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Supplemental Digital Content is Available in the Text. Introduction: This article describes an article-based alternative for maintenance of certification that the American Board of Psychiatry and Neurology developed and began pilot testing in 2019. The rationale for and components of the pilot program are presented along with data on participant performance and feedback from the first year of implementation in three primary specialties (neurology, child neurology, and psychiatry) and one subspecialty (child and adolescent psychiatry). Methods: Evaluation of the pilot program was guided by a widely used validity framework. Data were collected that addressed the five categories of validity evidence: content, response process, internal structure, relation to other variables, and consequences. Results: Enrollment ranged from 66.7% for psychiatrists to 75.3% for child neurologists. For the 2019 cohort, the pass rates ranged from 92.6% for child and adolescent psychiatry to 98.7% for neurology, and very small numbers of diplomates failed or did not complete the process. For psychiatrists, there was a modest, but significant, relationship between performance on previous and subsequent maintenance of certification examinations. Ninety percent or more agreed that: the articles were easy to access and helpful to their practices; the mini-tests were a fair assessment of their understanding of the articles; and their test-taking experience was satisfactory. Discussion: Most eligible diplomates participated in the article-based pilot project, and they strongly preferred this format to the traditional multiple-choice examinations. Most important, the pilot was perceived to be a meaningful and relevant learning activity that had a positive effect on patient care. [ABSTRACT FROM AUTHOR]

Introduction: The authors sought to identify how physician specialty certification is defined in the North American literature. Methods: A rigorous, established six-stage scoping review framework was used to identify the North American certification literature published between January 2006 and May 2016 relating to physician specialty certification. Data were abstracted using a charting form developed by the study team. Quantitative summary data and qualitative thematic analysis of the purpose of certification were derived from the extracted data. Results: A two stage screening process identified 88 articles that met predefined criteria. Only 14 of the 88 articles (16%) contained a referenced purpose of certification. Eighteen definitions were identified from these articles. Definitional concepts included lifelong learning and continuous professional development, assessment of competence and performance, performance improvement, public accountability, and professional standing. Discussion: Most articles identified in this scoping review did not define certification or describe its purpose or intent. Future studies should provide a definition of certification to further scholarly examination of its intent and effects and inform its further evolution. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate a longitudinal assessment program for physical medicine and rehabilitation (LA-PM&R) as a replacement for the American Board of Physical Medicine and Rehabilitation maintenance of certification examination. Design: In this quality improvement study, randomly selected American Board of Physical Medicine and Rehabilitation diplomates were invited to participate in the LA-PM&R. Participants' maintenance of certification scaled scores were compared with LA-PM&R nonparticipants. We examined the association between LA-PM&R scores and maintenance of certification scaled scores and performance on clone items placed on both examinations. Results: There were 2222 American Board of Physical Medicine and Rehabilitation diplomates eligible to take the maintenance of certification examination from February 2018 to February 2019. Invitations were sent to 1050 randomly selected diplomates, of whom 448 initially agreed. Three hundred eighteen individuals completed more than two quarters of LA-PM&R participation and took the maintenance of certification examination. Two hundred sixty-six diplomates took the maintenance of certification examination in the same period who did not participate in LA-PM&R. The LA-PM&R group scored higher on the maintenance of certification examination than the control group (P < 0.05). Performance on the two examinations were highly correlated, r =.50, P < 0.0001. On clone items, LA-PM&R participants had 74% correct on the LA-PM&R but 86% correct on the maintenance of certification examination (P < 0.01). Conclusions: The LA-PM&R program leads to better learning and retention of information than the 10-yr maintenance of certification examination. [ABSTRACT FROM AUTHOR]

Introduction: Specialists in a Maintenance of Certification program are required to participate in assessment activities, such as chart audit, simulation, knowledge assessment, and multisource feedback. This study examined data from five different specialties to identify variation in participation in assessment activities, examine differences in the learning stimulated by assessment, assess the frequency and type of planned changes, and assess the association between learning, discussion, and planned changes. Methods: E-portfolio data were categorized and analyzed descriptively. Chi-squared tests examined associations. Results: A total of 2854 anatomical pathologists, cardiologists, gastroenterologists, ophthalmologists, and orthopedic surgeons provided data about 6063 assessment activities. Although there were differences in the role that learning played by discipline and assessment type, the most common activities documented across all specialties were self-assessment programs (n = 2122), feedback on teaching (n = 1078), personal practice assessments which the physician did themselves (n = 751), annual reviews (n = 682), and reviews by third parties (n = 661). Learning occurred for 93% of the activities and was associated with change. For 2126 activities, there were planned changes. Activities in which there was a discussion with a peer or supervisor were more likely to result in a change. Conclusions and Discussion: Although specialists engaged in many types of assessment activities to meet the Maintenance of Certification program requirements, there was variability in how assessment stimulated learning and planned changes. It seems that peer discussion may be an important component in fostering practice change and forming plans for improvement which bears further study. [ABSTRACT FROM AUTHOR]

Physician credentialing processes aim to improve patient safety and quality, but little research has examined their direct relationship with surgical outcomes. Using national Medicare claims for 2009 to 2013, the authors studied the association between board certification and completion of Maintenance of Certification (MOC) requirements and surgeon rates of complications for 8 elective procedures. Exemplar surgeons were defined as those in the lowest decile of complication rates, and outlier surgeons were those in the highest decile. The analysis included 1.9 million procedures performed by 14 598 surgeons (64% orthopedics, 17% general surgery, 11% urology, 7% neurosurgery). Board-certified surgeons were less likely to be outliers (odds ratio 0.79 [0.66-0.94]). However, completion of MOC was not associated with differences in complication rates in orthopedic surgery or urology. Incorporating additional assessment methods into MOC, such as video evaluation of technical skills, retraining on state-of-the-art care, and peer review, may facilitate further improvements in surgical quality. [ABSTRACT FROM AUTHOR]

Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design. [ABSTRACT FROM AUTHOR]

There is immense change affecting obstetrical and gynecologic medical practice at this moment in time-involving reimbursement with the shift from volume-based to value-based care, increasing regulation, and workforce sustainability. Aspects to be reviewed in this chapter include reimbursements and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), electronic medical records, physician satisfaction surveys, maintenance of certification, and physician burnout. [ABSTRACT FROM AUTHOR]

The successful remediation of clinicians demonstrating poor performance in the workplace is essential to ensure the provision of safe patient care. Clinicians may develop performance problems for numerous reasons, including health, personal factors, the workplace environment, or outdated knowledge/skills. Performance problems are often complex involving multifactorial issues, encompassing knowledge, skills, and professional behaviors. It is important that (where possible and appropriate) clinicians are supported through effective remediation to return them to safe clinical practice. A review of the literature demonstrated that research into remediation is in its infancy, with little known about the effectiveness of remediation programs currently. Current strategies for the development of remediation programs are mostly "intuitive"; a few draw upon established theories to inform their approach. Similarly, although it has been established that identification of the nature/scope of performance problems through assessment is an essential first step within remediation, the need for a more widespread "diagnosis" of why the problems exist is emerging. These reasons for poor performance, particularly in the context of experienced practicing clinicians, are likely to have an impact on the potential success of remediation and should be considered within the "diagnosis." A new model for diagnosing the performance problems of the clinicians has been developed, using behavioral change theories to explore known barriers to successful remediation, such as insight, motivation, attitude, self-efficacy and the working environment, in addition to addressing known deficits regarding knowledge and skills. This novel approach is described in this article. An initial feasibility study has demonstrated the acceptability and practical implementation of our model. [ABSTRACT FROM AUTHOR]

Around the world, policy-makers, academics, and health service professionals have become increasingly aware of the importance of remediation, the process by which poor performance is "remedied," as part of the changing landscape of medical regulation. It is, therefore, an opportune time to critique the UK experience with remediation policy. This article frames, for the first time, the UK remediation policy as developing from a central policy aim that was articulated in the 1990s: to accelerate the identification of underperformance and, subsequently, remedy any problems identified as soon as possible. In pursuit of this aim, three policy trajectories have emerged: professionalizing and standardizing remediation provision; linking remediation with other forms of regulation, namely relicensure (known in the UK as medical revalidation); and fostering obligations for doctors to report themselves and others for remediation needs. The operationalization of policy along these trajectories, and the challenges that have arisen, has relevance for anyone seeking to understand or indeed improve remediation practices within any health care system. It is argued here that the UK serves as an example of the more general challenges posed by seeking to integrate remediation policy within broader frameworks of medical governance, in particular systems of relicensure, and the need to develop a solid evidence base for remediation practices. [ABSTRACT FROM AUTHOR]

Introduction: Multisource feedback (MSF) instruments are used to and must feasibly provide reliable and valid data on physicians' performance from multiple perspectives. The "INviting Co-workers to Evaluate Physicians Tool" (INCEPT) is a multisource feedback instrument used to evaluate physicians' professional performance as perceived by peers, residents, and coworkers. In this study, we report on the validity, reliability, and feasibility of the INCEPT. Methods: The performance of 218 physicians was assessed by 597 peers, 344 residents, and 822 coworkers. Using explorative and confirmatory factor analyses, multilevel regression analyses between narrative and numerical feedback, item-total correlations, interscale correlations, Cronbach's a and generalizability analyses, the psychometric qualities, and feasibility of the INCEPT were investigated. Results: For all respondent groups, three factors were identified, although constructed slightly different: "professional attitude," "patient-centeredness," and "organization and (self)-management." Internal consistency was high for all constructs (Cronbach's a $ 0.84 and item-total correlations $ 0.52). Confirmatory factor analyses indicated acceptable to good fit. Further validity evidence was given by the associations between narrative and numerical feedback. For reliable total INCEPT scores, three peer, two resident and three coworker evaluations were needed; for subscale scores, evaluations of three peers, three residents and three tofour coworkers were sufficient. Discussion: The INCEPT instrument provides physicians performance feedback in a valid and reliable way. The number of evaluations to establish reliable scores is achievable in a regular clinical department. When interpreting feedback, physicians should consider that respondent groups' perceptions differ as indicated by the different item clustering per performance factor [ABSTRACT FROM AUTHOR]

Introduction: Maintenance of Certification (MOC) programs are facing competing pressures from physicians and regulators to design and deliver systems that ensure physicians sustain or maintain competence postcertification. Adding to these pressures is an emerging discourse of dissatisfaction by physicians participating in MOC programs suggesting physicians themselves are seeking programs that are relevant to their scope of practice. The object was to determine Canadian specialists' views of a redesigned Royal College of Physician and Surgeons of Canada's MOC program in five priority areas: complexity, motivation, impact, credit sufficiency, and enhancement. Methods: A national, cross-specialty, survey of Royal College of Physician and Surgeons of Canada's MOC program users who had participated for at least 1 year. Results: Five thousand two hundred fifty nine respondents were included in the analysis. A majority of participates either "agreed" (2258, 43%) or "strongly agreed" (631, 12%) that the new framework was simpler to understand and the redesigned submission templates were simpler to use ("agree" 2297 [43.7%], "strongly agree" 701 [13.3%]). A total of 64.5% had a good understanding of the program purposes; however, some respondents believe the program does not yet deliver intended outcomes. Maintaining Fellowship designation, regulatory requirements, and a desire to remain up-to-date were indicated as the primary motivators for engaging in MOC. The program has had a modest influence on users' approach to lifelong learning ("neither agree nor disagree"). Discussion: The program redesign reduced the perceived complexity of the MOC framework however it is described by some, as additional work (an add-on) by necessitating the documentation of participation in learning activities. An important "disconnect" between the program purposes and how physicians operationalize engagement was also illuminated by our study. Further attention needs to be paid to shifting the culture of continuing professional development to one that enables physicians to sufficiently demonstrate their continuing competence and enhanced performance meaningfully through participation in MOC programs. [ABSTRACT FROM AUTHOR]

Introduction: The development of recertification programs (now referred to as Maintenance of Certification or MOC) by the members of the American Board of Medical Specialties provides the opportunity to study knowledge base across the professional lifespan of physicians. Research results to date are mixed with some studies finding negative associations between age and various measures of competency and others finding no or minimal relationships. Methods: Four groups of multiple choice test items that were independently developed for certification and MOC examinations in psychiatry and neurology were administered to certification and MOC examinees within each specialty. Percent correct scores were calculated for each examinee. Differences between certification and MOC examinees were compared using unpaired t tests, and logistic regression was used to compare MOC and certification examinee performance on the common test items. Results: Except for the neurology certification test items that addressed basic neurology concepts, the performance of the certification and MOC examinees was similar. The differences in performance on individual test items did not consistently favor one group or the other and could not be attributed to any distinguishable content or format characteristics of those items. Discussion: The findings of this study are encouraging in that physicians who had recently completed residency training possessed clinical knowledge that was comparable to that of experienced physicians, and the experienced physicians' clinical knowledge was equivalent to that of recent residency graduates. The role testing can play in enhancing expertise is described. [ABSTRACT FROM AUTHOR]

Introduction: Physician payment in the United States will be increasingly tied to quality measurement and performance. Whether participation in quality improvement (QI) through Maintenance of Certification for Family Physicians Performance in Practice Modules (PPMs) is useful and results in practice change remains unknown. Methods: All PPM feedback data from inception to April 2014 were analyzed using descriptive statistics by year, topic, and number of PPMs completed. Qualitative content analysis was applied to analyze responses to open-ended questions on practice changes. Results: Of note, 29,755 diplomates completed 38,201 PPMs; median 1 interquartile range (1, 1). Nearly two-thirds (65.8%, n = 25,150) of PPMs had completed feedback surveys. Of note, 78.7% of respondents indicated that they would change patient care and 90.2% indicated that they would continue QI activities after completing the PPM. Respondents endorsed high relevance to practice (90.5%), high currency of clinical information (86.4%), and high usefulness of clinical information (80.5%). When feedback was analyzed by the number of PPMs completed, respondents were less likely to change care but reported increased usefulness to practice and stable intention to continue QI efforts with more PPMs completed. Of note, 86.0% of respondents who said that they would change care provided examples: these varied by PPM topic but "doing more," focusing on patients, and education were common. Discussion: These findings suggest that QI completed through the PPMs may assist family physicians in improving the care they provide. Furthermore, ratings by the number of PPMs completed suggest that repeated exposure to QI efforts produce continued relevance and usefulness, even when changes in practice decline. [ABSTRACT FROM AUTHOR]

Introduction The Royal College of Physicians and Surgeons of Canada modified its Maintenance of Certification (MOC) framework in 2011 to further incentivize assessment activities compared to group and self-learning. The purpose of this study was to explore physician's perceptions of their access to assessment activities, barriers to participation in assessment, and the need for the Royal College to further support its fellows in gaining access to assessment activities. Methods A questionnaire-based survey was sent to all participants of the MOC program as part of a program evaluation examining recent changes to the MOC program. Results 5259 respondents contributed responses. Most physicians were comfortable with the revised framework for assessment while approximately 40% were neutral regarding whether lack of access to self-assessment activities was a problem. Respondents expressed a need for more self-assessment programs particularly those developed outside of Canada. Neither a lack of feedback about performance or discomfort with recording performance gaps was perceived as a barrier to participation in assessment activities. Physician comments were consistent with the quantitative data and elaborated on the need to develop and recognize more assessment activities. Discussion Physicians accepted the revised MOC program framework but perceived difficulty in accessing assessment programs, activities, and tools. As the framework changed again January 2014, requiring all fellows and MOC program participants to completion of at least 25 credits in each section of the MOC program (including assessment) during their new 5-year MOC cycle, additional resources will be needed to support opportunities for physicians to engage in assessment. [ABSTRACT FROM AUTHOR]

Introduction We investigated whether using an audience response system (ARS) as part of continuing education (CE) activities enhances immediate and long-term knowledge acquisition or learner reactions. Method A multicenter single-blinded controlled trial involving pharmacists at 2 metropolitan teaching hospitals was used for this investigation. Pharmacists were allocated to either (a) an interactive presentation incorporating multiple-choice questions (MCQs) answered using an ARS, or (b) the same, but noninteractive, presentation using summary points instead of MCQs. Baseline knowledge was evaluated using a 10-item questionnaire, which was also used to evaluate immediate and long-term (6 weeks later) knowledge acquisition. Learner reactions were evaluated through feedback questionnaires. Results The control and ARS intervention presentations were attended by 44 and 35 pharmacists, respectively. The 6-week follow-up questionnaire was completed by 35 control (80%) and 27 (77%) ARS group participants. Baseline knowledge was similar across groups (5.0 ± 1.6 SD vs 5.2 ± 1.6; p = .44) with no differences in immediate (8.3 ± 1.5 vs 7.9 ± 1.5; p = 0.30) or long-term (7.0 ± 1.6 vs 7.0 ± 1.5; p = 0.93) knowledge acquisition. Feedback regarding the use of an ARS was overwhelmingly positive, with participants feeling more strongly that the ARS enabled them to compare knowledge to that of their peers ( p < .001). Discussion There was no observed benefit of an ARS in relation to immediate or long-term knowledge acquisition. The use of an ARS, however, appeared to facilitate enhanced interactivity and participant self-reflection of knowledge, with strong participant desire to continue their use in future CE activities. [ABSTRACT FROM AUTHOR]

The American Board of Medical Specialties Maintenance of Certification Program (ABMS MOC) is designed to provide a comprehensive approach to physician lifelong learning, self-assessment, and quality improvement (QI) through its 4-part framework and coverage of the 6 competencies previously adopted by the ABMS and the Accreditation Council for Graduate Medical Education (ACGME). In this article, the theoretical rationale and exemplary empiric data regarding the MOC program and its individual parts are reviewed. The value of each part is considered in relation to 4 criteria about the relationship of the competencies addressed within that part to (1) patient outcomes, (2) physician performance, (3) validity of the assessment or educational methods utilized, and (4) learning or improvement potential. Overall, a sound theoretical rationale and a respectable evidence base exists to support the current structure and elements of the MOC program. However, it is incumbent on the ABMS and ABMS member boards to continue to examine their programs moving forward to assure the public and the profession that they are meeting expectations, are clinically relevant, and provide value to patients and participating physicians, and to refine and improve them as ongoing research indicates. [ABSTRACT FROM AUTHOR]

A unique quality improvement (QI) curriculum was implemented within the Division of General Internal Medicine to improve QI knowledge through multidisciplinary, team-based education, which also met the QI requirement for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) and the Mayo Quality Fellows program. Participants completed up to 4 QI learning modules, including pretest and posttest assessments. A participant who successfully completed all 4 modules received certification as a Silver Quality Fellow and credit toward the quality requirement for ABIM MOC. Of 62 individuals invited to participate, 33 (53%) completed all 4 modules and corresponding pretests and posttests. Participants substantially improved knowledge in all 4 quality modules. Study group participants’ pretest scores averaged 71.0%, and their posttest scores averaged 92.7%. Posttest scores of reference group participants compared favorably, averaging 89.2%. Initial assessments showed substantial knowledge improvements and successful implementation of staff-developed QI projects. [ABSTRACT FROM PUBLISHER]

Introduction: Board certification has evolved from a 'point-in-time' event to a process of periodic learning and reevaluation of medical competence through maintenance of certification (MOC). To better understand MOC participation, the transtheoretical model (TTM) was used to describe physicians' perceptions of MOC as a sequence of attitudinal changes. Method: Data were from a survey of internal medicine (IM) physicians' attitudes toward periodic reevaluation through MOC. An overall importance or decisional balance score was computed for each physician by summing his or her ratings across the 10 quality measures. The decisional balance score was used to classify physicians according to their acceptance of MOC, aligned with the 3 early TTM stages-of-change groups-precontemplation (PC), contemplation (C), and preparation (P)-where PC was least accepting and P was most accepting. Effect sizes assessed whether differences in attitudes toward reevaluation via MOC were of sufficient magnitude to support the TTM principles. Results: The difference in degree of acceptance of MOC between the P group and the PC and C groups was significant ( p < 0.001), but the effect size was lower than predicted by the 'strong' principle. Resistance to MOC for the PC and C groups was significantly greater than the P group ( p < 0.001) and supported the 'weak' principle. Physicians' beliefs about how often they should demonstrate performance on quality measures aligned well with the American Board of Internal Medicine's MOC requirements, with the P group believing in more frequent assessments than the PC and C groups ( p < 0.001). Conclusions: Results show that physicians in the Preparation stage had overcome resistance to MOC as predicted by the 'weak' principle of the TTM, but their attitude scores about the benefits of MOC were below what was expected by theory. This suggests that the structure of MOC may have made it easier for physicians to overcome barriers to MOC participation but may have lacked adequate resources to promote the benefits of participating in the process. More effort is needed to understand the specific benefits of MOC for reevaluating competencies, how to engage physicians and other stakeholders in the design of MOC, and how to communicate the rationale and evidence to those who are less accepting of MOC. [ABSTRACT FROM AUTHOR]

The ultimate goal of physician education is the application of knowledge and skills to patient care. The Maintenance of Certification (MOC) for Anesthesiologists program incorporates mannequin-based simulation to help realize this goal. Results from the first 2 years of experience suggest that 583 physician participants transferred knowledge and skills from their simulated experiences into real-world practice. Participants consistently found the experience educationally valuable and clinically relevant, and reported that it led to changes in practice. This first experience with mannequin-based simulation for MOC indicates that physicians accept this teaching modality, many with enthusiasm. Simulation education addresses many of the identified intentions of current continuing medical education (CME) and can help educators realize goals for educating physician-learners. [ABSTRACT FROM AUTHOR]

Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and preventive services using a common approach across specialties. The long-term goal of IPIP is to create an ongoing, sustained system across multiple levels of the health care system to accelerate improvement. IPIP core program components include alignment of leadership and leadership accountability, promotion of partnerships to promote health care quality, development of attractive incentives and motivators, regular measurement and transparent sharing of performance data, participation in organized quality improvement efforts using a standardized model, development of enduring collaborative improvement networks, and practice-level support. A prototype of the program was tested in 2 states from March 2006 to February 2008. In 2008, IPIP began to spread to 5 additional states. IPIP uses the leadership of the medical profession to align efforts to achieve large-scale change and to catalyze the development of an infrastructure capable of testing, evaluating, and disseminating effective approaches directly into practice. [ABSTRACT FROM AUTHOR]

The article focuses on the Maintenance of Certification (MOC) program established by the American Board of Medical Specialties (ABMS). It notes that the program aims to give an educational experience and integrate patient safety setting within various disciplines that deals with communication, epidemiology, and safety culture. It also notes that MOC is projected to create a positive effect on the public and professionals. Several requirements for physicians concerning MOL are also presented.

Introduction: Despite the existence of guidelines for attention deficit hyperactivity disorder (ADHD), clinical practices vary substantially. Practitioners can apply quality improvement (QI) strategies to adapt office processes and clinical practice towards evidence-based care. We identified facilitators and barriers to participation in a professional society–led structured collaborative to learn QI methods and improve care. Methods: Ten chapters of the American Academy of Pediatrics participated in the effort. Support to chapter leaders included conference calls, listserv, technical support, and data aggregation. Support from the chapters to participating pediatricians included online continuing medical education modules, a workshop, chart reviews, and QI coaching. Qualitative data were obtained through interviews of 22 project leaders and reviews of project progress reports. Quantitative results were obtained from surveys of 186 physician participants. Outcomes included facilitators/barriers to program implementation, evidence for sustained chapter QI infrastructure, and participant assessment of improvements in care. Results: Facilitators included physician opinion leaders, a workshop, conference calls, QI support, and opportunities for shared learning. Barriers included lack of time, competing clinical priorities, challenges of using the online module, and underutilization of listservs. Seven chapters planned ongoing activities around attention deficit hyperactivity disorder (ADHD), eight had specific plans to use QI infrastructure for additional clinical topics, and three developed significant QI infrastructure. Physicians believed care improved. Discussion: As requirements grow for participation in QI for maintenance of certification, national and state-level professional societies are interested in and can develop infrastructure to support quality improvement. Coaching, tools, and support from the national organization and QI experts are helpful in facilitating efforts. [ABSTRACT FROM AUTHOR]

Introduction: Several recent studies highlight that physicians are not very accurate at assessing their competence in clinical domains when compared to objective measures of knowledge and performance. Instead of continuing to try to train physicians to be more accurate self-assessors, the research suggests that physicians will benefit from learning programs that encourage them to reflect on their clinical practice, continuously seek answers to clinical problems they face, compare their knowledge and skills to clinical practice guidelines and benchmarks, and seek feedback from peers and their health care team. Methods: This article describes the self-assessment learning activities of the College of Family Physicians of Canada Maintenance of Proficiency program (Mainpro®) and the Royal College of Physicians and Surgeons of Canada Maintenance of Certification program. (MOC) Results: The MOC and the Mainpro® programs incorporate several self-evaluation learning processes and tools that encourage physicians to assess their professional knowledge and clinical performance against objective measures as well as guided self-audit learning activities that encourage physicians to gather information about their practices and reflect on it individually, with peers and their health care team. Physicians are also rewarded with extra credits when they participate in either of these kinds of learning activities. Discussion: In the future, practice-based learning that incorporates self-assessment learning activities will play an increasingly important role as regulators mandate that all physicians participate in continuing professional development activities. Research in this area should be directed to understanding more about reflection in practice and how we can enable physicians to be more mindful. [ABSTRACT FROM AUTHOR]

Introduction: National health care concerns have led to the emergence of maintenance of certification (MOC) as a means to ensure the competence of practicing physicians. Little is known about physician perceptions of the barriers and/or benefits of MOC or proportions of physicians who participate in MOC programs. The purposes of this study were to assess physicians' plans for participating in MOC and to identify influences on decisions to participate. Methods: A geographically stratified, random sample of 755 licensed practicing physicians in the state of Oregon were surveyed regarding certification status, awareness of MOC requirements, influences on decision to participate in MOC, and resources available and/or desired to assist with MOC. Results: Three hundred seventy-six of 755 surveys were returned for ±5% margin of error at 95% confidence level. Of the respondents 91% were board certified; 95% with time-limited certificates planned to recertify. Factors rated “extremely important” in decisions to recertify were to “demonstrate expertise in my specialty” (50%), to “demonstrate my medical knowledge is up to date” (52%), and to “demonstrate my competency to provide patient care in my specialty” (51%). Practice groups provided physicians with few resources for MOC; 29% report that their practices provided no resources for the MOC process. Discussion: These results are important for hospitals, medical institutions, medical educators, and CME program planners. Although the large majority of physicians with time-limited certificates plan to participate in maintenance of certification, lack of some resources (time, money, and administrative support) and reluctance to utilize others (systems-based care) are identified as barriers to the success of MOC. [ABSTRACT FROM AUTHOR]

The article highlights the results of a study on the role of physicians and certification boards to improve quality. It notes that one of the challenges for physicians is how to choose the interventions that will work best in their setting. Certification boards are nonprofit, physician-led organizations which have traditionally set the standards for physician clinical competence. It also explains the major challenges in moving quality improvement forward at the physician level.

Introduction: The American Board of Internal Medicine (ABIM) recognized that certification and recertification must be based on an assessment of performance in practice as well as an examination of medical knowledge. Physician self-assessment of practice performance is proposed as one method that certification boards may use to evaluate competence in practice-based learning and improvement and systems-based practice. Methods: Sixteen practicing general internists and endocrinologists with 10-year time-limited certification participated in a beta test of the ABIM's diabetes practice improvement module (PIM) as part of their recertification program. A PIM consists of a self-directed medical record audit, practice system survey, and patient survey. A quality improvement education specialist from the Connecticut Quality Improvement Organization provided on-site and distance consultation on quality improvement methods and tools. An independent audit assessed the reliability of physician self-audit. Qualitative interviews were conducted at 2 time points to assess for physician satisfaction and behavioral change in quality improvement. Results: Fourteen physicians completed the diabetes PIM. All but 1 physician found the medical record audit to provide important information about the practice. Of the 11 physicians who completed a follow-up interview, 10 stated that the quality improvement education specialist helped improve their practice. Discussion: Self-assessment using the ABIM diabetes PIM as part of recertification provides valuable practice information and can lead to meaningful behavioral change by physicians. Collaboration with an educator in quality improvement appears to facilitate the effects of the practice improvement module. Future work should investigate the effect on patient outcomes. [ABSTRACT FROM AUTHOR]

The board certification movement was founded out of a concern for the quality of care, and today, more than 85% of all physicians licensed to practice medicine in the United States have been certified by an American Board of Medical Specialties (ABMS) member board. There is increasing evidence of a need for continuous monitoring and promotion of quality as well as for assessment and documentation that certified medical specialists are keeping up-to-date so that their continuing competence can be documented. To help, the ABMS established a program called Maintenance of Certification, a system that includes periodic examination of knowledge and the comprehensive evaluation of practice. Maintenance of Certification includes 4 major components: professional standing, including an unrestricted license to practice medicine; lifelong learning and self-assessment; demonstrated cognitive expertise; and practice performance assessment. The efforts of the Conjoint Committee on Continuing Medical Education press continuing medical education providers to facilitate self-directed learning and directed self-learning while driving lifelong learning and assessment into the clinical practices of all physicians who seek to continuously upgrade their knowledge, skills, and behaviors to provide quality medical care. [ABSTRACT FROM AUTHOR]

Increased accountability for facilitating and demonstrating the continued competence of physicians and improvements in the quality of health care are being called for by government, the public, and organized medicine. Areas of critical skills have been identified by the Institute of Medicine, the Accreditation Council for Graduate Medical Education, and the American Board of Medical Specialties. These “competencies” serve as the framework around which medical school curricula, residency programs, and continuing medical education (CME) can be built. Much discussion revolves around the reform of CME, and the organizations most involved have developed innovative plans and initiatives to ensure that CME is optimally positioned to support physicians in learning and change. The Accreditation Council for Continuing Medical Education (ACCME) supports a new and expanded role for the CME provider in physicians' lifelong learning, including periodic self-assessment and practice performance improvement. CME providers can assist in the determination of need (self-assessment) by the physician, the delivery of education to meet that need, and the evaluation of education used to meet the need, especially as it relates to the practice performance of the physician. The ACCME, working with accredited providers, has embraced these expectations and believes that CME can meet these challenges with an approach that also expects independence from commercial interests and freedom from commercial bias. The CME enterprise is uniquely positioned to deliver effective education for learning and change. [ABSTRACT FROM AUTHOR]

The American Board of Medical Specialties (ABMS) is working closely with its 24 member boards to implement the four components of a Maintenance of Certification (MOC) program. Those components include evidence of professional standing, lifelong learning and self-assessment, cognitive expertise, and evaluation of performance in practice. The new MOC program of the ABMS represents a dramatic shift from how graduate medical education, initial certification in the medical specialties, and recertification in the medical specialties are being conducted. This article updates how specialty boards are implementing the four components. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The Role of Simulation in Continuing Medical Education for Acute Care Physicians: A Systematic Review" published in the same issue.

The article discusses various reports within the issue, including articles on continuing medical education, the assessment of physicians and the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) program.