification, OCC is intended as an ongoing, lifelong process.1-4 
Toward this end, the AOA Board of Trustees mandated the Bureau of Osteopathic Specialists (BOS) and its 18 specialty certifying boards to fully implement OCC by January 1, 2013. 
Non–Time-Limited Certifications
The AOA does not require DOs with non–time-limited certifications (also known as “lifetime,” “non–time-dated,” or “non-expiring” certifications) to participate in OCC. They may, however, choose to recertify voluntarily, particularly if their state adopts Maintenance of Licensure legislation. 
Components of OCC
The only addition to the previous recertification process for those DOs with time-limited certifications is Component 4—Practice Performance Assessment and Improvement. Previous articles in the Journal of the American Osteopathic Association1-5 have detailed the following 5 components of OCC:
  •  
    Component 1—Unrestricted Licensure
  •  
    Component 2—Lifelong Learning / Continuing Medical Education
  •  
    Component 3—Cognitive Assessment
  •  
    Component 4—Practice Performance Assessment and Improvement
  •  
    Component 5—Continuous AOA Membership
Component 1—Unrestricted Licensure
To meet this requirement, AOA–board-certified physicians must hold a valid, unrestricted license to practice medicine in 1 of the 50 United States—or Canada—and must adhere to the AOA's Code of Ethics.6 Licensure of DOs who do not meet this requirement will be reviewed by a subcommittee of the BOS, and those DOs whose certifications are affected have an appeal mechanism through the BOS and AOA Board of Trustees. A description of the appeals process can be found in the BOS Handbook at http://www.osteopathic.org/inside-aoa/development/aoa-board-certification/Documents/bos-handbook.pdf. 
Component 2—Lifelong Learning/Continuing Medical Education
This component requires all AOA–board-certified physicians to fulfill a minimum of 120 continuing medical education (CME) credits during each 3-year CME cycle. Whereas most specialty certifying boards require physicians to accrue 120 credits during each cycle, there are 2 that mandate 150 credits: the American Osteopathic Board of Family Physicians and the American Osteopathic Board of Neuromusculoskeletal Medicine. 
The AOA also requires DOs to earn a minimum of 50 specialty credits for each specialty certifying board on which they hold primary board certification. Credits in specialty CME are not required to be in Category 1-A. 
Physicians who have a Certification of Special Qualifications or a Certification of Added Qualifications must earn a minimum of 13 credits of the 50 specialty credits in the focus area of each subspecialty certificate held. Osteopathic physicians who have earned 4 or more combined Certifications of Special Qualifications and Certifications of Added Qualifications will need to earn more than 50 specialty credits in order to meet this requirement.7 
Component 3—Cognitive Assessment
American Osteopathic Association board certifications are valid for 6 to 10 years, depending on the specialty. During each certification cycle, DOs are required to pass examinations that assess their specialty medical knowledge, as well as core competencies in the provision of health care and practice of osteopathic medicine. These examinations may be written, oral, or practical/clinical. For more information, DOs should visit their respective specialty board websites (Table), which will explain the examination process for a given specialty in detail. 
Table.
AOA Specialty Certifying Boards and OCC Requirementsa,b
Component 2 Component 3 Component 4
American Osteopathic Board of… Website OCC Period, y Lifelong Learning and CME Creditsc Self-Assessment Modules or Activities Cognitive Assessmentd Practice Performance Assessment and Improvement
Anesthesiology http://www.aobanes.com 10 120 20 modules per certification period; as applicable, 5 modules per certification period for subspecialty certification Written 1 module every certification cycle (10 years)
Dermatology http://www.aobd-derm.org/ 10 120 None required Written 2 modules every certification cycle (10 years)
Emergency Medicine http://www.aobem.org/ 10 120 1 module per certification period Written and oral 2 modules every certification cycle (10 years)
Family Physicians http://www.aobfp.org 8 150 None required Written and practical 2 modules every 3 years for first 6 years
Internal Medicine http://www.aobim.org/ 10 120 None required Written 100 points each certification cycle (10 years) with a minimum of 20 points every 3 years
Nuclear Medicine http://www.aobnm.org/ 10 120 None required Written Not required
Neurology and Psychiatry http://www.aobnp.org 10 120 None required Written 1 module every 3 years
Neuromusculoskeletal Medicine http://www.aobnmm.org/ 10 150 None required Written 1 module every 3 years
Obstetrics and Gynecology http://www.aobog.org/ 6 120 None required Written 5 modules each certification cycle (6 years)
Ophthalmology and Otolaryngology–Head and Neck Surgery http://www.aoboo.org/ 10 120 None required Written 1 module each certification cycle (10 years); must occur in years 1-6
Orthopedic Surgery http://www.aobos.org/ 10 120 15 hours each CME cycle Written 1 module every 3 years
Pathology http://www.aobpath.org/ 10 120 15 credits each CME cycle Written 2 modules every certification cycle (10 years)
Pediatrics http://www.aobp.org/ 9 120 6 eJournal articles and assessments and 3 POMT modules each CME cycle Written 1 module each CME cycle (3 years)
Physical Medicine and Rehabilitation http://www.aobpmr.org/ 10 120 None required Oral 1 module every 3 years
Preventive Medicine http://www.aobpm.org/ 9 120 None required Written 1 module each certification period (9 years)
Proctology http://www.aobpr.org/ 10 120 None required Written 1 module every 3 years
Radiology http://www.aocr.org/ 10 120 2 modules per year (2 SAMs per year; 6 per 3-year AOA CME cycle) Written 3 modules each certification cycle (10 years); can only complete 1 every 3 years
Surgery http://www.aobs.org/ 10 120 None required Written 2 modules each CME cycle (3 years)
  a These requirements were current as of February 7, 2013.
  b Requirements for Components 1 and 5 are uniform for all specialties. Component 1 (“Unrestricted Licensure”) requires that physicians maintain medical licensure through the Osteopathic Continuous Certification (OCC) cycle, adhere to American Osteopathic Association (AOA) Code of Ethics, and, if required, participate in remedial activities. Component 5 (“Continuous AOA Membership”) requires that physicians maintain active AOA membership throughout the OCC period.
  c For each 3-year AOA continuing medical education (CME) cycle, physicians are required to earn CME credits, including 50 specialty credits. As applicable, physicians must also earn 13 credits per CME cycle for subspecialty certification such as Certification of Added Qualifications (CAQ) or Certification of Special Qualifications (CSQ).
  d Physicians are required to take examination(s) once per OCC cycle.
  Abbreviations: OMM, osteopathic manipulative medicine; POMT, pediatric osteopathic manipulative treatment; SAM, self-assessment modules.
Table.
AOA Specialty Certifying Boards and OCC Requirementsa,b
Component 2 Component 3 Component 4
American Osteopathic Board of… Website OCC Period, y Lifelong Learning and CME Creditsc Self-Assessment Modules or Activities Cognitive Assessmentd Practice Performance Assessment and Improvement
Anesthesiology http://www.aobanes.com 10 120 20 modules per certification period; as applicable, 5 modules per certification period for subspecialty certification Written 1 module every certification cycle (10 years)
Dermatology http://www.aobd-derm.org/ 10 120 None required Written 2 modules every certification cycle (10 years)
Emergency Medicine http://www.aobem.org/ 10 120 1 module per certification period Written and oral 2 modules every certification cycle (10 years)
Family Physicians http://www.aobfp.org 8 150 None required Written and practical 2 modules every 3 years for first 6 years
Internal Medicine http://www.aobim.org/ 10 120 None required Written 100 points each certification cycle (10 years) with a minimum of 20 points every 3 years
Nuclear Medicine http://www.aobnm.org/ 10 120 None required Written Not required
Neurology and Psychiatry http://www.aobnp.org 10 120 None required Written 1 module every 3 years
Neuromusculoskeletal Medicine http://www.aobnmm.org/ 10 150 None required Written 1 module every 3 years
Obstetrics and Gynecology http://www.aobog.org/ 6 120 None required Written 5 modules each certification cycle (6 years)
Ophthalmology and Otolaryngology–Head and Neck Surgery http://www.aoboo.org/ 10 120 None required Written 1 module each certification cycle (10 years); must occur in years 1-6
Orthopedic Surgery http://www.aobos.org/ 10 120 15 hours each CME cycle Written 1 module every 3 years
Pathology http://www.aobpath.org/ 10 120 15 credits each CME cycle Written 2 modules every certification cycle (10 years)
Pediatrics http://www.aobp.org/ 9 120 6 eJournal articles and assessments and 3 POMT modules each CME cycle Written 1 module each CME cycle (3 years)
Physical Medicine and Rehabilitation http://www.aobpmr.org/ 10 120 None required Oral 1 module every 3 years
Preventive Medicine http://www.aobpm.org/ 9 120 None required Written 1 module each certification period (9 years)
Proctology http://www.aobpr.org/ 10 120 None required Written 1 module every 3 years
Radiology http://www.aocr.org/ 10 120 2 modules per year (2 SAMs per year; 6 per 3-year AOA CME cycle) Written 3 modules each certification cycle (10 years); can only complete 1 every 3 years
Surgery http://www.aobs.org/ 10 120 None required Written 2 modules each CME cycle (3 years)
  a These requirements were current as of February 7, 2013.
  b Requirements for Components 1 and 5 are uniform for all specialties. Component 1 (“Unrestricted Licensure”) requires that physicians maintain medical licensure through the Osteopathic Continuous Certification (OCC) cycle, adhere to American Osteopathic Association (AOA) Code of Ethics, and, if required, participate in remedial activities. Component 5 (“Continuous AOA Membership”) requires that physicians maintain active AOA membership throughout the OCC period.
  c For each 3-year AOA continuing medical education (CME) cycle, physicians are required to earn CME credits, including 50 specialty credits. As applicable, physicians must also earn 13 credits per CME cycle for subspecialty certification such as Certification of Added Qualifications (CAQ) or Certification of Special Qualifications (CSQ).
  d Physicians are required to take examination(s) once per OCC cycle.
  Abbreviations: OMM, osteopathic manipulative medicine; POMT, pediatric osteopathic manipulative treatment; SAM, self-assessment modules.
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Component 4—Practice Performance Assessment and Improvement
Component 4 requires that diplomates engage in quality improvement by means of comparison of personal practice and patient chart information, measured against national benchmarks and standards for each specialty. 
Component 4 is the only new requirement for holders of time-limited AOA board certifications. Each board has developed practice performance assessment (PPA) projects customized for each specialty. 
It is the intention of the AOA that the PPAs be relevant to its diplomates' practice. The AOA recognizes that DOs may specialize in an area that is not precisely defined by the name of their initial AOA board certification. For instance, a DO certified through the American Osteopathic Board of Family Practice may specialize in women's health issues only or dermatology only. Those physicians may petition their specialty board to take another board's PPA to meet the criteria set forth by their board. 
Component 5—Continuous AOA Membership
The AOA requires that physicians maintain an active membership throughout the OCC cycle. Membership in the AOA provides DOs with many advantages, including online resources, practice management assistance, national advocacy for DOs and the profession, access to professional publications, and CME opportunities. 
Clinically Inactive and Academic Physicians
Physicians who do not actively practice medicine, such as educators or researchers, may apply to their specialty board for nonclinical status of their certification. They will need to participate fully in all aspects of OCC as required by their specialty certifying board. The PPA requirement for Component 4—which may encompass, for example, communication or multicultural issues—applies to all DOs regardless of status of osteopathic medical practice. 
CMS Maintenance of Certification Program Incentive
Four AOA boards were awarded conditional approval of their OCC processes for the Maintenance of Certification (MOC) Program Incentive offered by the Centers for Medicaid and Medicare Services (CMS) for the 2012 reporting year. These boards were the American Osteopathic Board of Internal Medicine, the American Osteopathic Board of Obstetrics and Gynecology, the American Osteopathic Board of Pediatrics, and the American Osteopathic Board of Radiology. 
The AOA applied to CMS on behalf of all specialty certifying boards for the 2013 reporting year as well, and all AOA board certification specialties and subspecialties have been approved for the CMS MOC Program Incentive. 
This incentive allows diplomates to apply for an additional 0.5% incentive payment for 2013 for submitted Medicare claims. Interested participants must register for and meet the basic Physician Quality Reporting System requirements and be board certified in order to qualify for this incentive. Physicians must perform MOC activities more frequently than required for the simpler MOC in Components 2, 3, and 4 of OCC. Additional information about the CMS MOC Program Incentive will be available at Osteopathic.org. 
Maintenance of Licensure and OCC
The AOA and the BOS continue to work with the Federation of State Medical Boards (FSMB) as state medical boards begin working on projects to determine readiness for requiring Maintenance of Licensure. The FSMB has affirmed to the state boards that participation and compliance with OCC would meet all requirements for state Maintenance of Licensure. The pilot projects are currently under way, with more information and reports planned for early summer 2013. More information on Maintenance of Licensure is available on the FSMB's website at www.fsmb.org. 
Dashboard
To see the OCC requirements and track each OCC milestone, DOs may log on to Osteopathic.org and click the “My OCC” tab. The tab links to a dashboard of each of the 5 components of OCC. Diplomates are able to access at-a-glance information on the OCC process for each of their board certifications and to upload documents for their specialty certifying board to review. 
Currently, OCC is limited to AOA–board-certified physicians only. During the next year, the AOA anticipates pilot testing projects for non-certified DOs as well as non-DOs who are interested in participating in OCC. 
More information on OCC is available at http://www.osteopathic.org/inside-aoa/development/aoa-board-certification/Pages/osteopathic-continuous-certification.aspx. The website includes frequently asked questions about OCC and links to each specialty certifying board's website for detailed information on its respective OCC requirements and policies. A list of each board's website and summary of OCC requirements can be found in the Table. 
Conclusion
As the OCC process rolls out, board-certified DOs are expected to keep track of the many changes to the certification process, carefully reviewing all information from the AOA and from their respective specialty certifying boards. 
   Financial Disclosures: None reported.
 
References
Ayres RE, Scheinthal S, Ramirez A, Bell EC. Osteopathic certification evolving into a continuous certification model. J Am Osteopath Assoc. 2008;108(3):159-165. [PubMed]
Ayres RE, Scheinthal S, Gross C, Bell EC. Osteopathic specialty board certification. J Am Osteopath Assoc. 2009;109(3):181-190. [PubMed]
Ayres RE, Scheinthal S, Gross C, Bell EC. Osteopathic specialty board certification. J Am Osteopath Assoc. 2010;110(3):183-192. [PubMed]
Ayres RE, Scheinthal S, Gross C, Bell EC. Osteopathic specialty board certification. J Am Osteopath Assoc. 2011;111(4):280-288. [PubMed]
Ayres RE, Scheinthal S, Gross C, Bell EC. Changes to osteopathic specialty board certification. J Am Osteopath Assoc. 2012;112(4):226-231.
AOA Code of Ethics. American Osteopathic Association website. http://www.osteopathic.org/inside-aoa/about/leadership/Pages/aoa-code-of-ethics.aspx. Accessed April 15, 2013.
Rodgers D. AOA Continuing Medical Education. J Am Osteopath Assoc. 2013;113(4):320-338. [PubMed]
Table.
AOA Specialty Certifying Boards and OCC Requirementsa,b
Component 2 Component 3 Component 4
American Osteopathic Board of… Website OCC Period, y Lifelong Learning and CME Creditsc Self-Assessment Modules or Activities Cognitive Assessmentd Practice Performance Assessment and Improvement
Anesthesiology http://www.aobanes.com 10 120 20 modules per certification period; as applicable, 5 modules per certification period for subspecialty certification Written 1 module every certification cycle (10 years)
Dermatology http://www.aobd-derm.org/ 10 120 None required Written 2 modules every certification cycle (10 years)
Emergency Medicine http://www.aobem.org/ 10 120 1 module per certification period Written and oral 2 modules every certification cycle (10 years)
Family Physicians http://www.aobfp.org 8 150 None required Written and practical 2 modules every 3 years for first 6 years
Internal Medicine http://www.aobim.org/ 10 120 None required Written 100 points each certification cycle (10 years) with a minimum of 20 points every 3 years
Nuclear Medicine http://www.aobnm.org/ 10 120 None required Written Not required
Neurology and Psychiatry http://www.aobnp.org 10 120 None required Written 1 module every 3 years
Neuromusculoskeletal Medicine http://www.aobnmm.org/ 10 150 None required Written 1 module every 3 years
Obstetrics and Gynecology http://www.aobog.org/ 6 120 None required Written 5 modules each certification cycle (6 years)
Ophthalmology and Otolaryngology–Head and Neck Surgery http://www.aoboo.org/ 10 120 None required Written 1 module each certification cycle (10 years); must occur in years 1-6
Orthopedic Surgery http://www.aobos.org/ 10 120 15 hours each CME cycle Written 1 module every 3 years
Pathology http://www.aobpath.org/ 10 120 15 credits each CME cycle Written 2 modules every certification cycle (10 years)
Pediatrics http://www.aobp.org/ 9 120 6 eJournal articles and assessments and 3 POMT modules each CME cycle Written 1 module each CME cycle (3 years)
Physical Medicine and Rehabilitation http://www.aobpmr.org/ 10 120 None required Oral 1 module every 3 years
Preventive Medicine http://www.aobpm.org/ 9 120 None required Written 1 module each certification period (9 years)
Proctology http://www.aobpr.org/ 10 120 None required Written 1 module every 3 years
Radiology http://www.aocr.org/ 10 120 2 modules per year (2 SAMs per year; 6 per 3-year AOA CME cycle) Written 3 modules each certification cycle (10 years); can only complete 1 every 3 years
Surgery http://www.aobs.org/ 10 120 None required Written 2 modules each CME cycle (3 years)
  a These requirements were current as of February 7, 2013.
  b Requirements for Components 1 and 5 are uniform for all specialties. Component 1 (“Unrestricted Licensure”) requires that physicians maintain medical licensure through the Osteopathic Continuous Certification (OCC) cycle, adhere to American Osteopathic Association (AOA) Code of Ethics, and, if required, participate in remedial activities. Component 5 (“Continuous AOA Membership”) requires that physicians maintain active AOA membership throughout the OCC period.
  c For each 3-year AOA continuing medical education (CME) cycle, physicians are required to earn CME credits, including 50 specialty credits. As applicable, physicians must also earn 13 credits per CME cycle for subspecialty certification such as Certification of Added Qualifications (CAQ) or Certification of Special Qualifications (CSQ).
  d Physicians are required to take examination(s) once per OCC cycle.
  Abbreviations: OMM, osteopathic manipulative medicine; POMT, pediatric osteopathic manipulative treatment; SAM, self-assessment modules.
Table.
AOA Specialty Certifying Boards and OCC Requirementsa,b
Component 2 Component 3 Component 4
American Osteopathic Board of… Website OCC Period, y Lifelong Learning and CME Creditsc Self-Assessment Modules or Activities Cognitive Assessmentd Practice Performance Assessment and Improvement
Anesthesiology http://www.aobanes.com 10 120 20 modules per certification period; as applicable, 5 modules per certification period for subspecialty certification Written 1 module every certification cycle (10 years)
Dermatology http://www.aobd-derm.org/ 10 120 None required Written 2 modules every certification cycle (10 years)
Emergency Medicine http://www.aobem.org/ 10 120 1 module per certification period Written and oral 2 modules every certification cycle (10 years)
Family Physicians http://www.aobfp.org 8 150 None required Written and practical 2 modules every 3 years for first 6 years
Internal Medicine http://www.aobim.org/ 10 120 None required Written 100 points each certification cycle (10 years) with a minimum of 20 points every 3 years
Nuclear Medicine http://www.aobnm.org/ 10 120 None required Written Not required
Neurology and Psychiatry http://www.aobnp.org 10 120 None required Written 1 module every 3 years
Neuromusculoskeletal Medicine http://www.aobnmm.org/ 10 150 None required Written 1 module every 3 years
Obstetrics and Gynecology http://www.aobog.org/ 6 120 None required Written 5 modules each certification cycle (6 years)
Ophthalmology and Otolaryngology–Head and Neck Surgery http://www.aoboo.org/ 10 120 None required Written 1 module each certification cycle (10 years); must occur in years 1-6
Orthopedic Surgery http://www.aobos.org/ 10 120 15 hours each CME cycle Written 1 module every 3 years
Pathology http://www.aobpath.org/ 10 120 15 credits each CME cycle Written 2 modules every certification cycle (10 years)
Pediatrics http://www.aobp.org/ 9 120 6 eJournal articles and assessments and 3 POMT modules each CME cycle Written 1 module each CME cycle (3 years)
Physical Medicine and Rehabilitation http://www.aobpmr.org/ 10 120 None required Oral 1 module every 3 years
Preventive Medicine http://www.aobpm.org/ 9 120 None required Written 1 module each certification period (9 years)
Proctology http://www.aobpr.org/ 10 120 None required Written 1 module every 3 years
Radiology http://www.aocr.org/ 10 120 2 modules per year (2 SAMs per year; 6 per 3-year AOA CME cycle) Written 3 modules each certification cycle (10 years); can only complete 1 every 3 years
Surgery http://www.aobs.org/ 10 120 None required Written 2 modules each CME cycle (3 years)
  a These requirements were current as of February 7, 2013.
  b Requirements for Components 1 and 5 are uniform for all specialties. Component 1 (“Unrestricted Licensure”) requires that physicians maintain medical licensure through the Osteopathic Continuous Certification (OCC) cycle, adhere to American Osteopathic Association (AOA) Code of Ethics, and, if required, participate in remedial activities. Component 5 (“Continuous AOA Membership”) requires that physicians maintain active AOA membership throughout the OCC period.
  c For each 3-year AOA continuing medical education (CME) cycle, physicians are required to earn CME credits, including 50 specialty credits. As applicable, physicians must also earn 13 credits per CME cycle for subspecialty certification such as Certification of Added Qualifications (CAQ) or Certification of Special Qualifications (CSQ).
  d Physicians are required to take examination(s) once per OCC cycle.
  Abbreviations: OMM, osteopathic manipulative medicine; POMT, pediatric osteopathic manipulative treatment; SAM, self-assessment modules.
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