JULY 2023 1
ABIM invites diplomates to help develop the
Gastroenterology MOC exam blueprint
Based on feedback from physicians that MOC assessments
should better reflect what they see in practice, in 2016 the
American Board of Internal Medicine (ABIM) invited all certified
gastroenterologists to provide ratings of the relative frequency
and importance of blueprint topics in practice.
This review process, which resulted in a new MOC exam
blueprint, will be used on a periodic basis to inform and update
all MOC assessments created by ABIM. No matter what form
ABIM’s assessments ultimately take, they will need to be
informed by front-line clinicians sharing their perspective on
what is important to know.
A sample of over 400 gastroenterologists, similar to the total
invited population of gastroenterologists in age, gender, time
spent in direct patient care, and geographic region of practice,
provided the blueprint topic ratings. ABIM used this feedback
to update the blueprint for MOC assessments (beginning with
the Spring 2017 administration of the traditional, 10-year
MOC exam).
To inform how assessment content should be distributed
across the major blueprint content categories, ABIM considered
the average respondent ratings of topic frequency and
importance in each of the content categories. A second
source of information was the relative frequency of patient
conditions in the content categories, as seen by certified
gastroenterologists and documented by national health care
data (described further under Content distribution below).
To determine prioritization of specific assessment content
within each major medical content category, ABIM used the
respondent ratings of topic frequency and importance to set
thresholds for these parameters in the exam assembly process
(described further under Detailed content outline below).
Purpose of the Gastroenterology MOC
Assessments
MOC assessments are designed to evaluate whether a certified
gastroenterologist has maintained competence and currency
in the knowledge and judgment required for practice. The MOC
assessments emphasize diagnosis and management of
prevalent conditions, particularly in areas where practice has
changed in recent years. As a result of the blueprint review by
ABIM diplomates, MOC assessments place less emphasis on
rare conditions and focus more on situations in which physician
intervention can have important consequences for patients.
For conditions that are usually managed by other specialists,
the focus is on recognition rather than on management.
Assessment format
The traditional, 10-year MOC exam contains up to 220 single-
best-answer multiple-choice questions, of which approximately
50 are new questions that do not count in the examinee’s
score. Examinees taking the traditional, 10-year MOC exam
will have access to an external resource (i.e., UpToDate
®
) for
the entire exam.
The LKA for MOC, is a five-year cycle in which physicians
answer questions on an ongoing basis and receive feedback
on how they’re performing along the way. More information
on how assessments are developed can be found at abim.org/
about/exam-information/exam-development.aspx.
Most questions describe patient scenarios and ask about
the work done (that is, tasks performed) by physicians in the
course of practice:
• Diagnosis: making a diagnosis or identifying an
underlying condition
• Testing: ordering tests for diagnosis, staging, or follow-up
• Treatment/Care Decisions: recommending treatment
or other patient care
• Risk Assessment/Prognosis/Epidemiology: assessing
risk, determining prognosis, and applying principles from
epidemiologic studies
• Pathophysiology/Basic Science: understanding the
pathophysiology of disease and basic science knowledge
applicable to patient care
GASTROENTEROLOGY Blueprint
For traditional, 10-year Maintenance of Certification (MOC) exam and Longitudinal Knowledge Assessment (LKA
™
)
JULY 2023 2
ABIM is committed to working toward health equity and
believes that board-certified physicians should have an
understanding of health care disparities. Therefore, health
equity content that is clinically important to each discipline
will be included in assessments, and the use of gender, race,
and ethnicity identifiers will be re-evaluated.
Clinical scenarios presented take place in outpatient or
inpatient settings as appropriate to a typical gastroenterology
practice. Clinical information may include patient photographs,
imaging studies, electrocardiograms, endoscopic videos, and
other media to illustrate relevant patient findings.
A tutorial, including examples of question format, can be found
at abim.org/maintenance-of-certification/exam-information/
gastroenterology/exam-tutorial.aspx.
Content distribution
Listed below are the major medical content categories that
Define the domain for the Gastroenterology traditional, 10-year
MOC exam and LKA. The relative distribution of content is
expressed as a percentage of the total assessment. To
determine the content distribution, ABIM considered the
average respondent ratings of topic frequency and importance.
To cross-validate these self-reported ratings, ABIM also
considered the relative frequency of conditions seen in
Medicare patients by a cohort of certified gastroenterologists.
Informed by these data, the Gastroenterology Approval
Committee and Board have determined the medical category
targets, shown below.
Assessment questions in the content areas above also
may address topics in endoscopy, genetic conditions,
medication management and risks, nutritional support, and
quality benchmarking.
How the blueprint ratings are used to assemble
the MOC assessment
Blueprint reviewers provided ratings of relative frequency in
practice for each of the detailed content topics in the blueprint
and provided ratings of the relative importance of the topics
for each of the tasks described in Assessment format above.
In rating importance, reviewers were asked to consider factors
such as the following:
• High risk of a significant adverse outcome
• Cost of care and stewardship of resources
• Common errors in diagnosis or management
• Eect on population health
• Eect on quality of life
• When failure to intervene by the physician deprives a
patient of significant benefit
Frequency and importance were rated on a three-point scale
corresponding to low, medium, or high. The median importance
ratings are reflected in the Detailed content outline below. The
Gastroenterology Approval Committee and Board, in partnership
with the physician community, have set the following parameters
for selecting MOC assessment questions according to the
blueprint review ratings:
• At least 75% of questions will address high-importance
content (indicated in green)
• No more than 25% of questions will address medium-
importance content (indicated in yellow)
• No exam questions will address low-importance content
(indicated in red)
Independent of the importance and task ratings, no more than
17% of questions will address low-frequency content (indicated
by “LF” following the topic description).
CONTENT CATEGORY Target %
Esophagus 12%
Stomach and Duodenum 15%
Liver 22%
Biliary Tract 10%
Pancreas 11%
Small Intestine 10%
Colon 20%
Total 100%
JULY 2023 3
Detailed content outline for the Gastroenterology traditional, 10-year MOC exam and LKA
I
ESOPHAGUS
(12% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
I.A ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)
I.A.1 Anatomic abnormalities
LF
I.A.2 Esophageal physiology
I.B SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)
I.B.1 Dysphagia
I.B.2 Heartburn
I.B.3 Chest pain
I.B.4 Globus sensation
I.C DISEASES AND DISORDERS (10% of exam)
I.C.1 Oropharyngeal disorders
I.C.2
Gastroesophageal reux disease
(GERD)
I.C.3
Esophageal motility and functional
disorders
I.C.4 Barrett esophagus
I.C.5 Foreign body and food impaction
I.C.6 Esophageal injury
LF
I.C.7 Esophageal infections
LF
The content selection priorities below are applicable beginning with the Spring 2017 traditional, 10-year MOC exam and are subject
to change in response to future blueprint review.
Note: The same topic may appear in more than one medical content category.
– High Importance: At least 75% of questions
will address topics and tasks with this
designation.
– Medium Importance: No more than 25%
of questions will address topics and tasks
with this designation.
– Low Importance: No questions will
address topics and tasks with
this designation.
LF
– Low Frequency: No more than 17% of questions will address topics with this designation, regardless of task or importance.
JULY 2023 4
– High Importance: At least 75% of questions
will address topics and tasks with this
designation.
– Medium Importance: No more than 25%
of questions will address topics and tasks
with this designation.
– Low Importance: No questions will
address topics and tasks with
this designation.
LF
– Low Frequency: No more than 17% of questions will address topics with this designation, regardless of task or importance.
I
ESOPHAGUS
continued…
(12% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
I.C DISEASES AND DISORDERS continued… (10% of exam)
I.C.8 Neoplasms of the esophagus
I.C.8.a Benign
LF
I.C.8.b Malignant
I.C.9 Esophageal ulcerations
I.C.10 Eosinophilic esophagitis
I.C.11 Esophageal varices
I.C.12
Systemic disorders involving the
esophagus
LF
II
STOMACH AND DUODENUM
(15% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
II.A ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)
II.A.1 Anatomic abnormalities
LF
II.A.2
Physiology of the stomach and
duodenum
II.B SYMPTOMS AND CLINICAL PRESENTATION (3% of exam)
II.B.1 Upper gastrointestinal bleeding
II.B.2
Dyspepsia and upper abdominal
pain
II.B.3 Nausea and vomiting
II.C DISEASES AND DISORDERS (10.5% of exam)
II.C.1 Gastric mucosal disorders
II.C.1.a Inammatory
II.C.1.b Inltrative
LF
II.C.2 Peptic ulcer disease
II.C.2.a
Helicobacter pylori
II.C.2.b Medication-induced
JULY 2023 5
– High Importance: At least 75% of questions
will address topics and tasks with this
designation.
– Medium Importance: No more than 25%
of questions will address topics and tasks
with this designation.
– Low Importance: No questions will
address topics and tasks with
this designation.
LF
– Low Frequency: No more than 17% of questions will address topics with this designation, regardless of task or importance.
II
STOMACH AND DUODENUM
continued…
(15% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
II.C DISEASES AND DISORDERS continued… (10.5% of exam)
II.C.3 Neoplasms of the stomach and duodenum
II.C.3.a Benign
II.C.3.b Malignant
LF
II.C.4
Gastric motility and functional
disorders
II.C.5 Post-surgical conditions
II.C.5.a Bariatric surgery
II.C.5.b Gastric resection
LF
II.C.5.c Surgery for benign disease
LF
II.C.5.d Surgery for malignant disease
LF
III
LIVER
(22% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
III.A ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (2% of exam)
III.A.1 Anatomic abnormalities
LF
III.A.2 Hepatic physiology
III.B SYMPTOMS AND CLINICAL PRESENTATION (2% of exam)
III.B.1 Abnormal liver chemistries
III.B.2 Jaundice
III.B.3 Portal hypertension
III.B.3.a Varices
III.B.3.b Ascites and hepatic hydrothorax
III.B.3.c Hepatorenal syndrome
LF
III.B.3.d Portosystemic encephalopathy
III.B.3.e Pulmonary complications
LF
III.B.4 Pruritus
LF
JULY 2023 6
– High Importance: At least 75% of questions
will address topics and tasks with this
designation.
– Medium Importance: No more than 25%
of questions will address topics and tasks
with this designation.
– Low Importance: No questions will
address topics and tasks with
this designation.
LF
– Low Frequency: No more than 17% of questions will address topics with this designation, regardless of task or importance.
III
LIVER
continued…
(22% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
III.C DISEASES AND DISORDERS (18% of exam)
III.C.1 Inherited disorders
III.C.1.a Iron overload
LF
III.C.1.b Wilson disease
LF
III.C.1.c Alpha
1
-antitrypsin deciency
LF
III.C.1.d Cystic brosis
LF
III.C.1.e Sickle cell hepatopathy
LF
III.C.2 Cholestatic liver diseases
III.C.2.a Primary biliary cholangitis
III.C.2.b Primary sclerosing cholangitis
LF
III.C.2.c Secondary biliary cholangitis
LF
III.C.3 Viral hepatitis (6% of exam)
III.C.3.a Hepatitis A
LF
III.C.3.b Hepatitis B
III.C.3.b.i)
Acute hepatitis B
LF
III.C.3.b.ii)
Chronic hepatitis B
III.C.3.c Hepatitis C
III.C.3.c.i)
Acute hepatitis C
LF
III.C.3.c.ii)
Chronic hepatitis C
III.C.3.d Delta hepatitis
LF
III.C.3.e Hepatitis E
LF
III.C.4 Autoimmune hepatitis
III.C.5 Vascular liver disease
LF
III.C.6 Alcoholic liver disease
III.C.7 Nonalcoholic fatty liver disease
III.C.8 Drug-induced liver disease
JULY 2023 7
– High Importance: At least 75% of questions
will address topics and tasks with this
designation.
– Medium Importance: No more than 25%
of questions will address topics and tasks
with this designation.
– Low Importance: No questions will
address topics and tasks with
this designation.
LF
– Low Frequency: No more than 17% of questions will address topics with this designation, regardless of task or importance.
III
LIVER
continued…
(22% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
III.C DISEASES AND DISORDERS continued… (18% of exam)
III.C.9 Pregnancy-related liver disease
LF
III.C.10 Acute liver failure
LF
III.C.11 Neoplasms of the liver
III.C.11.a Benign
III.C.11.b Malignant
III.C.12 Liver abscess
LF
III.C.13
Hepatic manifestations of
systemic disease
III.C.14 Liver transplantation
III.C.14.a Indications and complications
III.C.15
Surgical considerations for patients
who have liver disease
III.C.16
Extrahepatic manifestations in
patients who have liver disease
IV
BILIARY TRACT
(10% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
IV.A ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)
IV.A.1 Anatomic abnormalities
LF
IV.A.2 Physiology of the biliary tract
LF
IV.B SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)
IV.B.1 Obstructive jaundice
IV.B.2 Right upper quadrant pain
IV.B.3 Hemobilia
LF
JULY 2023 8
– High Importance: At least 75% of questions
will address topics and tasks with this
designation.
– Medium Importance: No more than 25%
of questions will address topics and tasks
with this designation.
– Low Importance: No questions will
address topics and tasks with
this designation.
LF
– Low Frequency: No more than 17% of questions will address topics with this designation, regardless of task or importance.
IV
BILIARY TRACT
continued…
(10% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
IV.C DISEASES AND DISORDERS (8% of exam)
IV.C.1 Gallstone disease
IV.C.2 Gallbladder diseases
IV.C.3 Bile duct diseases
IV.C.4 Biliary infections
IV.C.5 Neoplasms of the biliary tract
IV.C.5.a Benign
LF
IV.C.5.b Malignant
IV.C.6
Biliary motility and functional
disorders
LF
V
PANCREAS
(11% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
V. A ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)
V.A.1 Anatomic abnormalities
LF
V.A.2 Physiology of the pancreas
LF
V. B SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)
V.B.1 Duct disruptions
V.B.2 Malabsorption
V.B.3 Ascites
V. C DISEASES AND DISORDERS (8% of exam)
V.C.1 Acute pancreatitis
V.C.2 Chronic pancreatitis
V.C.3 Neoplasms of the pancreas
V.C.3.a Benign
V.C.3.b Malignant
JULY 2023 9
– High Importance: At least 75% of questions
will address topics and tasks with this
designation.
– Medium Importance: No more than 25%
of questions will address topics and tasks
with this designation.
– Low Importance: No questions will
address topics and tasks with
this designation.
LF
– Low Frequency: No more than 17% of questions will address topics with this designation, regardless of task or importance.
VI
SMALL INTESTINE
(10% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
VI.A ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (2% of exam)
VI.A.1 Congenital anomalies
LF
VI.A.2 Acquired structural anomalies
LF
VI.A.3
Digestion, absorption, and
malabsorption
VI.A.4 Mechanical obstruction and ileus
VI.B SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)
VI.B.1 Diarrhea
VI.B.2 Acute abdominal pain
VI.B.3 Chronic abdominal pain
VI.B.4 Bleeding from small intestinal source
VI.B.5
Abdominal distention, bloating,
and gas
VI.C DISEASES AND DISORDERS (7% of exam)
VI.C.1
Small bowel motility and functional
disorders
VI.C.2 Small bowel infections
VI.C.3 Small bowel injury
LF
VI.C.4 Immunologic and inammatory disorders of the gut
VI.C.4.a Eosinophilic gastroenteritis
LF
VI.C.4.b Crohn disease of the small bowel
VI.C.4.b.i)
Complications
VI.C.4.b.ii)
Extra-intestinal manifestations
VI.C.4.c Celiac disease
VI.C.5 Neoplasms of the small bowel
VI.C.5.a Benign
LF
VI.C.5.b Malignant
LF
VI.C.6
Vascular disorders of the small
bowel
JULY 2023 10
– High Importance: At least 75% of questions
will address topics and tasks with this
designation.
– Medium Importance: No more than 25%
of questions will address topics and tasks
with this designation.
– Low Importance: No questions will
address topics and tasks with
this designation.
LF
– Low Frequency: No more than 17% of questions will address topics with this designation, regardless of task or importance.
VII
COLON
(20% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
VII.A ANATOMY, DEVELOPMENT, AND PHYSIOLOGY (<2% of exam)
VII.A.1 Volvulus and intussusception
LF
VII.A.2 Defecation
VII.B SYMPTOMS AND CLINICAL PRESENTATION (<2% of exam)
VII.B.1 Constipation
VII.B.2 Diarrhea
VII.B.3 Fecal incontinence
VII.B.4 Lower gastrointestinal bleeding
VII.B.5 Abdominal pain
VII.C DISEASES AND DISORDERS (17% of exam)
VII.C.1
Colorectal motility and functional
disorders
VII.C.2 Colorectal infections
VII.C.3 Colorectal injury
LF
VII.C.4 Inammatory bowel disease
VII.C.4.a Microscopic colitis
VII.C.4.b Ulcerative colitis
VII.C.4.c
Crohn disease
VII.C.4.d
Drug-induced inammatory bowel
disease
LF
VII.C.5 Diverticular disease
VII.C.5.a Hemorrhage
VII.C.5.b Diverticulitis
VII.C.6 Appendicitis
LF
VII.C.7 Neoplasms of the colon and rectum (5% of exam)
VII.C.7.a Benign
VII.C.7.b Malignant
JULY 2023 11
– High Importance: At least 75% of questions
will address topics and tasks with this
designation.
– Medium Importance: No more than 25%
of questions will address topics and tasks
with this designation.
– Low Importance: No questions will
address topics and tasks with
this designation.
LF
– Low Frequency: No more than 17% of questions will address topics with this designation, regardless of task or importance.
VII
COLON
continued…
(20% of exam) Diagnosis Testing
Treatment/
Care Decisions
Risk Assessment/
Prognosis/
Epidemiology
Pathophysiology/
Basic Science
VII.C DISEASES AND DISORDERS continued… (17% of exam)
VII.C.8
Vascular disorders of the colon
and rectum
VII.C.9 Perianal and anorectal disorders
VII.C.10 Post-surgical colorectal conditions
LF
