More Than Reducing Complexity: Canadian Specialists’ Views of the Royal College’s Maintenance of Certification Framework and Program

Introduction: Maintenance of Certification (MOC) programs are facing competing pressures from physicians and regulators to design and deliver systems that ensure physicians sustain or maintain competence postcertification. Adding to these pressures is an emerging discourse of dissatisfaction by physicians participating in MOC programs suggesting physicians themselves are seeking programs that are relevant to their scope of practice. The object was to determine Canadian specialists’ views of a redesigned Royal College of Physician and Surgeons of Canada’s MOC program in five priority areas: complexity, motivation, impact, credit sufficiency, and enhancement. Methods: A national, cross-specialty, survey of Royal College of Physician and Surgeons of Canada’s MOC program users who had participated for at least 1 year. Results: Five thousand two hundred fifty nine respondents were included in the analysis. A majority of participates either “agreed” (2258, 43%) or “strongly agreed” (631, 12%) that the new framework was simpler to understand and the redesigned submission templates were simpler to use (“agree” 2297 [43.7%], “strongly agree” 701 [13.3%]). A total of 64.5% had a good understanding of the program purposes; however, some respondents believe the program does not yet deliver intended outcomes. Maintaining Fellowship designation, regulatory requirements, and a desire to remain up-to-date were indicated as the primary motivators for engaging in MOC. The program has had a modest influence on users’ approach to lifelong learning (“neither agree nor disagree”). Discussion: The program redesign reduced the perceived complexity of the MOC framework however it is described by some, as additional work (an add-on) by necessitating the documentation of participation in learning activities. An important “disconnect” between the program purposes and how physicians operationalize engagement was also illuminated by our study. Further attention needs to be paid to shifting the culture of continuing professional development to one that enables physicians to sufficiently demonstrate their continuing competence and enhanced performance meaningfully through participation in MOC programs.