Deconstruction Part 4 of MOC by Michelle Lofwall, MD

1. 6AAAP News Summer 2013
Associate Editor’s Column
Deconstructing Part 4 of Maintenance of Certification (MOC)
Michelle Lofwall, MD, Associate Editor
Next year my ABPN certification expires, and like many others, I was confused about what I needed to do for the new Part 4
Practice in Performance (PIP) component. My hope here is to clearly explain the Part 4 requirements and provide some
helpful recommendations. First, it is helpful to register on-line for an ABPN folio account (www.abpn.com). This account
allows one to log all MOC activities so that it can provide feedback on exactly how many hours and how many modules of
what kind of activities one needs to do in order to maintain their board certification. Second, plan ahead and get familiar
with Part 4 soon, even if your recertification is several years away, because Part 4 activities are meant to be continuous
assessments and reassessments over time. Third, remember that AAAP has a very helpful and friendly expert in MOC, Miriam
Giles, who is available to answer questions (thank you, Miriam!).
Now, here are the details. There are two components to Part 4; the PIP Patient and Peer Feedback Module and the PIP Clinical
Module. To complete one cycle of Patient and Peer Feedback Forms, one must first have at least five patient and five peers fill
out the ABPN-certified Patient and Peer Feedback Forms, respectively. These one-page forms can be downloaded from the
ABPN website. Distribute the forms to your patients and peers and then collect them. Peers do not have to be physicians.
Peers are defined by the ABPN website as including “professional healthcare staff such as, psychologists, social workers,
counselors, and nurses.” After you review their feedback, make a plan to improve, document that plan, and then reassess
with another round of five patient and five peer feedback forms within 24 months. You may reassess with the same patients or
different ones. This then completes one PIP Patient and Peer Feedback Module cycle.
The other component is completion of a PIP Clinical Module. Choose a PIP Clinical Module that is applicable to your clinical
practice because you will be reviewing your clinical care of patients in reference to the evidence-based guidelines provided
for that PIP Clinical Module topic. For instance, I did the APA’s PIP titled “Physician Practice Assessment Tools for the
Screening and Assessment of Adults with Substance Use Disorder.” It begins with a 4-page written explanation of the goals of
the PIP and references for additional reading. It then leads into the first part of the PIP module, which is the physician
assessment checklist. To complete this, you will need to review five of your patient charts in order to document on the
checklist whether you documented in your charts the specified evidence-based practice behaviors. After completing this
assessment, determine which evidence-based practices you would like to improve upon and document an improvement plan.
There are recommended educational resources within the PIP as well. The improvement plan is the second component of the
PIP module. After the improvement plan is implemented and some time has passed to allow for change in your practice,
repeat the physician assessment checklist with either the same 5 patients charts or new ones and document the results of the
improvement plan on patient care. This is the third and final part of the PIP module. After each stage of the PIP module is
completed (i.e., the physician assessment with chart review, improvement plan, and re-assessment with chart review)
complete the evaluation survey provided in the PIP module and send it to APA. Upon receipt of the evaluation(s), APA then
will send a certificate of completion with CME credit that is based on the amount of hours you specified working on the PIP
module. Also, many forms (e.g., the patient and peer feedback forms, patient assessment checklist, and performance
improvement plan) are not reviewed by anyone else but you. It may be wise to keep these in case the ABPN requests these or
begins audits in the future. Overall, after completing a PIP module, I did make a clinical improvement that I likely would not
have made without going through this process, so that part was helpful. Good luck!
Michelle Lofwall, MD/AAAP News/ Summer 2013