The implementation of MOC has raised many questions from Diplomates.  Below, is an attempt to provide answers to those most common.  For additional information, please email

MOC is an evolving process in which the Trustees of the ABU, in conjunction with the ABMS, periodically develop new policies and guidelines.  Consequently, some of the information below may change, in which case Diplomates will receive ample advance notification.


What is Maintenance of Certification?

Maintenance of Certification (MOC) is an initiative of the American Board of Medical Specialties (ABMS) aimed at ensuring quality patient care from certified physician specialists through an ongoing process of professional self-improvement.  MOC entails four basic components.  Completion of these components allows Diplomates of the ABU to maintain their general certification in urology and any urologic subspecialty certification. 


Why did the ABMS find it necessary to develop MOC?

Two publications by the Institute of Medicine (IOM), “To Err is Human” and “Crossing the Quality Chasm”, as well as a number of studies published in the literature, identified the need for such improvements to medical care.  In response, the ABMS and the Accreditation Council for Graduate Medical Education (ACGME) established the framework of the MOC program in 1998.


What are the basic requirements of MOC?

  1. Licensure and peer review
  2. Continuing Medical Education
  3. Practice log, Practice Assessment Protocols (PAP), Patient Safety Module
  4. A computerized, multiple choice exam


What is the framework of the MOC program?

The MOC program is built around the six core competencies for physicians:  patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.  Recognizing that not all of the competencies can be mastered during specialty training, after initial certification requirements have been met, the MOC program continually promotes lifelong self-assessment and improvement efforts.


How does the ABU address the core competencies of MOC?

The ABU evaluates Diplomates through the MOC process using the following components:

  • Evidence of Professional Standing is addressed through the maintenance of an unrestricted license to practice medicine.
  • Evidence of Self-Assessment is demonstrated by the completion online of a Practice Assessment Protocol (PAP) four times during the 10-year MOC cycle and a Patient Safety Module.  See the block diagram for timing.
  • Evidence of Lifelong Learning is shown by the completion of 90 hours of urology-focused continuing medical education (CME), 30 hours of which must be Category 1 as defined by the American Urological Association, twice during the 10-year MOC cycle.
  • Evidence of Performance in Practice is demonstrated through the completion of a 6-month electronic practice log during year 7, 8 or 9 of the 10-year MOC cycle.
  • Evidence of Cognitive Expertise is demonstrated through a secure computer-based, closed-book examination during year 7, 8 or 9 of the 10 year MOC cycle.

Is participation in MOC mandatory?

While Board Certification is voluntary, MOC is a requirement for all Diplomates who were originally certified in 1985 or later and have time-limited certificates in order to maintain their certification.

If a time-limited Diplomate earns a subspecialty certificate, the expiration date of the original urology certificate will be extended to match that of the subspecialty certificate.  The Diplomate will not be required to enter the recertification process, but will enter the MOC process as of completion of subspecialty certification, and will be required to complete all components on that schedule.  

All Trustees of the Board are required to participate in MOC during their tenure on the Board, even those with time-unlimited certificates.


Does a time-unlimited certificate exempt a Diplomate from participation in the MOC program?

Diplomates who originally certified before 1985 and have time unlimited certificates will maintain those certificates as time-unlimited.  However, if the Diplomate also earns a subspecialty certificate, the Diplomate will enter the MOC process for the subspecialty certificate. 

Participation in the MOC program is not required for Diplomates with time-unlimited certificates; however the Diplomate may choose to enter the process at any time.  Requirements for hospital credentials may require evidence of continuous certification efforts.  In addition, some states are considering the implementation of Maintenance of Licensure programs, similar to the MOC program.

If the Diplomate with a time-unlimited certificate fails the MOC computer-based examination, the original time-unlimited certificate still remains in effect.


Will MOC replace recertification?

The MOC program will replace recertification by 2018, by which time all time-limited Diplomates will have completed the recertification process and will have entered MOC upon completion of recertification.


If I do not participate in the MOC program, will I still be Board certified?

If you do not participate in the MOC program, you will still be Board-certified only if you possess a time-unlimited certificate.  All ABU certificates issued after January 1, 1985, are time-limited and expire ten years from the year of certification.  Diplomates with time-limited general urology certificates and those of subspecialty certificates are subject to MOC by the deadlines specified in order to maintain Board certification.


What are the consequences if a Diplomate fails to complete the requirements of MOC before the deadline?

A Diplomate is required to make application to the MOC process in Level 1 according to the published timeline.   Certification is contingent upon the Diplomate completing the required elements of MOC according to schedule, so if the Diplomate has not entered the process by Level 2, the Diplomate will no longer be certified.   Requirements to re-enter the process are outlined in the current handbook.


When do I begin the MOC process?

Beginning in 2007, all Diplomates with a time-limited certificate  enter the four level MOC process in the year of original certification or recertification, and complete the first level of MOC two years later, according to the stated timeline.  The requirements of MOC are mostly completed online using the ABU website.  For MOC Levels 1 through 3, an instructional letter which includes username and password is mailed to the Diplomate in April and all requirements are to be met by October 1 of the same year.  For MOC Level 4, a similar instructional letter is mailed in December.  Diplomates at Level 4 select one of the following three years in which to to satisfactorily complete all requirements by a July 1 deadline in order to sit for the October exam of the same year.


How will I know when I have to do something?

The office of the American Board of Urology will notify Diplomates holding a time-limited certificate when each phase of MOC is required.  At that time, the handbook  Information for Applicants for Maintenance of Certification, detailing the MOC process, will be available here.  For assistance in accessing the handbook online, please call the ABU office at 434/979-0059.

It is the responsibility of the Diplomate to keep the ABU informed of any change of address or contact information.


What will I have to do?

The components of MOC are similar to the components required for Recertification.  Diplomates will be required to periodically complete self-assessment programs developed by the Board, meet continuing medical education requirements, and submit a practice log as part of this process.  Successful completion of an examination will be required within the two year period prior to expiration of the Diplomate’s current certificate.

The first level of MOC will include submission of an online application, documentation of an unrestricted medical license, and completion of an online Practice Assessment Protocol (PAP) in an area of their practice.  Requirements for Levels 2, 3, and 4 include documenting unrestricted medical licensure, completion of further PAPs; completion and documentation of CME credits, satisfactory peer reviews, and an adequate practice log submission, culminating with a computer-based examination at the end of Level 4.


What is a Practice Assessment Protocol (PAP)?

These non-graded learning tools were developed by the ABU in 2007 to encourage self-review, an evaluative comparison of case management with current Clinical Guidelines, and the opportunity to reflect on management deviations to determine justifiability.  Diplomates select a specific diagnosis, and using a small number of sequential cases, answer a short series of questions pertaining to treatment of these patients.  A score is given based on compliance with guideline recommendations to which the Diplomate is then linked.  Having read the relevant AUA guideline or similar document, the Diplomate is then briefly quizzed on the subject matter and required to make corrections as necessary.  This process, estimated to take about 30 minutes, is repeated in 60 days using a set of different cases.  Comparing the pair of scores enables the Diplomate to gauge improvements to guideline adherence subsequent to the first PAP.


How many CME credits are required for the MOC program?

Ninety hours of CME credits, of which 30 must be Category 1, as defined by the Accreditation Council for Continuing Medical Education (ACCME), earned within three years prior to the deadline, are required at Level 2 and Level 4 of MOC, according to this timeline.


How do I document my CME credits?

For Category 1 credits, CME providers issue written verification of a Diplomate’s participation in a qualifying activity.  To satisfy the requirements of MOC, Diplomates must furnish the Board with an official copy of Category 1 credits earned.  Diplomates are required to maintain a record of all CME credits.  A sheet to track Category 2 credits can be downloaded here.


What fees will I have to pay for MOC?

 A $200 annual certificate fee charged to all participating ABU diplomates replaced previous recertification and maintenance of certification fees.   Annual fees must be current in order for Diplomates to participate in MOC.



Will a new certificate be issued every two years?

No, upon successful completion of Level 1, Level 2 and Level 3, Diplomates receive a letter verifying completion of that phase of MOC.   A new full-sized certificate is sent to Diplomates upon successful completion of Level 4.


Who will be notified when I complete each level of MOC?

The American Board of Medical Specialties (ABMS), American Urological Association (AUA), and the American College of Surgeons (ACS) are notified when the Diplomate has successfully completed each level of MOC.


Can I get a verification that I have completed MOC if my state requires this as part of maintenance of my medical license?

Yes, upon a Diplomate’s written request, the ABU will provide, at no charge, a letter to the Diplomate verifying certification status.  For verification letters needing to be provided to a third party, a $50 fee applies.  Requests and payment, by check or money order, should be mailed to the Board office.


Will changes be made to the MOC program?

Due to the evolving nature of MOC, it is highly possible that refinements will be made to the program in the future.   Any such changes will be posted on this website before going into effect.


The American Board of Urology (ABU) is organized to encourage study, improve standards, and promote competency in the practice of Urology. The Board evaluates candidates who are duly licensed to practice medicine, and arranges and conducts examinations for the purpose of certification, subspecialty certification, recertification, and ongoing maintenance of certification. Certificates are conferred by the Board to candidates who successfully complete all requirements for a given certificate...

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