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The article highlights Infectious Diseases Society of America's support for lifelong learning among infectious diseases physicians, urging the American Board of Internal Medicine (ABIM) to revise its Maintenance of Certification (MOC) program. Topics discussed include dissatisfaction with the current MOC program, the need for clinically relevant and inclusive professional development, and proposed changes to reduce burden and enhance flexibility in recertification.

Background: Only 62.6% of fellowship-trained and American Board of Internal Medicine (ABIM)-certified geriatricians maintain their specialty certification in geriatric medicine, the lowest rate among all internal medicine subspecialties and the only subspecialty in which physicians maintain their internal medicine certification at higher rates than their specialty certification. This study aims to better understand underlying issues related to the low rate of maintaining geriatric medicine certification in order to inform geriatric workforce development strategies., Methods: Eighteen-item online survey of internists who completed a geriatric medicine fellowship, earned initial ABIM certification in geriatric medicine between 1999 and 2009, and maintained certification in internal medicine (and/or another specialty but not geriatric medicine). Survey domains: demographics, issues related to maintaining geriatric medicine certification, professional identity, and current professional duties., Results: 153/723 eligible completed surveys (21.5% response). Top reasons for not maintaining geriatric medicine certification were time (56%), cost of maintenance of certification (MOC) (45%), low Medicare reimbursement for geriatricians' work (32%), and no employer requirement to maintain geriatric medicine certification (31%). Though not maintaining geriatric medicine certification, 68% reported engaging in professional activities related to geriatric medicine. Reflecting on career decisions, 56% would again complete geriatric medicine fellowship, 21% would not, and 23% were unsure. 54% considered recertifying in geriatric medicine. 49% reported flexible MOC assessment options would increase likelihood of maintaining certification., Conclusions: The value proposition of geriatric medicine certification needs strengthening. Geriatric medicine leaders must develop strategies and tactics to reduce attrition of geriatricians by enhancing the value of geriatric medicine expertise to key stakeholders., (© 2024 The American Geriatrics Society.)

Background: Little is known about how physicians experience preparing for board recertification examinations. As women make up a growing proportion of the primary care physician workforce, we aimed to explore how primary care physicians experience the personal and professional impacts of recertification examination preparation activities, and whether these impacts differ by gender. Materials and Methods: We conducted exploratory qualitative semistructured interviews with 80 primary care physicians, who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine recertification examination and who practice outpatient care. We used an iterative recruitment approach to obtain a representative sample. We applied a team-based constant comparative analytic approach to identify and categorize themes related to how preparing for the recertification examination impacted their personal or professional lives, and then compared these themes by physician gender. Results: We interviewed 41 male and 39 female participants. Physicians most frequently described taking time from personal rather than professional activities to study, but often said this was ''no big deal.'' Physicians described impacts on personal life such as missing out on family or leisure time, conflicts with parenting responsibilities, and an increased reliance on their spouse for domestic and childcare duties. Female physicians more frequently described parenting and leisure time impacts than males did. Conclusions: Recertification examination preparation impacts physicians' personal lives in a variety of ways and are sometimes experienced differently along gendered lines. These findings suggest opportunities for employers, payers, and specialty boards to help physicians ease potential burdens related to maintaining board certification. [ABSTRACT FROM AUTHOR]

The American board of internal medicine ( ABIM) establishes standards for physicians. The American geriatrics society ( AGS) is a not-for-profit membership organization of nearly 6,000 health professionals devoted to improving the health, independence, and quality of life of all older people. Beginning in 2013, ABIM redesigned its governance structure, including the role of the specialty boards. Specialty boards are charged with responsibilities for oversight in four main areas: (1) the assessments used in initial certification and maintenance of certification ( MOC); (2) medical knowledge self-assessment and practice assessment in the specialty; (3) building relationships with relevant professional societies and other organizational stakeholders; and (4) issues related to training requirements for initial certification eligibility within the specialty. The aim of this paper is to inform the geriatrics community regarding the function of geriatric medicine board ( GMB) of the ABIM, and to invite the geriatrics community to fully engage with and leverage the GMB as a partner to: (1) develop better certification examinations and processes, identifying better knowledge and practice assessments, and in establishing appropriate training and MOC requirements for geriatric medicine; (2) leverage ABIM assets to conduct applied research to guide the field in the areas of training and certification and workforce development in geriatric medicine; (3) make MOC relevant for practicing geriatricians. Active engagement of the geriatrics community with ABIM and the GMB will ensure that certification in geriatric medicine provides the greatest possible value and meaning to physicians, patients, and the public. [ABSTRACT FROM AUTHOR]

Objective: To quantitatively assess radiologists' preferences for Maintenance of Certification (MOC) and Continuing Certification (CC) using a survey of attitudes and perceptions., Methods: A questionnaire that assessed attitudes and perceptions and included a discrete choice or trade-off task was developed by ACR staff in conjunction with an independent market research agency and the Survey Subcommittee of the ACR Task Force on Certification in Radiology. The trade-off exercise was integrated into this methodology to better understand the underlying utilities or preferences of the components of MOC-CC among respondents and to better enable specific recommendations on how to optimize the current program. The survey was administered via e-mail to 17,305 ACR members. The demographic and practice characteristics of the 1,994 (11.5%) respondents were similar to the ACR radiologist membership and correspond to a normal distribution. At a 95% confidence level, with a margin of error 2.1%, we believe that the respondent population fairly reflects the actual population., Results: Similar proportions judged the existing program as excellent or very good (36%), or fair or poor (35%), with 27% neutral. MOC-CC was perceived more often as excellent or very good by those who were grandfathered yet still participating in MOC, were in academic practice, were in an urban setting, were older, or had a role with the ABR. In contrast, MOC-CC was more often judged as fair or poor by those who were not grandfathered, were in private practice, were in a rural setting, or were younger. The current MOC-CC program is not well regarded by diplomates, with few showing preference or acceptability. The program's reception is most sensitive to the following attributes: absence or presence of a practice quality improvement requirement, Online Longitudinal Assessment content including or excluding general radiology in addition to one's specialty and inclusion or exclusion of self-assessment as part of the CME., Conclusion: ACR members diverged in their attitudes toward MOC, with differences among specific demographic and practice characteristics. The current package of features of MOC-CC was widely viewed as unsatisfactory, and a more optimal feature set arose from a simulation exercise., (Copyright © 2022 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Study Objective: To determine the attitudes and perceptions of diplomates of the American Board of Anesthesiology (ABA) regarding the value of Board certification, Maintenance of Certification (MOC), and the specific components. Design: Survey instrument. Setting: American Board of Anesthesiology, Raleigh, NC, USA. Subjects: Diplomates of the ABA. Measurements: A SurveyMonkey link was sent to 3,000 randomly selected 1) non-time-limited diplomates who were not enrolled in MOC, 2) non-time-limited diplomates who were enrolled in MOC, and 3) time-limited diplomates of the ABA (1,000 survey requests per group). The surveys queried demographics, attitudes about the value of Board certification, and attitudes and knowledge about Maintenance of Certification in Anesthesiology (MOCA). Main Results: 17% to 27% of diplomates from each group completed the survey. The majority of these diplomates perceived Board certification to be of value in demonstrating competence, although fewer believed that Board certification reflected competence. The elements of Professional Standing and Lifelong Learning and Self-Assessment were perceived to be significantly more relevant to the practice of the diplomates than were the Cognitive Examination and Practice Performance Assessment and Improvement activities. Diplomates demonstrated concerns about the cost and complexity of MOC, a lack of evidence that it improves practice, and a belief that the Cognitive Examination covered topics that were not relevant to their current practice. Conclusions: Although diplomates of the ABA highly value Board certification and report that the components of the MOCA program have potential relevance to their practices, they expressed significant concerns about the program as it is currently implemented. [ABSTRACT FROM AUTHOR]

Abstract: The American Board of Surgery Maintenance of Certification program requires more effort on the part of individual diplomates, but the principle is to create a better way of documenting the approach to maintenance of certification. The Maintenance of Certification program was designed to document that American Board of Surgery diplomates are maintaining the necessary competencies to provide quality care. [Copyright &y& Elsevier]

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]

Healthcare certification organizations carefully balance a commitment to bring value to their membership through programs that support lifelong learning and professional growth, while protecting the public by ensuring competent certified practitioners. These certifying bodies are challenged with remaining current with their maintenance of certification programs while keeping pace with the growing breadth of knowledge, industry standards and guidelines, innovative advances, and rapid technological gains in testing and assessment. Within the context of process innovation, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) evaluated the current landscape of Longitudinal Assessment (LA) as a potential strategy for the assessment of core knowledge as part of their Continued Professional Certification Program for Certified Registered Nurse Anesthetists. This manuscript details the evaluation of LA using a Logic Model as the tool to scaffold inquiry, a review of LA literature, an environmental scan of current LA programs with identification of LA program elements available, and the results of a LA feasibility study. The findings substantiate that continued professional certification which incorporates a LA strategy can augment lifelong learning, but is not an assessment strategy that can be implemented without thoughtful planning, customization and continuous maintenance., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate evolving practice patterns in secondary cleft rhinoplasty., Design: Retrospective review of data submitted during Maintenance of Certification (MOC)., Setting: Evaluation of MOC data from the American Board of Plastic Surgery., Participants: Tracer data for secondary cleft rhinoplasty were reviewed from August 2006 through March 2020, and the data subdivided from 20062012 and 20132020 to evaluate changes in practice patterns., Interventions: Practice patterns in tracer data were compared to those from evidence-based medicine (EBM) literature over this time period., Main Outcome Measures: Practice patterns were compared to EBM trends during the study period., Results: A total of 90 cases of secondary cleft rhinoplasty were identified. The average age at operation was 13 years (range 4-77). Cumulative data demonstrated 61% to present with nasal airway obstruction and 21% to have undergone primary nasal correction at the time of cleft lip repair; 72% of patients experienced no complications, with the most common complications being asymmetry (10%) and vertical asymmetry of alar dome position (6%). Cartilage graft was used in 68% of cases, with 32% employing septal cartilage. Change in practice patterns between 2006 to 2012 and 2013 to 2020 demonstrated increase in dorsal nasal surgery (26% vs 43%, P = .034), use of osteotomies (14% vs 38%, P = .010), septal resection and/or straightening (26% vs 48%, P = .034), and turbinate reduction (8% vs 30%, P = .007)., Conclusions: These tracer data provide long-term data by which to evaluate evolving practice patterns for secondary cleft rhinoplasty. When evaluated relative to EBM literature, future research to further improve outcomes can be better directed.

The American Board of Internal Medicine (ABIM) is implementing new methods for the development of examination content in response to feedback from the internal medicine community and in recognition that there is always room for improvement in the assessment of the skills and knowledge of practicing physicians. First, ABIM is exploring a new cognitive model-based approach to content development in efforts to improve exam relevancy. Second, ABIM has created a new Item-Writing Task Force in an effort to ensure a broad representation of internists from across the country who are engaged in all aspects of clinical practice. Through these mechanisms, the goal is the improved fairness and validity evidence of examinations that are relevant to how medicine is practiced today.

Reduction of unexplained variation in medical practice and health outcomes is of paramount importance, which indicates a need for a continuum of medical learning that begins in medical school and continues until the end of a professional career. That, in turn, indicates need for continuing assessment of professional competence. The American Board of Pediatrics, the American Academy of Pediatrics, and the Accreditation Council for Graduate Medical Education are working together to develop a common approach to documenting acquisition of competence during residency and maintenance of competence thereafter. A common approach will eliminate redundancy and make it possible to follow the evolution of professional competence over time. [ABSTRACT FROM AUTHOR]

As members of the American Board of Internal Medicine's (ABIM) Infectious Disease (ID) Board we've heard from many of our colleagues asking for greater flexibility in maintaining their ABIM Board Certification. The ID Board-and ABIM as a whole-has engaged with the physician community over the past several years to gain a deeper understanding of what is most important to them, and how an enhanced Maintenance of Certification (MOC) program could support their commitment to keeping up with advances in medical knowledge. This article serves as an update about how ABIM has evolved its assessments over time and on our progress in developing a new longitudinal pathway that is anticipated to become available in most specialties in 2022, and will launch in ID in 2023., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

OBJECTIVE. Physicians across specialties have expressed concerns about Maintenance of Certification (MOC) programs of American Board of Medical Specialties member boards, calling for research about MOC acceptance, adoption, and value. The purpose of this study was to characterize diagnostic radiologists' participation in the American Board of Radiology (ABR) MOC program, the framework for its new Online Longitudinal Assessment program. MATERIALS AND METHODS. Practicing U.S. radiologists were identified from the Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File. Corresponding ABR diplomate certification information was obtained through the ABR public search engine. Focused on diagnostic radiologists (defined as those whose only ABR certificate is in diagnostic radiology), MOC participation rates were calculated across various physician characteristics for those whose participation was mandated by the ABR (time-limited certificates) and for those whose participation was not mandated (lifetime certificates). RESULTS. Among 20,354 included diagnostic radiologists, 11,479 (56.4%) participated in MOC. Participation rates were 99.6% (10,058/10,099) among those whose MOC was ABR mandated and 13.9% (1421/10,225) among those whose participation was not mandated ( p < 0.001). The rates of nonmandated participation were higher (all p < 0.001) for academic than for non-academic radiologists (28.0% vs 11.3%), subspecialists than for generalists (17.0% vs 11.5%), and those in larger practice groups (< 10 members, 5.0%; 10-49 members, 12.6%; ≥ 50 members, 20.7%). State-level rates of nonmandated participation varied from 0.0% (South Dakota, Montana) to 32.6% (Virginia) and positively correlated with state population density ( r = 0.315). CONCLUSION. Although diagnostic radiologists with time-limited certificates nearly universally participate in MOC, those with lifetime certificates (particularly general radiologists and those in smaller and nonacademic practices) participate infrequently. Low rates of nonmandated participation may reflect diplomate dissatisfaction or negative perceptions about MOC.

Continuous quality improvement is a component of professionalism. Maintenance of Certification (MOC) is a mechanism in the USA for physicians to keep current with medical knowledge and contribute to practice improvement. Little is known about primary care physicians' perceptions of the practice improvement (Part IV) components of MOC. We aimed to determine primary care physicians' perceptions of their professional responsibility to participate in Part IV MOC. This was a cross-sectional study of primary care physicians using the American Medical Association Masterfile. We developed a nine-item survey, designed from expert consensus and literature to determine views on Part IV MOC as a professional responsibility. We surveyed 1500 randomly selected primary care physicians via mail from November 2014 to May 2015. The response rate was 42% (627 of 1,500): 47% (273 of 585) were family practitioners and 49% (289 of 585) were internists. Factor analysis revealed a two-factor survey, with five items pertaining to positive views of MOC Part IV and four items pertaining to negative views. Internists were more likely to view MOC Part IV as time consuming (82.0% vs. 70.3%, P = .001), expensive (50.9% vs. 38.8%, P = .004), and not relevant to practice (39.1% vs. 23.8%, P < .001). Family medicine practitioners were more likely to view MOC Part IV as improving patient care (64.5% vs. 48.8%, P < .001) and maintaining professional responsibility (48.7% vs. 32.5%, P < .001). Regardless of specialty, most physicians viewed MOC Part IV as time intensive, not beneficial for career advancement, and not a professional responsibility. Family medicine practitioners demonstrated more positive views of MOC Part IV. The difference between family medicine practitioners and internists could be related to the ABIM MOC controversy. Future changes to practice improvement requirements could focus on limiting time requirements and on clinical relevance. Abbreviations: ABIM: American Board of Internal Medicine; AMA: American Medical Association; CQI: continuous quality improvement; IRB: institutional review board; MOC: Maintenance of Certification; QI: quality improvement [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.

Background: Some have questioned whether successful performance in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program is meaningful. The association of the ABIM Internal Medicine (IM) MOC examination with state medical board disciplinary actions is unknown., Objective: To assess risk of disciplinary actions among general internists who did and did not pass the MOC examination within 10 years of initial certification., Design: Historical population cohort study., Participants: The population of internists certified in internal medicine, but not a subspecialty, from 1990 through 2003 (n = 47,971)., Intervention: ABIM IM MOC examination., Setting: General internal medicine in the USA., Main Measures: The primary outcome measure was time to disciplinary action assessed in association with whether the physician passed the ABIM IM MOC examination within 10 years of initial certification, adjusted for training, certification, demographic, and regulatory variables including state medical board Continuing Medical Education (CME) requirements., Key Results: The risk for discipline among physicians who did not pass the IM MOC examination within the 10 year requirement window was more than double than that of those who did pass the examination (adjusted HR 2.09; 95% CI, 1.83 to 2.39). Disciplinary actions did not vary by state CME requirements (adjusted HR 1.02; 95% CI, 0.94 to 1.16), but declined with increasing MOC examination scores (Kendall's tau-b coefficient = - 0.98 for trend, p < 0.001). Among disciplined physicians, actions were less severe among those passing the IM MOC examination within the 10-year requirement window than among those who did not pass the examination., Conclusions: Passing a periodic assessment of medical knowledge is associated with decreased state medical board disciplinary actions, an important quality outcome of relevance to patients and the profession.

Surgical learning starts in medical school and continues through retirement. Assessment of knowledge and skills across a variety of arenas at each stage is an obligation of the profession in its duty to the public. The American Board of Surgery is engaged in standardization and assessment to a greater or lesser degree at each stage of surgical learning., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Radiologists in the United States are required to complete the Practice Quality Improvement (PQI) program as part of their Maintenance of Certification by the ABR. The Institute for Healthcare Improvement's (IHI) Model for Improvement (MFI) offers an alternative to the 3-phase approach currently advocated by the ABR. The MFI implicitly assumes that many interventions will need to be tested and refined for any meaningful project, and provides a project management approach that enables rapid assessment and improvement of performance. By collecting data continuously, rather than simply before and after interventions, more interventions can be tested simultaneously and projects can progress more rapidly. In this article, we describe the ABR's 3-phase approach, and introduce the MFI and how it can be employed to affect positive changes. Using a radiology case study, we demonstrate how one can utilize the MFI to enable rapid quality improvement., (Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Rationale and Objectives: Completing a systems-based practice project, equivalent to a practice quality improvement project (PQI), is a residency requirement by the Accreditation Council for Graduate Medical Education and an American Board of Radiology milestone. The aim of this study was to assess the residents' perspectives on quality improvement projects in radiology., Materials and Methods: Survey data were collected from 154 trainee members of the Association of University Radiologists to evaluate the residents' views on PQI., Results: Most residents were aware of the requirement of completing a PQI project and had faculty mentors for their projects. Residents who thought it was difficult to find a mentor were more likely to start their project later in residency (P < .0001). Publication rates were low overall, and lack of time was considered the greatest obstacle. Having dedicated time for a PQI project was associated with increased likelihood of publishing or presenting the data (P = .0091). Residents who rated the five surveyed PQI steps (coming up with an idea, finding a mentor, designing a project, finding resources, and finding time) as difficult steps were more likely to not have initiated a PQI project (P < .0001 for the first four and P = .0046 for time)., Conclusion: We present five practical areas of improvement to make PQI a valuable learning experience: 1) Increasing awareness of PQI and providing ideas for projects, 2) encouraging faculty mentorship and publication, 3) educating residents about project design and implementation, 4) providing resources such as books and funds, and 5) allowing dedicated time., (Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics., Study Design: Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses., Results: The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time., Conclusions: Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth., (Copyright © 2013 Mosby, Inc. All rights reserved.)

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., (Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.)

The medical profession is facing an imperative to deliver more patient-centered care, improve quality, and reduce unnecessary costs and waste. With significant unexplained variation in resource use and outcomes, even physicians and health care organizations with "the best" reputations cannot assume they always deliver the best care possible. Going forward, physicians will need to demonstrate professionalism and accountability in a different way: to their peers, to society in general, and to individual patients. The new accountability includes quality and clinical outcomes but also resource utilization, appropriateness and patient-centeredness of recommended care, and the responsibility to help improve systems of care. The pediatric collaborative improvement network model represents an important framework for helping transform health care. For individual physicians, participation in a multisite network offers the opportunity to demonstrate accountability by measuring and improving care as part of an approach that addresses the problems of small sample size, attribution, and unnecessary variation in care by pooling patients from individual practices and requiring standardization of care to participate. For patients and families, the model helps ensure that they are likely to receive the current best evidence-based recommendation. Finally, this model aligns with payers' goals of purchasing value-based care, rewarding quality and improvement, and reducing unnecessary variation around current best evidenced-based, effective, and efficient care. In addition, within the profession, the American Board of Pediatrics recognizes participation in a multisite quality improvement network as one of the most rigorous and meaningful approaches for a diplomate to meet practice performance maintenance of certification requirements.