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Quarterly Questions is the new gold standard for board certification


Dr. Mali discusses how the Quarterly Questions program assesses fundamental (“walking around”) knowledge needed in the everyday practice of ophthalmology (40 questions annually), as well as the application of information from five journal articles (10 questions annually).

Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Joshua Mali, MD, a vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, FL. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica. 

Dr. MaliDue to the successful pilot year for Quarterly Questions in 2017 (see Dr. Mali's top 5 stories in ophthalmology in 2017), the American Board of Ophthalmology (ABO) has announced the program’s adoption as the official assessment pathway for all diplomates for completion of the Maintenance of Certification (MOC).

Therefore, as of 2019, Quarterly Questions will replace the DOCK (Demonstration of Ophthalmic Cognitive Knowledge) examination for all diplomates. The ABO is one of the first members of the American Board of Medical Specialties (ABMS) to adopt this type of MOC assessment program, and is truly a leader among all the ABMS certifying boards in the board-certification process.

In this article, I will focus on what all board-certified ophthalmologists need to know about the process.

What are Quarterly Questions?

The Quarterly Questions program assesses fundamental (“walking around”) knowledge needed in the everyday practice of ophthalmology (40 questions annually), as well as the application of information from five journal articles (10 questions annually). The 40 fundamental knowledge questions-based on the things ophthalmologists see and do every day-should not require preparation in advance.

However, the journal article questions do require reading five articles from a list of options and answering 10 questions based on the articles’ content.

Overall, the program is designed to assess the knowledge of practicing ophthalmologists and uses a longitudinal assessment model where a pass/fail decision is made based on diplomate performance over time. This supports the academic ideal of life-long learning and replaces the traditional closed-book comprehensive exam at the end of the 10-year re-certification cycle.


How does it work?

The ABO issues 50 new questions on an annual basis, released in quarterly segments (hence the name), which is composed of 40 knowledge questions and 10 article-based questions. A diplomate has the flexibility of accessing the Quarterly Questions platform with a computer, tablet or mobile device via a user-friendly interface.

Beginning in 2018, more subspecialty content will be available to provide focused questions for ophthalmology subspecialists. Diplomates will answer each single-correct answer choice knowledge question (without the use of outside resources) within a one-minute timeframe. These can be answered one at a time, in small batches or all in one sitting.

During the pilot project, the ABO found that most diplomates were able to answer the questions within 30 seconds. The article-based questions have a five-minute timeframe and may be re-attempted once if the initial answer choice is incorrect. Diplomates will receive and review instant feedback with question-by-question performance and will be able to track how their score compares to the diplomate community.

Additionally, commentary feedback will include the rationale and references for each question, along with relevant learning resources for further study if desired. The cumulative scoring is based on 250 questions answered correctly over the 10-year certification cycle on an overall passing standard.


What happens during the 2018 transition year?

The ABO has announced a gradual transition to the new program that will keep the DOCK examination in place for diplomates completing re-certification in 2018.

However, based on diplomate requests to utilize the new pathway, those who have not yet taken the DOCK and whose certificates expire in 2018 have the ability to choose either Quarterly Questions or the DOCK exam. Starting in 2019, the DOCK is scheduled to be retired and all diplomates who wish to recertify will participate in Quarterly Questions.


What are the benefits of the Quarterly Questions program?   

As a board-certified ophthalmologist currently participating in the Quarterly Questions program, I can attest with first-hand experience just how fantastic and well-designed the program is for us. I strongly encourage all of my board-certified colleagues to participate in the program and get started right away (if you have not already done so).

Additionally, all diplomates can claim 7.5 continuing medical education (CME) credits for every year of successful Quarterly Questions participation. Of note, the 7.5 CME annual credits will also count toward the 8 Self-Assessment CME (SACME) requirements by the ABO on an average annual basis to maintain certification.

Remember, all ABO-certified diplomates must obtain an average of 25 AMA PRA Category 1 credits annually, of which include eight credits of SACME. At least 80% of the CME credits must be specific to ophthalmology. To further support my opinion about how outstanding the Quarterly Question program is, more than 1,700 diplomates participated in the program this year (answering more than 63,000 questions in the process) and 96% said they would recommend the program to a colleague.

George B. Bartley, MD, chief executive officer of the ABO, states, “We are pleased that our diplomates are finding the Quarterly Questions program to be a good fit for their needs.  Although the DOCK is a psychometrically excellent examination, many colleagues found the experience stressful and it is expensive to be away for a half-day or more from one’s practice. Quarterly Questions can be done at the convenience of the diplomate, affords an opportunity for learning as well as assessment, and, with the ability to earn CME credits, is financially essentially equal to the annual fee to maintain certification.”      


What is the ABO’s vision for board certification?

Dr. Bartley explains, “About one-third of our diplomates hold non-time-limited (so-called “lifetime”) certificates. All ABO directors participate in MOC, and we hope that our colleagues who hold non-time-limited certificates will join with their younger colleagues and enroll in the Quarterly Questions program. This would be an admirable demonstration to their patients that they support the idea of life-long learning and accountability.”

With the successful Quarterly Questions program in place, the future is bright for board certification standards and self-regulation in ophthalmology. The strong leadership in the ABO should be commended for their tireless effort to continue to provide the highest level of professional standards for ophthalmology and being the leading example for all certifying specialty boards in medicine.   

For more information, visit https://abop.org

Special thanks to Dr. Bartley and Meghan McGowan from the ABO for their contributions to this article. -Dr. Mali




Mali, J. Dr. Mali's top 5 stories in ophthalmology in 2017 (so far). Ophthalmology Times.       Sept. 2017. 


Joshua Mali, MD

P: 941/923-2020

Dr. Mali is a board-certified ophthalmologist and vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, FL. 

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