OSTEOPATHIC CONTINUOUS CERTIFICATION
About Osteopathic Continuous Certification (OCC)
OCC embodies the principles of lifelong learning and continuous improvement designed
for the benefit of the public and the profession. The goal of OCC is to continually set
the standards of excellence in the field of Emergency Medicine by focusing on the six
core competencies integral to quality medical care: medical knowledge, patient care,
interpersonal/communication skills, professionalism, practice based learning and
improvement, and systems-based practice. These competencies were established by
the American Osteopathic Association (AOA), the certifying organization for the
American Osteopathic Board of Emergency Medicine (AOBEM) and the other 17
osteopathic medical specialties.
The History of OCC
In 2008 the American Osteopathic Association (AOA) Board of Trustees approved the
recommendation by the Bureau of Osteopathic Specialists (BOS) to implement an
Osteopathic Continuous Certification (OCC) process. All Certifying Boards are
mandated to be fully operational and compliant with all OCC components by January
2013. The practice of Emergency Medicine has changed dramatically since its founding
in 1980. What began as a one time assessment to obtain a lifetime certificate has
evolved into a lifelong learning assessment and continuous certification. Every
certificate issued by AOBEM since 1992 is valid for 10 years and expires on December
31 of the tenth year. In order to maintain the validity of the certificate for another 10
years, the diplomate must complete the OCC process.
The Value of OCC
Specialized residency training and initial board certification established initial standards
for performance, but did not assure maintenance of proficiency over a practice lifetime.
Regulatory agencies, health maintenance organizations, and the community require
reassurance and documentation of continual professional development and education
by physicians. OCC is a professional response to the need for public accountability and
transparency. AOBEM believes high standards for certified emergency physicians lead
to better health care for emergency patients. The principles behind OCC are designed
to assure that the highest standards of patient care are practiced and maintained and to
assure patients, physicians, and other stakeholders that physicans are being continually
assessed and continually improving patient care. This is congruent with AOBEM’s
mission to protect the public by ensuring the excellence of osteopathic emergency
physicians.
The Federation of State Medical Licensing Boards (FSMB) recently approved language
that would allow OCC participation to serve as a proxy for state-based Maintenance of
Licensure (MOL). The Joint Commission strongly encourages hospitals to measure the
six core competencies of their medical staff every two years as part of the credentialing
process. In the future, the OCC program may help fulfill Joint Commission
requirements. Some pay-for-performance models reward physicians for ongoing
performance evaluation and evidence of involvement in improvement.
The AOBEM OCC process offers physicians a program to keep skills and knowledge
current in a rapidly changing field. It also responds to the healthcare consumers who
demand evidence of a physician’s ongoing excellence in the field of Emergency
Medicine.
OCC Components
The AOBEM OCC process is designed to document that emergency physicians certified
by AOBEM are maintaining the skills and knowledge necessary to provide quality
patient care. The program gives diplomates the opportunity to demonstrate to peers,
patients and the general public a commitment to lifelong learning and improvement in
their practice of Emergency Medicine.
OCC acknowledges that diplomates have already demonstrated a commitment to
excellence by becoming certified and builds upon this. OCC incorporates six core
competencies, as defined by the AOA, into an evaluation process by which emergency
physicians can document their ongoing commitment to excellent patient care.
The Six Core Competencies
1. Patient Care: provide care that is compassionate, appropriate, and effective
treatment
2. Medical Knowledge: demonstrate knowledge about established and evolving
diagnostics and treatments
3. Interpersonal and Communication Skills: demonstrate skills that result in effective
information gathering and transmission to patients, their families and professional
associates.
4. Professionalism: demonstrate a commitment to carrying out professional
responsibilities, adhering to the AOA
Code of Ethics, and sensitivity to diverse
patient populations.
5. Systems Based Practice: demonstrate awareness of and responsibility to larger
context and ability to use system resources to provide optimal care (e.g., coordinating
care across multiple specialties, professions, or sites).
6. Practice Based Learning and Improvement: able to investigate and evaluate their
patient care, collect scientific evidence and improve their practice of medicine.
The Four Part Process of AOBEM OCC
1. Professional Status: Emergency physicians must hold a valid, unrestricted and
unqualified medical license in the states where they practice or in any one state if in
active military practice. Diplomats must also maintain continuous membership in good
standing in the American Osteopathic Association. Such membership insures that a
physician meets the AOA’s Continuing Medical Education (CME) requirements for
certification and adheres to the AOA Code of Ethics.
2. Continuous Osteopathic Learning Assessment (COLA): A COLA module involves
reading assigned articles from the literature and then completing an on-line examination
concerning those articles. The list of assigned articles and applications for the
examination are posted on the AOBEM website. The articles cover the entire table of
specificity over an 8 year cycle (Core competency #2), as well as articles covering
physician communication skills, cultural competency, physician interpersonal skills (core
competency #3) and systems based practice (core competency #5). A new COLA
module is available each year. In order to be eligible for the Formal Re-Certification
Examination (FRCE), a diplomate must take a minimum of 8 COLA modules within a 10
year cycle. Additionally, the diplomat must receive a passing score on at least 6 of the
COLA modules. Taking and passing 6 COLA modules will not satisfy the requirement,
as the physician must have attempted at least 8 COLA modules. Beginning in 2012
(those diplomates who will be taking the FRCE in 2020), diplomates must take and
PASS at least 8 COLA modules. Each COLA module is available on-line for 3 years
only. Diplomats have access only to those modules that are available on-line; thus, it is
important that physicians keep current with each of the modules. Candidates have an
initial 3 opportunities to successfully pass a COLA module. If unsuccessful after these
initial 3 attempts, the candidate may pay the COLA fee again. She/he then has another
3 opportunities to pass the module.
DIPLOMATS WHO FAIL TO MEET THE COLA REQUIREMENTS FOR THE FRCE,
WILL NOT BE PERMITTED TO TAKE THE FRCE. THEY MUST THEN RE-ENTER
THE CERTIFICATION PROCESS AND COMPLETE IT IN ITS ENTIRETY (PART 1,
PART 2, AND PART 3 OF THE PRIMARY CERTIFICATION PROCESS). THESE
DIPLOMATES WOULD MAINTAIN THEIR CURRENT CERTIFICATION UNTIL
IT EXPIRES; HOWEVER, TO BECOME “RE-CERTIFIED” THE PHYSICIAN MUST
RE-ENTER AND COMPLETE THE ENTIRE PRIMARY CERTIFICATION PROCESS.
3. Formal Re-Certification Examination (FRCE): The entire Table of Specificity and its
core content will be covered in the FRCE. Diplomates are required to take this
examination every 10 years to maintain Osteopathic Continuous Certification. The
examination consists of a computer based multiple choice examination (core
competencies # 1 and #2), as well as an oral examination (core competencies #1, 2, 3,
and 4). It should be noted that diplomats may take the FRCE as early as 2 years prior
to the expiration of their certificate. Diplomats also have a maximum of 2 years after
the expiration of their certificate to successfully complete the FRCE. Failure to
successfully complete the FRCE will require the physician to re-enter the certification
process in its entirety (Part 1, Part 2, and Part 3).
4. Practice Performance: Beginning in 2013, diplomats will need to perform a practice
assessment as a part of the Osteopathic Continuous Certification. This component of
Continuous Certification consists of a process whereby the practicing clinician assesses
the quality of his/her care provided by comparing it to that of peers and national
benchmarks. This process promotes improved care through application of "best
evidence" and consensus recommendations. Practice Performance must be completed
once every 10 year recertification cycle. The completed Practice Performance Form
must be submitted with the individual's OCC application form in order to be credentialed
for the recertification exams. No charts will need to be submitted. The process consists
of 4 steps as outlined below:
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Step 1: To initiate the process, identify a target area for clinical improvement.
The target area may be a disease entity, a clinical care issue, or an access-tocare issue (e.g., through-put or left-before-treatment). The target area requires a
population or clinical issue that is measurable for improvement and has
recognized comparison data available. The clinician will need to choose
appropriate data points as measures of quality.
Step 2: Collect and review data points from 10 patient charts from the targeted
area of study. The patient charts must be his/her own patient encounters.
Step 3: The data points from the 10 charts are then compared to evidencebased guidelines or expert consensus statements or comparable peer data.
Interpretation and analysis of the data points can then be used to identify areas
for improvement. Next, develop and implement a practice performance
improvement program. This plan may include an educational piece, personal
reminders, or a change in process (e.g., adding the NEXUS criteria for cervical
spine imaging to the electronic medical record, in order to avoid unnecessary
radiation in trauma patients).
Step 4: After implementation of the process improvement plan, review at least
10 new charts of the targeted area of improvement. Measure and analyze the
data, and then evaluate for improvement.
Those physicians not involved in clinical practice must complete the "AOBEM
Recertification Non-Clinical Form". These physicians are still required to complete the
Practice Performance Modules. Their status will be reported to the AOA as "AOBEM
Certified: Non-Clinical". Should these physicians return to active practice, they will be
required to complete 1 practice performance module within the first year of return to
practice.