Maintenance of Certification (MOC) was 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. A ten year cycle, MOC entailed four levels and these basic components: licensure and peer review; continuing medical education; practice log, Practice Assessment Protocols (PAP), and modules for patient safety and professionalism/ethics; and a computerized, multiple choice exam Completion of these components allowed Diplomates of the ABU to maintain their general certification in urology and any urologic subspecialty certification. Responding to Diplomate feedback, in 2017, the ABU dismantled its MOC program and created, instead, the Lifelong Learning program as a certification requirement.

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. Beginning in 2007, all ABU Diplomates with time-limited certificates were enrolled in MOC. In 2017, The ABU created and implemented its own certificate maintenance program titled Lifelong Learning.

Lifelong Learning (LLL) is a 2017 initiative of the American Board of Urology aimed at ensuring quality patient care from its certified urologists through an ongoing process of professional self-improvement. It is a retooled version of the former Maintenance of Certification (MOC) program. A ten year cycle, LLL is comprised of two Levels and these basic components: licensure and peer review; continuing medical education; practice log, Practice Assessment Protocols (PAP), modules for patient safety and professionalism/ethics, videos for patient safety; and a computerized, multiple choice knowledge assessment. Completion of these components allows Diplomates of the ABU to maintain their general certification in urology and any urologic subspecialty certification.

The LLL 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 LLL program continually promotes lifelong self-assessment and improvement efforts.

The ABU evaluates Diplomates through the LLL 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) two times during the 10-year LLL cycle: a Patient Safety Module (PSM) once; Patient Safety Videos (PSV) once; and a Professionalism and Ethics Module (PEM) once. See the block diagram for timing.
• Evidence of Lifelong Learning is shown twice during the 10 year LLL cycle by the completion of 90 hours of urology-focused continuing medical education (CME), of which 30 hours must be Category 1 as defined by the American Urological Association.
• 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 LLL cycle.
• Evidence of Cognitive Expertise is demonstrated through a secure, computer-based, closed-book knowledge assessment during year 7, 8 or 9 of the 10 year LLL cycle.

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

If a time-limited Diplomate earns a subspecialty certificate, the expiration date of the original urology certificate will be extended to coincide that of the subspecialty certificate. Once subspecialty certified, the Diplomate will re-enter the LLL process and be required to complete all components on that schedule accordingly.

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

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 LLL process for the subspecialty certificate.

Participation in the LLL program is not required for Diplomates with time-unlimited certificates; however the Diplomate may voluntarily enter the process at any time, as certain hospital credentials may require evidence of continuous certification efforts, or for various other reasons.

Regardless of a Diplomate’s performance in LLL, the original time-unlimited certificate still remains in effect.

The LLL program replaced recertification in 2018. All time-limited Diplomates have completed the recertification process and have entered the LLL process.

If you do not participate in the LLL 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 date of certification. Diplomates with time-limited general urology certificates and those holding subspecialty certificates are subject to LLL by the deadlines specified in order to maintain Board certification.

A Diplomate is required to make application to the LLL process in Level 1 according to the published timeline. Certification is contingent upon the Diplomate completing the required elements of LLL according to schedule. If the Diplomate fails to enter the process on time, a late fee of $275 applies, and the certificate is no longer in good standing with jeopardy of revocation. Requirements to re-enter the process are outlined in the current handbook.

Beginning in 2007, all Diplomates with a time-limited certificate entered the four level MOC process in the year of original certification or recertification... Similarly, all Diplomates certifying or recertifying in/after 2017 must enter the two level process of LLL, which replaced MOC in that year. The requirements of LLL are mostly completed online using the ABU website. For LLL Level 1, an instructional letter which includes username and password is mailed to the Diplomate in January and all requirements are to be completed before April 1 of the last eligible year of their timeline. For LLL Level 2, a similar instructional letter is mailed in January. Diplomates at Level 2 may elect to meet these requirements and recertify in either years 7, 8 or 9 following their certification or recertification. A Level 2 letter of invitation will be sent at each year until the Diplomate exercises the opportunity to enter. All Level 2 requirements must be satisfactorily completed by the deadline in order to sit for the October exam of the same year.

All diplomates are encouraged to enter the diplomate portal on a regular basis. Your placement and status within LLL is clearly shown.   The office of the American Board of Urology will notify Diplomates holding a time-limited certificate via email when each phase of LLL is required. At that time, the handbook Information for Applicants for Lifelong Learning, detailing the LLL process, will be available here. For assistance in accessing the handbook online, please call the ABU office at 434/979-0059.  Please maintain a current email address in your diplomate portal.

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

LLL has two levels with components of LLL due at years 2-5 and, at the Diplomate’s discretion, either year 7,8, or 9.  Twice in the ten-year cycle, Diplomates must complete self-assessment programs developed by the Board, meet continuing medical education and peer review requirements, and, at Level 2, submit a practice log as part of this process.  The Knowledge Assessment exam must be completed within the three year period prior to expiration of the Diplomate’s current certificate. All assigned CME activity based on that exam must be completed within one year and prior to the expiration date of the certificate.

These non-graded learning tools were developed by the ABU 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.

Twice in the 10 year cycle, ninety hours of CME credits, of which 30 must be Category 1, as defined by the Accreditation Council for Continuing Medical Education (ACCME) are due. These must be earned within three years prior to the deadline, and are required at Level 1 and Level 2 of LLL.

For Category 1 credits, certified CME providers issue written verification of a Diplomate’s participation in a qualifying activity. To satisfy the requirements of LLL, 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. Examples of Category 2 activities and how to document them can be found here.

The $275 Annual Certificate Fee, a streamlined replacement of all Recertification and Lifelong Learning (LLL) (formerly Maintenance of Certification) application fees, was implemented in 2009 to provide reliable income for the operations of the Board. The fee is mandatory for any time-limited ABU Diplomate and for any subspecialty certified Diplomate, regardless of Recertification or Lifelong Learning program status. Currency with Annual Certificate Fee is required for Diplomates to participate in LLL.

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

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 LLL.

Yes, upon a Diplomate’s written request, the ABU will provide, at no charge, a letter to the Diplomate verifying certification status. Should the Diplomate need a verification letter provided to a third party, a $50 fee applies. Requests and payment, by check or money order, should be mailed to the Board office. Please allow up to two weeks for processing.