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In this guest post, David H. Johnson, MD, Chair of the American Board of Internal Medicine (ABIM) Board of Directors and Internal Medicine Chairman at UT Southwestern Medical Center in

Dallas, and Rebecca Lipner, PhD, Senior Vice President of Evaluation, Research, and Development at the ABIM explain what determines pass rates for the MOC exam.

Two previous commentaries have addressed MOC exam pass rates: the increasing failure rate for first-time Maintenance of Certification (MOC) examinees and speculation about why physicians may

be failing MOC exams.

Recently, based on a slow decline in pass rates over the past 5 years for the American Board of Internal Medicine Maintenance of Certification exam, some social media observers have made

erroneous assertions about how the exams are constructed and scored.

Without a full understanding of the exam process, they have nevertheless claimed that the exam is being made more difficult, that the standard for passing the exam changes every time an exam

is given, or that the exam is "graded on a curve." These assertions are all incorrect.

ABIM exams are constructed to assess the competencies required for certification and maintenance of certification. ABIM assembles the exam so that the content proportions and difficulty

level are the same across administrations, thus ensuring fairness. Someone taking the exam in the spring would experience the same level of difficulty if they took the exam in the fall. Our

tests for psychometric validity assure this consistency.

The minimum passing score (i.e., "passing standard") that ABIM sets is based on the exam's content, and physician subject matter experts determine how much of that content a physician needs

to get correct to be deemed certified. A content-based standard is used to set the passing score.

The method combines the judgments of many physician experts and is well-researched and commonly used in credentialing exams. As long as a physician gets enough content correct (demonstrates

appropriate mastery of the content), he/she will pass the exam; it doesn't matter how well others who take the exam at the same time perform.

Considering all MOC exams, a physician must answer, on average, about 65 percent of items correctly to achieve a passing score. The passing standard remains the same over exam

administrations and is reviewed periodically. Significant changes in the practice of the discipline may require that the passing standard be reset.

ABIM does not "grade on a curve," and the "pass rate" (i.e., the percent of physicians who pass the exam) is not set ahead of time. That is, no predetermined percentage of physicians will

pass or fail the examination. Once a passing standard for a discipline area is set, pass rates differ from year to year solely because the characteristics of physicians taking the exam

change each time it is given. A number of examinee-specific factors -- such as examinee motivation, training, preparation, and knowledge -- impact pass rates.

ABIM understands that taking the exam can be a high-stress event, and that failing can result in a number of significant consequences that may accompany losing certification. Our Board has

recently taken steps to address the feedback we have heard about the MOC exam:

We know there are myriad pressures on physicians right now. This is, in many ways, an unprecedented time. Therefore, now, more than ever, we take seriously our mission "to enhance the

quality of healthcare by certifying internists and subspecialists who demonstrate the knowledge, skills, and attitudes essential for excellent patient care." The MOC program remains an

integral part of how ABIM does this work.

There's no sitting on the fence when it comes to revised maintenance of certification (MOC) rules. This blog gathers MOC-related news and opinion to foster discussion on what has happened

since January 2014, when the American Board of Internal Medicine adopted the requirements -- and what is likely to happen in coming months.

Have a tip or want to counter a point? Email [email protected].