Cliff’s Notes: The ABA MOCA Cycle

  • Wald, Samuel, MD, MBA, FASA
| Jul 23, 2012

Editor’s Introduction: There is much confusion among anesthesiologists about MOCA. This week’s edition of CSA Online First is an attempt to clarify the requirements and share a simplified overview of the program. We encourage you to share this information with your group and your colleagues, and visit for more complete and detailed information.

Do I need to be in MOCA?

If you’re an ABA-certified anesthesiologist, you fall into one of two categories: You either have a time-limited certificate or you have a non-time limited certificate from the ABA. For the former, your certification will expire within ten years from the date of certification and the ABA will continue your certified status as long as you complete all Maintenance of Certification in Anesthesiology (MOCA) Program requirements. MOCA participation is mandatory for time-limited certification.

If you were certified before the year 2000, the certificate the ABA issued to you has no expiration date. Participation in the MOCA program is voluntary. You will not lose your certification if you do not satisfy the MOCA program requirements. Entering MOCA puts you at no increased risk to change your status. There is the upside of showing your commitment to lifelong learning for the benefit of patients and our specialty. It may also serve to meet regulatory and consumer demands for the future.

Each MOCA cycle is a 10-year period that includes FOUR components: Lifelong Learning and Self-Assessment; Professional Standing (medical licensure); Practice Performance; Cognitive Expertise. MOCA is based upon the six general competencies emphasized during residency of Medical Knowledge, Patient Care, Practice-Based Learning and Improvement, Professionalism, Interpersonal and Communication Skills and Systems- Based Practice.

Register at the ABA website, which has complete instructions on reporting of MOCA activities. When you register you will then be enrolled in a 10-year cycle that will show when each component must be completed.

The ABA has three basic objectives for physicians enrolled in MOCA:

1) Acquiring the knowledge and skills needed to be a board-certified anesthesiologist

2) Maintenance of the knowledge and skill throughout our careers

3) An emphasis on Quality of Practice for our specialty

MOCA Requirement One: Professional Standing

A physician must have at least one active, unrestricted license to practice medicine in a jurisdiction in the US or Canada; all licenses held must be unrestricted.

MOCA Requirement Two: Lifelong learning and Self-assessment

For those certified and/or who entered the MOCA cycle between 2000-2009, the ABA has defined increasing CME requirements. For a full explanation of the details, please visit the ABA website. In short, cohorts are divided up from 2000-2003, 2004-2007 and 2008-2009 with varying requirements.

Beginning in 2010 and through the present, 350 total CME are required over the 10-year cycle. At least 250 must be category 1 CME and up to 100 credits may be “other” CME. “Other” is defined as self-study, committee participation and teaching. No more than 70 CME may be counted toward the MOCA requirement in any given year.

Of these 350 total CME, 90 are required from the ASA SEE or ACE programs and 20 must be in a qualifying Patient Safety program that is available through the ASA and the ABMS. The upcoming 2012 ASA Annual Meeting has CME with this designation. Many organizations such as the ASA and CSA will automatically report CME credits for you to the ABA. Self-reported CME activities are subject to audit at least once during the MOCA cycle. You should keep documentation of CME activities for at least 3 years for audit.

MOCA Requirement Three: Cognitive Examination

At least 200 CME must be completed before the cognitive examination can be taken. It is only available in years 7-10 of the MOCA cycle and may be taken up to two times per year. There are 200 questions, 75% general, 25% subspecialty, geared to common knowledge.

MOCA Requirement Four: Practice Performance Assessment and Improvement

Three Components (One each per 10 years):

Case Evaluation, Attestation, Simulation

Case Evaluation

The assignment is to collect data to ultimately evaluate your individual or group practice. One must compare practice data to approved standards or guidelines, develop and implement an improvement plan.

The collection may involve outcome data from a specific period of time/patient group OR feedback from patients that relates to their clinical care. A comparison of evidence-based guidelines should be made with the collected information. As an alternative, a comparison with a meta-analysis or consensus opinion may also be acceptable.

A plan to implement a practice outcome improvement must be described with one of four possibilities: clinical reminders, personal education, system/process change, and/or clinical pathway. Individual or group efforts may qualify, but the individual anesthesiologist’s data must be extracted from the group data.

Lastly, new outcome data is collected after the new practice implementation to determine the change since the original collection and assessment. The goal is improvement and maintenance of the highest standard of practice.

Examples are available through the ABA website.


Three references will be submitted through the ABA portal account. The ABA will contact and solicit references to verify clinical activity and participation in practice improvement activities. The ABA requires that for a physician practicing anesthesiology or an anesthesiology subspecialty, there are evaluations of the participant’s clinical practice at the local level and that the participant is engaged in practice improvement activities.

ASA-Endorsed Simulation Education Course

This is NOT a pass/fail exam, but a contextual learning opportunity to assess and improve your practice in areas such as crisis management. It involves experiential learning with 6 hours minimum of total course instruction involving active participation in realistic simulation scenarios. After each difficult patient-care scenario peer debriefing occurs. The emphasis is on teamwork and communication and each participant will have at least one opportunity to be the primary anesthesiologist. Participating simulation centers (several are here in California) near you are available on the ASA website. You will find this to be a valuable experience!

Problems with MOCA

If a physician does not fulfill all requirements, ABA certification expires (time-limited only), the MOCA cycle will move one year forward, year one activities will be removed, and will need to be repeated. The ABA will move forward one year at a time in this manner for up to three years. If the three-year window passes without completion of all requirements, then complete re-certification will be necessary.

Although on its face the standards for fulfilling MOCA requirements may appear confusing, but there are basic components described by the ABA to make it easy to successfully navigate the MOCA certification in a timely manner. The CSA offers many CME activities from the Educational Programs Division appropriate for fulfilling MOCA requirements.


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