Meeting the Challenge of MOC

Part 3: Passing the final required element.

BY ANDREW RABINOWITZ, M.D.

In this three-part series, Andrew Rabinowitz, M.D., discusses the professional and personal challenges he has faced in meeting the requirements to maintain his standing as a board-certified ophthalmologist and his experience with the Maintenance of Certification (MOC) process. In the first installment (www.ophmanagement.com/moc1), which appeared in the April issue of Ophthalmology Management, Dr. Rabinowitz outlined the four primary areas in which an ophthalmologist must show evidence of proficiency. In Part 2, (www.ophmanagement.com/moc2), in the September issue, Dr. Rabinowitz related his successful efforts in passing the first two MOC requirements, the Online Record Review and the submission of acceptable CME credits. This final installment in the MOC series will bring readers up to date on the final phase of the MOC process, specifically, taking the Demonstration of Cognitive Knowledge (DOCK) examination.

I will end the suspense immediately.

For all of you who were rooting for me, I have now successfully completed all of the MOC elements and will remain board-certified for the next 10 years before having to go through this challenging process again.

If you are facing the MOC process in the near future, the good news is that the experience should be somewhat easier (and less expensive) for you than it was for those of us who served as pioneers. As I will explain, one of the obstacles to obtaining the resources necessary to study for the tests has recently been removed — a move that I heartily applaud.

Study Materials for DOCK

The pertinent study materials for the DOCK test can be obtained from two sources.

The first, and most valuable resource, comes from the American Board of Ophthalmology (ABO) Web site: www.abop.org. This site is the portal to the Periodic Ophthalmic Review Tests (PORT). Each PORT module is a self-contained 50-question practice examination.

At least two PORT modules are available for each subspecialty. Because my DOCK examination was going to consist of two glaucoma sections and one comprehensive ophthalmology section, I elected to purchase the available PORT modules for both glaucoma and comprehensive ophthalmology. Each PORT module cost $100.

Once the appropriate practice tests have been purchased, the applicant has 30 days to complete each PORT module. The modules are composed of questions that are similar in subject matter to those that will appear on the DOCK examination. The PORT modules were an excellent guide to the material that the ABO uses to create the DOCK examination. Once the 50 questions are completed, the test is automatically scored and the questions that were answered incorrectly are identified. Once the PORT is completed, it cannot be accessed again. Over the course of my preparation for the DOCK exam, I spent $900 on PORT materials.

The second source of study material for the DOCK is the American Academy of Ophthalmology (AAO) Web site: www.aao.org. In order to obtain the MOC materials created by the AAO, I had to purchase both the written as well as the online resources. The cost of these resources to me was nearly $900. Since my purchase of these materials, the AAO has made these resources available to all MOC candidates free of charge.

The AAO-generated MOC materials I received were not as well constructed as the PORT modules created by the ABO. The AAO-generated MOC materials were simply a global outline of a given topic such as glaucoma, cornea or neuro-ophthalmology. These materials do not provide significant detail regarding the outlined subjects.

In addition to the MOC subject outlines, the AAO has generated a series of review questions for comprehensive ophthalmology, as well as for each unique subspecialty on which the applicant will be tested. Unlike the PORT questions, which can only be viewed for a period of 30 days, and cannot be reviewed once the examination is completed, the AAO questions can be reviewed indefinitely. The AAO review questions were an excellent source of topics for further study. I found these questions to be of great value as I studied for the examination.

Internet Resources Proved Valuable

Thanks to the wonders of the Internet, studying for an examination can now be done with minimal use of traditional paper resources such as textbooks. In fact, my studies were completely virtual. My main study site was my laptop computer.

My virtual classroom included the study materials from the ABO and AAO Web sites, the powerful search powers of Google and the online resources of both peer-reviewed and trade journals.

My advice to those of you who will study and sit for this examination in the years to come is to make sure that you have access to a computer and a high-speed Internet connection. I would then visit the ABO Web site and purchase all of the PORTs available in your specialty. Concurrently, I would regularly visit the AAO Web site to go over their test questions. The cost for my study materials was just over $2,000 after adding up the cost of my PORTs and the AAO MOC study materials. With the AAO materials now free, you should be able to acquire all of the key resources for under $1,000.

Setting a Study Schedule

Like all busy ophthalmologists, my schedule is quite demanding. My wife and I also have young children. Despite the importance of the MOC tests, I did not want to isolate myself in total study mode and thus shortchange my family of the quality time I like to spend with them. My answer to these competing demands resulted in a sort of compromise. In the months that preceded the examination, I tried to carve out a few hours for study each Saturday and Sunday. If you have acquired the appropriate study materials and are generally well organized, a schedule such as mine should be sufficient.

Taking the DOCK Test

The DOCK examination is offered every day during September of each year.

Many months in advance of September, the applicant is sent notification from the ABO on how to sign up for the DOCK. The DOCK exam is given at Pyrometric Testing Centers, which are located in most major cities in the United States. The Pyrometric Centers provide the opportunity to take the examination close to home as opposed to having to cross the country to sit for the examination, as we had to do for our initial certification. The exam is given over a 3½-hour period.

The exam consists of three sections. Two of the sections can be in the applicant's specialty. The third part is in comprehensive or core ophthalmology. Each section contains 50 questions and must be completed in 60 minutes or less.

On the day of the exam, I arrived at the Pyrometric Center with my ABO-sponsored identification form and two types of picture identification, such as a driver's license or passport. I was unable to bring any personal items into the examination area.

Once I checked in at the test center, I was ushered to my test cubicle. At my cubicle, I logged on to the computer and began my test. I needed nearly 50 minutes to complete each of the glaucoma sections and 55 minutes to finish the section on general ophthalmology.

Sweet Relief

Roughly 8 weeks after sitting for the examination, I received notification from the ABO congratulating me on passing the examination. I was not told what my score was, but only that I did pass the examination.

Now that this ordeal is behind me, I can honestly say that I am quite relieved. My personal observations on the examination are that it was, for me, quite challenging. I found the questions to be more challenging than I had hoped and would strongly advise future test-takers to heed my warnings and commit at least 6 months worth of weekends for studying and preparing for the exam. If an applicant fails to pass the examination within the allotted three attempts, they will be deemed as having lost board certification. Applicants can, however, continue to take the examination annually until they pass and become recertified.

It is my sincere hope that this series will serve as a guide of sorts for future examinees. My belief is that the entire process is one that requires time, effort, money and commitment. Now that I have involuntarily donated these resources to the cause of achieving recertification, I can again turn my focus on the things that matter most: my family and my work. OM