*New policy, implemented in 2019, allows up to four years for completion of all L1 components. Lifelong Learning Timeline table is available in the handbook and on the ABU website.

The deadline for all L1 components is April 1 of the last eligible year of the diplomates L1 timeline, except for Part B of the PAP which is due by October 1. After April 1, a $200 late fee will be applied.

**We ask and strongly suggest that the LLL Knowledge Assessment be done at year 7 of the 10 -year cycle.

Since 1985, all ABU certificates have been time-limited.  Recertification was required for all Diplomates whose certificates were issued after January 1985 and before 2007.  This process mandated a review of the Diplomates practice once every ten years.  Recertification then transitioned to Maintenance of Certification (MOC) in 2007, as mandated by the American Board of Medical Specialties (ABMS).  MOC required completion of different levels of activity every 2 years.  There were several components examined:  Professionalism and Professional Standing (Licensure and Peer Review), Lifelong Learning and Self-assessment (CME), Assessment of Knowledge, Judgement and Skills (Examinations) and Improvement in Medical Practice (Outcomes and Quality Improvement).  

During the past several years, the ABU and many other ABMS member boards have been making changes to the MOC process as the mindset about its goals evolved.  Central to this evolution was the concept that certification should be “maintained continuously” through learning and self-improvement.  This is accomplished by establishing a physician’s performance based on a number of activities during active practice.  Identification of knowledge gap areas and collaborating with physicians to remediate their specific knowledge gaps were integral to this concept.  Therefore, the ABU no longer utilizes the term “MOC” and considers Lifelong Learning (LLL) to best reflect the philosophy of its current program.

Regarding the exam, several years ago, the ABU reverted to a modular Knowledge Assessment format in recognition that many urologists specialize in focused areas.  The decision was also made that approximately 30% of questions would be derived from the AUA SASP and Guidelines, encouraging continuous learning.  In the past, a low exam score could result in “failure” and loss of certification.  “Failure” occurring more often with older Diplomates in their 3rd recertification/MOC cycle underscored the need for continued learning.  With the transition to LLL, the ABU moved away from a “high stake” (pass/fail) MOC exam to a Knowledge Assessment helping to identify knowledge gaps and working with all Diplomates to eliminate those gaps.  The results of the modular exam are provided to all Diplomates with performance metrics.  Diplomates with knowledge gaps in specific content areas are assigned CME requirements for which they must document completion within one year.  Diplomates may suggest an alternative CME activity, provided it corresponds to their knowledge gap and includes a “post-test” to confirm gap resolution.  Those Diplomates not wanting to complete the required CME may elect to retake the Knowledge Assessment exam instead.  Resolving knowledge gaps is an essential component of the LLL program and Diplomates found to have such gaps must either complete the requisite CME activity or retake the exam to continue in the LLL program.

In order to continue certification, the ABU now assesses all Diplomate activities within LLL to determine if knowledge, judgement and skill necessary for patient care are maintained.  Aside from the Knowledge Assessment examination, other activities critical to making a summative decision on continued certification are peer review, practice billing log, and complication/mortality narratives.   Although time consuming for all involved (Diplomate, ABU staff and Trustees), these activities provide great insight into the daily practice of Diplomates and understanding of their practice standards. The practice billing log helps verify that Diplomates have selected the modular exam best fitting their clinical activity.  In addition, the practice logs enable the Trustees to be certain that the Diplomate has a sufficient case load to maintain skills.  Equally important, through log review and analysis, the ABU provides feedback to Diplomates regarding individual practice habits when warranted.

Though both programs addressed verification of licensure, Practice Assessment Protocols (PAP), CME, peer review, professionalism/ethics modules, patient safety modules, billing logs and the exam, with LLL, maintenance of the 10-year certificate has transitioned from the 4 MOC levels of required activities performed every two years down to just 2 LLL levels of activities occurring every four years.  This transition greatly reduced the required time Diplomates need to participate in LLL throughout the 10-year window.

LLL encourages Diplomate participation in formal registries such as MUSIC, PURC, AQUA, and ABMS portfolio programs.  Credit for participation in these quality improvement programs waives the PAP activity requirement.  While the number of quality improvement opportunities is expected to grow, only participation in those compliant with ABMS developed standards earn LLL credit.

The ABU recognizes that the LLL program will continually evolve.  The commitment to serve the public and conversations with Diplomates at Town Hall Meetings, AUA section meetings, and other venues has led the ABU to appreciate that, while improvements have been made to LLL, more are needed.  Looking ahead, the ABU Trustees envision LLL to become a program based on continuous, rather than time-limited, certification which enables Diplomates to take the knowledge assessment at home instead of at a testing center.  This program of Continuing Urologic Certification is under development and will be evaluated as a pilot beginning Spring 2021.  Diplomates qualifying for inclusion in the pilot will be invited to apply.  Further information can be found here:  Continuing Urologic Certification