MOCs, MOLs, MOOCs and MiniMOOCs

Advocates for maintenance of certification (MOC) are taking flak from those who claim the process of requiring recertification of medical professionals is time consuming, cumbersome, expensive, invalid and irrelevant. They are also concerned about mission creep i.e. requiring MOC to get licensure renewal, or maintenance of licensure (MOL).

The largest board certification organization in the nation, the American Board of Medical Specialties (ABMS), recently announced a record-breaking number of ABMS-certified physicians in the United States — 988,737 out of 989,323 physicians, to be exact — easily cementing its monopoly status for its physician certification enterprise. Amid this highly profitable business model is a significant but little-known driver that is exacerbating burnout and hastening the exit of physicians from clinical practice. ABMS Maintenance of Certification (MOC) is a proprietary continuing education product that to date has no high-quality evidence that it improves patient care. The cost and burden associated with MOC remains a significant factor driving physicians out of medicine.

At the same time, we are seeing an explosion of Massive Online Open Courses (MOOCs) in various permutations that some claim will radically change the higher education business model. Someone should connect the dots.

Like MOCs, MOOCS have their advocates and critics. The key issues have to do with high user dropout rates, problems measuring performance and outcomes and whether the platform can adequately address the learning style of a given student.

Some universities are offering mini-MOOCs. As an alternative to the full 8 week MOOC model, these may vary from on-line activities to support a single learning outcome, through to a full mini module lasting up to 3 weeks. Others are creating nanocourses.

MiniMOOCs for MOC have the potential to address some of the major barriers to acceptance. Of course, killing the medical specialty board cash cow will not sit well. However, those charged with demonstrating competencies should get out of their offices every once in a while and see whether someone else has already solved their problem. For example, MOOCS and companies that produce them, like Coursera, are migrating to using them for job training, not general education.

It is likely that more and more universities will be offering not just some online courses, but rather online degrees. While it is true that the curriculum in the first two years of medical school is changing from rote memorization of basic science information and including more clinical interaction earlier, it is reasonable that that basic science information will be offered online , not just to first year medical school students, but qualified undergraduates as well. Doing so could cure the cost of medical school, but only if the medical school business model changes as well.

Integrating basic science courses into clinical experiences increases student engagement. Some schools are now using the same approach to introduce topics in clinical informatics, data literacy, dexterity, innovation, and entrepreneurship.

Medicine has enough hubris to believe that sick care, behavioral health , health and wellness and medical education can be fixed from inside. It can't, and you don't need a pair of Google Glass to see that...even if you can find a pair now that they've been shelved.

Arlen Meyers, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack and Editor of Digital Health Entrepreneurship