I Chose the Traditional, 10-Year MOC Exam for Geriatrics and the LKA® for Internal Medicine

By June M. McKoy, MD, MPH, JD, MBA, LLM (Hons)

Dr. McKoy is a geriatrician and full Professor of Medicine, Preventive Medicine and Medical Education at Northwestern University Feinberg School of Medicine in Chicago. She holds a joint appointment in the Robert H. Lurie Comprehensive Cancer Center at Northwestern University where she serves as the Assistant Director for Diversity, Equity and Inclusion. Her primary research foci relate to medical education (wellness and burnout among trainees) and cancer and aging, including cancer survivorship, cancer pharmacoeconomics, comparative effectiveness analyses, HIV and cancer, and adverse drug reactions in older individuals living with cancer.

I am participating in the Longitudinal Knowledge Assessment (LKA®) for Internal Medicine (IM), and in November I took the traditional, 10-year Maintenance of Certification (MOC) exam in Geriatric Medicine. I like having the choice in how I maintain my certifications and the opportunity to determine the options that work best for me.

I chose the long form exam for geriatrics because I didn't want to take two longitudinal assessments at the same time and because that is the field I work in every day and I felt more comfortable with my knowledge base. I'm the Program Director for the Geriatrics Fellowship at Northwestern University and I do board review with my fellows every Friday. I also prep the fellows just before they take their board exams. I do a thorough review with them that has resulted in a 100% pass rate on the Geriatric Medicine Initial Certification Exam. I also precept internal medicine residents and medical students on the inpatient medicine teaching service. Given that I teach trainees, I have to prepare didactics. I am constantly learning and teaching, and I have to stay up to date. When it was time for me to take my geriatrics assessment, I knew I could easily take the exam and pass it without much additional effort.

I feel that the 10-year assessment option has value for those who want to sit one time and take the exam. There are lots of people like me who work closely with trainees and must remain current. For us, the 10-year exam is not as difficult to pass as it might be for someone who is not seeing a wide variety of clinical cases in their specialty on a regular basis.

I am not as close to internal medicine in terms of constancy as I am to geriatrics, so the Internal Medicine LKA made a lot more sense for me in terms of brushing up on my knowledge. While I don't maintain a longitudinal outpatient geriatrics primary care clinic, I see adult patients in skilled nursing rehab and on the internal medicine hospital service, so it's important for me to maintain my IM certification. I like the LKA for IM because it's an examination in practice and it allows me to slowly refresh my memory and stay current on topics I do not encounter every day.

The first time I tried the LKA I sat down with the intention of doing five questions but finished 30 in one sitting. It is intoxicating and academically fulfilling; you want to see what the answers are and what the explanations of the answers are. I don't see the LKA as a task, but rather as an opportunity to step back from teaching, to sit down once a quarter and see what I know. I can see what the gaps are in my knowledge and how can I fill those gaps so that I can be the best attending physician for my trainees and my patients.

The LKA is a wonderful option for someone whose practice might not be steeped in a particular specialty on a daily basis. It allows them to come back and gently relearn what they might have forgotten and also learn new things. Every day something new emerges in medicine; it's constantly evolving and it's easy to miss something. The LKA curates the answers so you can clearly and compellingly see whether you're right or wrong, and why.

I have learned a lot from the LKA that I have put into practice, especially around Infectious diseases. Guidelines shift sometimes and you might not be aware of the subtle shifts. I got one question incorrect -which would have been correct the year before - related to the treatment of recurrent Clostridium difficile infection. I did not know the guidelines had changed until I got that question wrong. I read the explanation, reviewed UpToDate to get more information on the answer and the background reasoning as to why the guidelines had shifted. I immediately instituted the change in my inpatient practice and shared the new information with my colleagues in IM and Geriatrics. The beauty of the LKA is learning things you can share with others in your practice and that you can apply to patient care that could result in better patient outcomes.

For physicians who are not sure which assessment to take, I'd think of it in terms of how prepared you think you are for the traditional, 10-year MOC exam and how much endurance you have for a full-day exam. If you are prepared, attend conferences, teach, read journals and feel you are current, maybe the traditional exam is the best option for you.

If you're unsure or concerned about how evidence-based medicine has changed over a 10-year period, then I'd say take the LKA and take "small bites" along the way. Consult with UpToDate, which the LKA allows, sit in your office, take a few questions at a time, and you'll do fine.

It's nice to be board certified, but in the end it's always about the patients. I want to be on top of my game so that both my older adult patients and my acutely ill hospitalized patients can continue to live long and live well. The LKA and the 10-year MOC exam both help me to do that, just in different ways.

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