Duty Hour Requirements: Time for a New Approach?

tual skills. They are pushing for thoughtful integration of the MOCprogram into their busyprofessional lives, so that the expense and time commitment are reasonable. An optimistic assessment is that medicine in the United States is actuallymoving in that direction—away from relying ongrueling testsonceperdecade, towardcreatingsystemsthat givephysicians feedbackonhowtheyareperformingandhow they can improve based on the actual care they deliver. The transition to this type of data-driven assessment is difficult, andwill remain challenginguntil information technology improves, along with the way physicians work with that technology and with their clinical colleagues. Professional societies and physicians have a duty to criticize the problems with MOC, but also to participate actively in improving it. They must guard against the temptation to “dumbdown”measures toappeaseangrycolleagues, and thus run the riskof endingupwithanMOCsystemthat simplydoes not accomplish the task at hand, a commitment to lifelong learning.They should recognize thedifficultyof creatingwhat physicianswant—a systemthat evaluates thembasedonwhat they do, but does not disrupt them as it does so. Insum,physiciansshouldworkconstructively tohelpMOC improve,muchasphysicians shouldwork continuously to improve how they collaborate with colleagues and with patients. In addition, physiciansmustmake the commitment to lifelong, meaningful learning to ensure that their knowledge and skills remain current and relevant. Patientswould be disappointedbyanything less. Themedical professionmaynever fullyunderstandtheeffectofMOC,but thatdoesnotmeanthat physicians should giveupor stop trying tomake it better. The MOC program is a work in progress, as are all good physicians.