Continuing Certification and Online Longitudinal Assessment

The Continuing Certification process with the ABR has four parts:¹

Part 1: Professionalism and Professional Standing 
Fulfilled by maintaining a license to practice medicine. 

Part 2: Lifelong Learning
Fulfilled by completing at least 75 Category 1 CME within the last three calendar years. The self-assessment CME (SA-CME) requirement was removed in 2024.

Part 3: Assessment of Knowledge, Judgment and Skills 
Meet or exceed the standard in a current cumulative (i.e., weekly) OLA score at some point in year five (5) or pass a Continuing Certification Exam (CCE) in year four (4) or five (5) of the Part 3 cycle.

Part 4: Improvement in Medical Practice 
Complete at least one Practice Quality Improvement (PQI) Project or Participatory Quality Improvement Activity within the last three years. This includes chart rounds and multidisciplinary tumor boards.

The ABR has made many changes over the past 18 years to ensure that the Continuing Certification process is effective and represents a minimal burden on diplomates. All radiation oncology diplomates who passed their initial board exams prior to 1995 received a lifetime certificate from the ABR. Eligibility requirements changed several times between 1996 and 2005. Anyone receiving their initial certification during this time frame was required to take a Maintenance of Certification (MOC) Exam every 10 years. Diplomates who did not pass this required exam could re-enter maintenance by taking and passing the initial certifying oral exam.

In 2015, in response to concerns from diplomates, the ABR announced significant changes to the MOC process. Along with changes to Part 4, the ABR eliminated the 10-year MOC Exam and replaced the exam with a modern approach to continuous assessment using Online Longitudinal Assessment (OLA) with two questions per week. This process was a significant improvement in many ways. OLA removed the need to study rigorously, take time off from work or travel for an exam (which was required prior to the ABR developing a secure, computer-based system for delivering remote exams). Diplomates can learn from incorrect answers by reading the accompanying rationale and reference and are presented with a similar question soon after. There is an opportunity to skip or decline 10 questions per year out of the total 104 provided, and there is a time limit for each question based on the depth and detail of the question. After completing each question, diplomates are surveyed to help inform the future development of questions, to establish relevance and to help determine the minimum standard for that question. Every question will have a different passing standard based on responses to the optional question rating process; therefore, the minimum passing standard may vary from diplomate to diplomate depending on which questions each diplomate answers.²

Diplomates must answer a minimum of 52 OLA questions per year over the five-year period, but the assessment includes only the most recent 200 scorable questions. Up to four weeks of questions can be pooled together before falling off the list of available questions. Diplomates not answering the required minimum of 52 questions will “forfeit” the unanswered questions. For example, if you are required to answer 52 questions and only answer 50, the two unanswered questions will be considered “forfeited” and counted as incorrect. The vast majority (98.8%) of radiation oncologists are enrolled in OLA, and most answer far more than the minimum number of questions required per year. Diplomates who are not performing well in OLA or choose not to participate may also fulfill the Continuing Certification Part 3 requirement by passing a CCE in year four or five of their five-year Part 3 cycle. The CCE is offered twice a year.

The first-time diplomates could potentially lose their certification for not participating in OLA or not passing a CCE before December 31, 2024. The ABR has published, emailed, posted or blogged over 120 independent communications since 2019 to ensure that all diplomates are aware of how to fulfill the Part 3 requirement. In addition, each year when paying their Continuing Certification fee, diplomates acknowledge their responsibility. Essentially, we all accepted that we are responsible for notifying the ABR of email address changes and for maintaining awareness of potential changes in the requirements. A global Continuing Certification attestation in 2021 required all diplomates from all four ABR disciplines to accept or decline this optional process. Those who signed agreed to participate in OLA or take the CCE to retain certification. Lifetime certification holders were not required to participate, but if they opted out, they were informed that they would not be listed as participating in the Continuing Certification program.

It is important to note that the ABR certifies in general radiation oncology. There is no subspecialty certification, so both OLA and the CCE include all disease sites. OLA questions are designed to be “walking around knowledge” or general radiation oncology questions that should not require study for most diplomates. The CCE, on the other hand, is inherently more difficult (but, as a point-in-time exam, allows for diplomates to prepare through targeted study). Diplomates who elect to take the exam in lieu of OLA should not expect it to be “walking around knowledge.” OLA and CCE are not primarily intended to improve your individual ability to provide care or to “make you a better doctor.” The target audience is in large part our patients, communities, colleagues and employers who express the importance of physicians being engaged in a continual education process.³

Although there are a very small number of our colleagues who are at risk of losing their certification in 2025, there has been near universal satisfaction with the OLA process and associated time requirement. Nonetheless, the ABR continues to refine and improve the Continuing Certification process and OLA content, including advances such as no longer requiring onerous annual attestations.

As one of the final diplomates who was required to take the MOC exam in 2014, I am very pleased with OLA as an alternative solution and appreciate the simple and quick approach to continuous learning.

The ABR continues to work toward providing one of the least burdensome assessment tools that follows the requirements⁴ as set by the American Board of Medical Specialties (ABMS).