Maintenance of Certification
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* J.T. Curnes

*“But he has nothing on at all,” said a little child at last. “Good heavens! listen to the voice of an innocent child,” said the father, and one whispered to the other what the child had said. “But he has nothing on at all,” cried at last the whole people. That made a deep impression upon the emperor, for it seemed to him that they were right; but he thought to himself, “Now I must bear up to the end.” And the chamberlains walked with still greater dignity, as if they carried the train which did not exist.1* 

Congratulations to Dr. David Hackney for his article regarding Maintenance of Certification (MOC) in the January 2006 issue of the *AJNR,*2 who exclaims, “Where are the ABR’s clothes?”

When I took the examination 10 years ago, I rationalized that the $3200 assessment was necessary to offset expenses and compensate the dedicated examiners who spent much of the week in Louisville. The reasons for the current fee and subsequent yearly dues, as well as requirements for distant travel to a testing site, are a mystery because the examination requires only a proctor (who gets $100 per day plus expenses)3 and is electronically graded. The rationale given on the ABR Website is that the cost is based on analysis of past expenses on a cost-per-candidate basis; this hardly seems relevant in light of the new format of an electronic examination on an ordinary PC.

Has the ABR reached out to the organizers of the ASNR, RSNA, ACR, and other major organizations to offer the examination at major medical meetings (San Diego, anyone)? Noooo. Neuroradiologists are eager to participate in the process, as evidenced by the immense crowds at the Neuroradiology SAM (self-assessment module) course on Monday of the 2005 RSNA. There were so many people at this interactive course that attendance at the scientific sessions suffered, much to the chagrin of the presenters and organizers, who spent months preparing those sessions in Chicago.

Maintenance of competency, at least in our practice, requires a familiarity with advanced imaging modalities, including diffusion/perfusion, rapid triage for appropriate angiography/interventional cases, spectroscopy and positron-emission tomographic imaging, and MR and CT angiography. If the board wants to measure competency by drilling down on a candidate’s knowledge of pathology in the third branchial arch, the test will fall short in evaluating modern clinical practice.

The initial wave of enthusiasm and respect for the process of MOC was exemplified by Dr. Taveras, who sat before an examiner back in 1995, showing by example that our subspecialty benefits from members who demonstrate continuing excellence. In the examination’s current form, many, including myself, see it as little more than an expensive piece of paper.

I was amused, but perhaps not surprised, by the editor’s footnote stating that the trustees of the board were given the opportunity to respond and chose not to. It does, however, raise a deeper question: Could not and should not the ABR trustees on our own ASNR Executive Committee have commented on these disturbing issues raised by Dr. Hackney?

Let’s hope the ABR doesn’t “bear up to the end,” like the emperor, but reaches out to neuroradiologists everywhere to structure an examination that measures current skills, is reasonably priced, and is more convenient. It benefits no one to have poor participation in an important initiative such as continuing education, least of all our patients.

## References

1.  Andersen HC. The emperor’s new clothes;1837
    
    

2.  Hackney DB. **Maintenance of certification: a rocky start to an important initiative.** AJNR Am J Neuroradiol 2006;27:2–3
    
    [FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo2OiIyNy8xLzIiO3M6NDoiYXRvbSI7czoyMToiL2FqbnIvMjcvNS85NTEuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.  Murtagh FR. **Fear and loathing at the MOC.** AJNR Am J Neuroradiol 2006;27:467–68
    
    [FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIyNy8zLzQ2NyI7czo0OiJhdG9tIjtzOjIxOiIvYWpuci8yNy81Lzk1MS4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

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