Primary Care Physicians’ Perceptions of Practice Improvement as a Professional Responsibility: A Cross-sectional Study

Author(s): C Stephenson, C Wittich, J Pacyna, M Wynia, O Hasan, J Tilburt

Date: 2018

Publisher: Medical Education Online

Volume/Edition: 23

Publication Type: Journal

Article:

This article discusses the results of a survey sent to primary care physicians (family medicine and internal medicine) for the period 2014-2015. While the majority of respondents indicated Maintenance of Certification (MOC) part IV activities can improve quality of care, it was also indicated that activities are time- and resource-intensive. Respondents identifying as family practitioners were more likely than those identifying as internists to view MOC part IV as an aspect of professionalism.

Value of ABNM Certification and MOC to Diplomates

Author(s): J Parker

Date: 2016

Publisher: Journal of Nuclear Medicine

Volume/Edition: 57(4)

Publication Type: Journal

Article:

This commentary provides a supportive overview of the American Board of Nuclear Medicine’s (ABNM) Maintenance of Certification (MOC) program including its examination structure and the value of participating in MOC.

O’ Surgery Case Log Data, Where Art Thou?

Author(s): M Patel, O Guillamondegui, M Ott, K Palmiter, A May

Date: 2012

Publisher: Journal of the American College of Surgeons

Volume/Edition: 215(3)

Publication Type: Journal

Article:

This article discusses a method of data capture, categorization, and reporting of acute care surgery fellows’ experiences using the American College of Surgeons (ACS) Case Log, which satisfies the American Board of Surgery (ABS) maintenance of certification (MOC) program.

A Blueprint for Maternal and Child Health Primary Care Physician Education in Medical Genetics and Genomic Medicine: Recommendations of the United States Secretary for Health and Human Services Advisory Committee on Heritable Disorders in Newborns and Children

Author(s): A Kemper, T Trotter, M Lloyd-Puryear, P Kyler, G Feero, R Howell

Date: 2010

Publisher: Academic Emergency Medicine

Volume/Edition: 12(2)

Publication Type: Journal

Article:

This article describes a workshop convened by the National Institutes of Health, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration in order to develop educational programs on genetics and genomics for primary care physicians involved in maternal and child health. Because many primary care physicians lack knowledge and training regarding genetics-based services, the workgroup identified the importance of incorporating this type of medical genetics and genomics education into all aspects of clinical training including residency training programs, continuing medical education programs, and maintenance of certification (MOC) programs.

A Single Activity With a Practice Quality Improvement Project for Faculty and a Quality Improvement Project for Residents

Author(s): H Kim, T Malatesta, N Simone, R Den, J McAna, A Dicker, V Bar Ad

Date: 2016

Publisher: Practical Radiation Oncology

Volume/Edition: 6(2)

Publication Type: Journal

Article:

This study assessed a practice quality improvement (PQI) project on a clinical transition of care policy for residents and faculty. The project showed the feasibility of a collaborative effort between residents and attendees to improve patient care and fulfill both Maintenance of Certification PQI and Accreditation Council of Graduate Medical Education Next Accreditation System (NAS) requirements.

Improving the Quality of Patient Care Through a Collaborative Maintenance of Certification and Next Accreditation System Project

Author(s): H Kim, T Malatesta, A Dicker, N Simone, R Den, V Bar Ad

Date: 2015

Publisher: Journal of Clinical Oncology

Volume/Edition: 33(15 suppl)

Publication Type: Journal

Article:

This survey study assessed a model for a collaborative performance improvement project between resident and attending physicians that met requirements for the Accreditation Council of Graduate Medical Education (ACGME) next accreditation system (NAS) for resident physicians. The project focused on creating a transition of care for residents while obtaining attendees’ perspectives, which included a survey to assess residents and formal signout-training. Survey results showed that perception on the sign-out process improved after the formal training. This project showed a successful attending and resident physician effort to improve processes. The project was approved by the American Board of Radiology (ABR) Maintenance of Certification (MOC) Group and MOC credit was received for participation.

 

Using Lean Principles to Manage Throughput on an Inpatient Rehabilitation Unit

Author(s): A Chiodo, R Wilke, R Bakshi, A Craig, D Duwe, E Hurvitz

Date: 2012

Publisher: American Journal of Physical Medicine and Rehabilitation

Volume/Edition: 91(11)

Publication Type: Journal

Article:

This study assessed the effects of applying lean management techniques to a quality improvement (QI) effort in order to manage throughput of patients in an inpatient rehabilitation unit at a university hospital. Processes like Lean methods of improvement are an important part of Maintenance of Certification (MOC) Part IV activities.

The EASE Quality Improvement Project: Improving Safe Sleep Practices in Ohio Children’s Hospitals

Author(s): J Macklin, M Gittelman, S Denny, H Southworth, M Arnold

Date: 2016

Publisher: Pediatrics

Volume/Edition: 138(4)

Publication Type: Journal

Article:

This study assessed the change in infant safe sleep practices after the implementation of a quality improvement program. This collaborative effort involved 6 children’s hospitals, with over 4000 patient audits. Outcomes showed a significant improvement of infants in a safe sleep environment. Changes observed were due to plan-do-study-act (PDSA) processes, improved hospital procedures, family education, and communication practices. Staff buy-in was an important part of the effort’s success. Hospitalists who participated received Maintenance of Certification (MOC) Part IV credit.

A Pilot Quality Improvement Program to Increase Pediatrician Injury Anticipatory Guidance

Author(s): M Gittelman, S Denny, S Anzeljc, M FitzGerald, M Arnold

Date: 2015

Publisher: Journal of Trauma and Acute Care Surgery

Volume/Edition: 79(3 suppl 1)

Publication Type: Journal

Article:

Knowledge of injury prevention (IP) may vary among primary care providers (PCPs). This study showed that a quality improvement (QI) effort using a tool that would allow PCPs to screen for injury risk, and communicate IP topics to families, was successful in not only ease of tool implementation, but also substantially improving coverage and discussion of IP topics. Physicians in each practice participating in the learning collaborative that submitted data received American Board of Pediatrics (ABP) Maintenance of Certification (MOC) Part IV credit for participation through the Ohio Chapter of the American Academy of Pediatrics (AAP).

 

A Quality Improvement Program in Pediatric Practices to Increase Tailored Injury Prevention Counseling and Assess Self-reported Changes Made by Families

Author(s): M Gittelman, A Carle, S Denny, S Anzeljc, M Arnold

Date: 2018

Publisher: Injury Epidemiology

Volume/Edition: 5(suppl 1)(17)

Publication Type: Journal

Article:

Practitioners were recruited from the Ohio Chapter of the American Academy of Pediatrics database and volunteered to participate in this quality improvement (QI) effort utilizing an injury prevention screening tool to facilitate discussions and rescreenings with families at subsequent practitioner visits. This study showed that using QI methodology can have substantial improvement in practitioner-patient communications. Physicians that submitted data received American Board of Pediatrics (ABP) Maintenance of Certification (MOC) part IV credit.

 

 

Maintenance of Certification Part 4 Credit and Recruitment for Practice-based Research

Author(s): J Gorzkowski, J Klein, D Harris, K Kaseeska, R Whitmore Shaefer, A Bocian, R Wasserman

Date: 2014

Publisher: Pediatrics

Volume/Edition: 134(4)

Publication Type: Journal

Article:

This study evaluates the recruitment of pediatricians into a study before and after the development and addition of a quality improvement (QI) curriculum approved for American Board of Pediatrics (ABPeds) Maintenance of Certification (MOC) part 4 credit. Post-MOC enrollment showed a significant increase, notably increasing enrollment of physicians in underserved areas.

Effectiveness of the ATS Core Curricula: Improving Knowledge and Providing Maintenance of Certification (MOC)

Author(s): C Dela Cruz, J Poston, G Michaud, G Pien, M Nevin, J Beck, C Thomson

Date: 2015

Publisher: American Journal of Respiratory and Critical Care Medicine

Volume/Edition: 191

Publication Type: Journal

Article:

This paper described the development of a curriculum by the Education Committee of the American Thoracic Society (ATS) that created multiple learning opportunities for Maintenance of Certification (MOC) credit. Participants seeking MOC credit experienced an improvement in knowledge across all content areas of the curriculum.

Teaching Quality Essentials: The Effectiveness of a Team-based Quality Improvement Curriculum in a Tertiary Health Care Institution

Author(s): A Majka, K Cook, S Lynch, V Garovic, A Ghosh, C West, P Mueller

Date: 2013

Publisher: American Journal of Medical Quality

Volume/Edition: 28(3)

Publication Type: Journal

Article:

This study showed that American Board of Internal Medicine (ABIM) quality improvement (QI) modules were effective in educating staff on QI while also engaging physicians in meeting ABIM recertification requirements.

Pediatrician Maintenance of Certification Using American Board of Pediatrics’ Performance Improvement Modules

Author(s): M Arvanitis, N deJong, L Leslie, D DeWalt, G Randolph, K Flower

Date: 2017

Publisher: Academic Pediatrics

Volume/Edition: 17

Publication Type: Journal

Article:

This study assessed completion and outcomes of Maintenance of Certification (MOC) part IV quality improvement (QI) activities. Study results showed that the majority of pediatricians who completed organization-developed activities completed American Board of Pediatrics (ABP) performance improvement modules (PIMs). Completion of the PIM was associated with improvement on nearly all quality measures.

Diuretic of Choice in ABFM Hypertension Self-assessment Module Simulations

Author(s): M Hagen, W Sumner, H Fu

Date: 2012

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 25

Publication Type: Journal

Article:

Chlorthalidone is recommended as the diuretic of choice in hypertension management. Usage of the diuretics chlorthalidone and hydrochlorothiazide in hypertension management was evaluated in an American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) self-assessment module.

Assessment of the Focused Practice Improvement Module of the American Board of Dermatology for Meeting Requirements of Maintenance of Certification

Author(s): E Stratman, S Miller

Date: 2017

Publisher: JAMA Dermatology

Volume/Edition: 289

Publication Type: Journal

Article:

This survey study of dermatologists who completed American Board of Dermatology (ABD) Maintenance of Certification (MOC) focused Practice Improvement (fPI) modules, showed that participants identified the module activities as relevant, and helpful in identifying practice gaps. The vast majority felt that the activities reaffirmed their practice, and would recommend the fPI modules.

A Learning Collaborative Model to Improve Human Papillomavirus Vaccination Rates in Primary Care

Author(s): C Rand, H Tyrrell, R Wallace-Brodeur, N Goldstein, P Darden, S Humiston, P Szilagyi

Date: 2018

Publisher: Academic Pediatrics

Volume/Edition: 18(2S)

Publication Type: Journal

Article:

This study evaluated a quality improvement (QI) intervention which trained providers on human papillomavirus (HPV) vaccination recommendations and communication methods. This QI effort offered American Board of Pediatrics (ABP) Maintenance of Certification (MOC) Part 4 credit, as well as American Board of Family Medicine (ABFM) MOC Part 4 credit, as incentives for participation. This QI effort showed that the intervention reduced missed opportunities for HPV vaccination in community practices.

Variation in Part-Time Work Among Pediatric Subspecialties

Author(s): G Freed, D Boyer, K Van, M Macy, J McCormick, L Leslie

Date: 2018

Publisher: Journal of Pediatrics

Volume/Edition:

Publication Type: Journal

Article:

This study examined workforce patterns of pediatric subspecialists enrolled in American Board of Pediatrics (ABP) Maintenance of Certification (MOC) from 2009-20015. The study found significant variation in part-time employment and the numbers of hours worked per week among the pediatric subspecialties.

Measuring and Improving Comprehensive Pediatric Cardiac Care: Learning form Continuous Quality Improvement Methods and Tools

Author(s): P Barach, L Kleinman

Date: 2018

Publisher: Progress in Pediatric Cardiology

Volume/Edition:

Publication Type: Journal

Article:

This article broadly discussed aspects of continuous quality improvement, noting that quality improvement (QI) is a component of American Board of Pediatrics (ABP) Maintenance of Certification (MOC) Part 4. ABP MOC Part 4 QI requires meaningful participation throughout QI efforts.

The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: A Population Cohort Study

Author(s): F McDonald, L Duhigg, G Arnold, R Hafer, R Lipner

Date: 2018

Publisher: Journal of General Internal Medicine

Volume/Edition:

Publication Type: Journal

Article:

This study looked at the association of disciplinary actions with passing the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) examination within ten years of initial certification. Disciplinary actions decreased with better MOC examination scores.

The Comprehensive Care Project: Measuring Physician Performance in Ambulatory Practice

Author(s): E Holmboe, W Weng, G Arnold, S Kaplan, S Normand, S Greenfield, R Lipner

Date: 2010

Publisher: Health Services Research

Volume/Edition: 45(6 part 2)

Publication Type: Journal

Article:

This study audited medical records for chronic and acute care conditions to assess physician performance in ambulatory practice. All physicians were participating in Maintenance of Certification (MOC). Findings showed significant associations between performance on a knowledge examination and the overall, chronic and preventive care composites.

Family Physicians’ Quality Interventions and Performance Improvement for Hypertension through Maintenance of Certification

Author(s): L Peterson, B Blackburn, J Puffer, R Phillips

Date: 2016

Publisher: Journal for Healthcare Quality

Volume/Edition: 38(3)

Publication Type: Journal

Article:

This study evaluated hypertension performance in practice modules (PPMs) completed by physicians as part of their Maintenance of Certification (MOC) programs from 2006-2013. Through the MOC program requirements, performance on quality measures improved the quality of patient care for the management of hypertension.

Improving Performance in Practice: Rx for Primary Care

Author(s): IPIP

Date: 2015

Publisher: The Commonwealth Fund

Volume/Edition:

Publication Type: Journal

Article:

This brief published in 2010 provides a detailed overview of the Improving Performance in Practice Program (IPIP), describes the structure of the quality improvement program, and provides examples of its results in several states where improvement was documented in outcome measures for asthma and diabetes. The brief concludes with a “Lessons Learned” section that emphasizes the benefits of participation in IPIP, one being its compliance with the ABMS Maintenance of Certification (MOC) program, while drawing several practical conclusions for the broader area of quality of improvement.

Interprofessional QI Training Enhances Competency and QI Productivity Among Graduates: Findings From Nationwide Children’s Hospital

Author(s): T Bartman, K Heiser, A Bethune, W Crandall, R McClead, J Davis, R Brilli

Date: 2018

Publisher: Academic Medicine

Volume/Edition: 93(2)

Publication Type: Journal

Article:

This article describes the efforts undertaken at Nationwide Children’s Hospital to incorporate quality improvement (QI) training within their institution by developing a course called “Quality Improvement Essentials” in 2012. In order to evaluate its effectiveness, surveys were conducted covering self-assessed QI competence in four areas:  1) QI knowledge, 2) testing and implementing change, 3) data management needs, and 4) disseminating science. The results of surveys were positive, indicating increased and maintained QI competency among staff.

Nationwide Children’s Hospital is a participating sponsor in the American Board of Medical Specialties (ABMS) Multi-Specialty Portfolio Program (MSPP). Approximately 40 percent of those physicians who participated in the course converted their course project to receive Maintenance of Certification (MOC) part IV credit.

Comparison of Content on the American Board of Internal Medicine Maintenance of Certification Examination With Conditions Seen in Practice by General Internists

Author(s): B Gray, J Vandergrift, R Lipner, M Green

Date: 2017

Publisher: Journal of the American Medical Association

Volume/Edition: 317(22)

Publication Type: Journal

Article:

This study analyzed whether the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) examinations have reflected practice conditions within internal medicine. Examinations from 2010-2013 were evaluated. Overall, it was found that examination questions generally reflected what occurs in practice with 69 percent of the questions on these examinations harmonizing with conditions in practice, but 31 percent of the questions did not.

Recent Trends in Continuing Medical Education Among Obstetricians-Gynecologists

Author(s): R Burwick

Date: 2011

Publisher: Obstetrics and Gynecology

Volume/Edition: 117 (5)

Publication Type: Journal

Article:

This survey study of physician members of the American College of Obstetricians and Gynecologists sought feedback regarding practices and opinions about continuing medical education (CME) activities. This survey revealed that those not mandated to participate in Maintenance of Certification (MOC) programs relied on alternative sources of CME such as meetings, various media, journal quizzes, and grand rounds, and those who did participate in MOC programs decreased use of these alternative sources of CME.

Simulation for Maintenance of Certification in Anesthesiology: The First Two Years

Author(s): W McIvor, A Burden, M Weinger, R Steadman

Date: 2012

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 32 (4)

Publication Type: Journal

Article:

This article discusses mannequin-based simulation, providing a background on the development and first two years of a simulation-based Continuing Medical Education (CME) course for Maintenance of Certification (MOC), the first use in MOC of mannequin-based simulation. The Workgroup on Simulation Education was created to explore simulation education among the American Society of Anesthesiologists (ASA) members. The results of the Workgroup’s tasks transitioned to a committee that saw the ASA working with the American Board of Anesthesiology (ABA) to create the curriculum and format for MOC-Anesthesiology (MOCA) simulation courses.

Maintenance of Certification and the Challenge of Professionalism

Author(s): D Nichols

Date: 2017

Publisher: Pediatrics

Volume/Edition: 139(5)

Publication Type: Journal

Article:

This review article provides an overview of research literature focusing on Board Certification and Maintenance of Certification (MOC). Overall, this review shows a growing amount of research indicating that participation in MOC is associated with improved processes of care.

Teaching and Assessing Professionalism in Radiology Resident Education

Author(s): A Kelly, L Gruppen, P Mullan

Date: 2017

Publisher: Academic Radiology

Volume/Edition: Mar 2017

Publication Type: Journal

Article:

This review article discusses challenges in training for and teaching towards professionalism, how professionalism is part of Maintenance of Certification (MOC) and the American Board of Radiology (ABR) competency assessment, and how greater understanding of professionalism as part of competency assessment is needed.

Maintenance of Certification Part 4: From Trial to Tribute

Author(s): K Shaw, L Tanzer, R Keren, A Taylor, P DeRusso, J St Geme

Date: 2017

Publisher: Journal of Pediatrics

Volume/Edition: 185

Publication Type: Journal

Article:

This article provides an overview of the Children’s Hospital of Philadelphia’s Maintenance of Certification (MOC) program initiatives and processes.

Practical Quality Improvement for the Allergist/Immunologist

Author(s): D Price, D Lang

Date: 2017

Publisher: Journal of Allergy and Clinical Immunology: In Practice

Volume/Edition: 5(3)

Publication Type: Journal

Article:

This article describes the origins of the field of quality improvement (QI), quality measures used in allergy and immunology, and meaningful participation.

Demonstrating Construct Validity of the American Board of Physical Medicine and Rehabilitation Part I Examination: An Analysis of Dimensionality

Author(s): M Raddatz, L Robinson

Date: 2017

Publisher: PM&R

Volume/Edition: 9(10)

Publication Type: Journal

Article:

This retrospective observational study evaluates the core knowledge requirements of the American Board of Physical Medicine and Rehabilitation part I certifcation examination (ABPMR-CE-1).

Outcomes from Pediatric Gastroenterology Maintenance of Certification Using Web-based Modules

Author(s): J Sheu, S Chun, E O'Day, S Cheung, R Cruz, J Lightdale, J Huang

Date: 2017

Publisher: Journal of Pediatric Gastroenterology and Nutrition

Volume/Edition: 64(5)

Publication Type: Journal

Article:

This cross-sectional study analyzed data taken from web-based Maintenance of Certification (MOC) quality improvement (QI) modules. This analysis showed significant practice variation across several processes and how the web-based MOC activities improved them.

Maintenance of Certification—A Prescription for Improved Child Health

Author(s): L First, D Gremse, J St Geme III

Date: 2017

Publisher: JAMA Pediatrics

Volume/Edition: 171(4)

Publication Type: Journal

Article:

This viewpoint article updates the pediatric community on changes the American Board of Pediatrics (ABP) is making which allow continuing medical education (CME) activities to also provide credit for Maintenance of Certification (MOC) part II.

Implementation of a Professional Society Core Curriculum and Integrated Maintenance of Certification Program

Author(s): W Carlos, J Poston, G Michaud, C Dela Cruz, A Luks, D Boyer, C Thompson

Date: 2017

Publisher: Annals of the American Thoracic Society

Volume/Edition: 14(4)

Publication Type: Journal

Article:

This article discusses the American Thoracic Society (ATS) maintenance of certification (MOC) program and the model for its development.

Provision of Palliative Care Services by Family Physicians Is Common

Author(s): C Ankuda, A Jetty, A Bazemore, S Petterson

Date: 2017

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 30(2)

Publication Type: Journal

Article:

This cross sectional study analyzed data from the 2013 American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) Demographic Survey regarding family physicians’ perceptions of palliative care.

Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department

Author(s): R Jennings, J Burtner, J Pellicer, D Nair, M Bradford, M Shaffer, J Tieder

Date: 2017

Publisher: Pediatrics

Volume/Edition: 139(4)

Publication Type: Journal

Article:

This evaluation of a quality improvement (QI) effort for Maintenance of Certification (MOC) found that coaching and mentoring from a regional hospital (i.e., Seattle Children’s Hospital) participating in the MOC Portfolio Program had a significant effect on a successful QI effort at a community hospital assisted by resources from the regional hospital. In this case the QI effort achieved reducing the number of head CT scans beyond its stated goals.

Training Matters: A Retrospective Study of Physician Disciplinary Actions by the Louisiana State Board of Medical Examiners, 1990–2010

Author(s): S Allen, R Marier, C Moulton, A Shankar

Date: 2016

Publisher: Journal of Medical Regulation

Volume/Edition: 102 (4)

Publication Type: Journal

Article:

This retrospective study looked at characteristics of physicians with disciplinary actions and found that those with board certification were less likely to have disciplinary actions.

The History, Role, and Value of Public Directors on Certifying Boards: The American Board of Ophthalmology Experience

Author(s): S Anderson, L Nora, C McEntee, M Fitzgerald, S Nugent

Date: 2016

Publisher: Ophthalmology

Volume/Edition: 123 (9 Supp)

Publication Type: Journal

Article:

This article discusses the evolution of governance structures of regulating and certifying bodies to include public directors and how the American Board of Ophthalmology (ABO) values their contributions.

Subspecialty Training and Certification in Geriatric Psychiatry: A 25-Year Overview

Author(s): D Juul, C Colenda, J Lyness, L Dunn, R Hargrave, L Faulkner

Date: 2017

Publisher: American Journal of Geriatric Psychiatry

Volume/Edition: 16

Publication Type: Journal

Article:

This article discusses the development of the geriatric psychiatry subspecialty certification, needed improvements in training, and recruitment needs.

A Practice Quality Improvement Project: Reducing Dose of Routine Chest CT Imaging in a Busy Clinical Practice

Author(s): E Takahashi, M Kohli, S Teague

Date: 2016

Publisher: Journal of Digital Imaging

Volume/Edition: 29(5)

Publication Type: Journal

Article:

This retrospective medical record review reinforces previous research showing the value of participating in MOC part IV projects. The part IV project in this case is part of the American Board of Radiology MOC process. It allowed the reduction of the radiation dose used in CT imaging of the chest. This project not only benefitted patients but also provided for additional CMS reimbursement.

Performance of Certification and Recertification Examinees on Multiple Choice Test Items: Does Physician Age Have an Impact?

Author(s): L Shen, D Juul, L Faulkner

Date: 2016

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 36(2)

Publication Type: Journal

Article:

This study contributes to research that skills decline over time and the ongoing process of Maintenance of Certification (MOC) contributes to maintaining clinical knowledge.

How Do Publicly Reported Medicare Quality Metrics for Radiologists Compare with Those of Other Specialty Groups?

Author(s): A Rosenkrantz, D Hughes, R Duszak

Date: 2016

Publisher: Journal of the American College of Radiology

Volume/Edition: 13 (3)

Publication Type: Journal

Article:

This retrospective study showed that participation in the Maintenance of Certification (MOC) program is an additional incentive because of PQRS. Radiologists performed highly in the MOC program specialty-specific metrics.

Transforming Physician Certification to Support Physician Self-motivation and Capacity to Improve Quality and Safety

Author(s): R Phillips, J Kennedy, C Jaen, K Stelter, J Puffer

Date: 2016

Publisher: Journal of Enterprise Transformation

Volume/Edition: 6 (3-4)

Publication Type: Journal

Article:

This article discusses the efforts ABFM is making to improve their programs including creating registries and assessment tools.

Physician Satisfaction With and Practice Changes Resulting From American Board of Family Medicine Maintenance of Certification Performance in Practice Modules

Author(s): L Peterson, A Eden, A Cochrane, M Hagen

Date: 2016

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 36(1)

Publication Type: Journal

Article:

This study contributes to research on the value of MOC part IV activities.

Relationship Between Physicians Active Participation in Maintenance of Certification and Patients Perspective of Care Surveys

Author(s): J Morrell, E Stratman

Date: 2016

Publisher: Journal of Patient Experience

Volume/Edition: 3 (2)

Publication Type: Journal

Article:

This study contributes to research indicating that the public values their physician’s participation in MOC. Although overall statistical significance was not great, the most relevant finding of this study was that physicians participating in MOC had higher patient experience scores than those who were not participating. Active enrollment in MOC versus passive enrollment in MOC is also an important consideration.

Laparoscopic Colectomy and the General Surgeon

Author(s): J Moore, A Pellet, N Hyman

Date: 2016

Publisher: Journal of Gastrointestinal Surgery

Volume/Edition: 20 (3)

Publication Type: Journal

Article:

This retrospective study looked at surgeons in rural settings seeking recertification and contributed to research on the need for continuous learning to maintain skills and use of simulation.

Current Workforce of General Pediatricians in the United States

Author(s): G Freed, L Moran, K Van, L Leslie

Date: 2016

Publisher: Pediatrics

Volume/Edition: 137 (4)

Publication Type: Journal

Article:

This survey study reinforced previous research on the value of participation in MOC part IV projects. In this particular survey study, American Academy of Pediatrics modules and MOC requirements were identified as reasons for greater participation in QI efforts. MOC is also valuable as it may identify where gaps in resources exist that may hinder private practices’ ability to participate in QI efforts.

Improving HPV Vaccination Rates Using Maintenance of Certification Requirements

Author(s): A Fiks, X Luan, S Mayne

Date: 2016

Publisher: Pediatrics

Volume/Edition: 137 (3)

Publication Type: Journal

Article:

This study underscored the results of a previous randomized study showing that HPV vaccination rates, and missed opportunities to discuss HPV vaccination with patients and families, needed improvement. Through MOC part IV, physicians were able to participate in a quality improvement project to address this problem. This study notes that a benefit of MOC-required QI projects is that they can engage physicians in projects that may not otherwise draw participation in the projects. MOC allows for meaningful participation in QI projects, which provides a way for a physician to be involved in the inception of a project through to the completion.

Maintenance of Certification and the Aging Neurosurgeon

Author(s): M Babu, L Liau, R Spinner, F Meyer

Date: 2016

Publisher: Neurosurgery

Volume/Edition: 63 (1)

Publication Type: Journal

Article:

This survey study (oral presentation) showed that most neurosurgeons , including those currently participating in MOC, grandfathered, and retired, felt that neurosurgeons aged 65 and older should undergo additional cognitive assessment, although most also felt that there should not be any mandatory cut-off age for practice. 42 percent believed that MOC should be tailored to gaining neurosurgeons. This survey work contributes to the practice considerations and needs of aging physicians and how MOC could be used to support those needs, while keeping patient safety paramount.

Understanding the Operative Experience of the Practicing Pediatric Surgeon

Author(s): F Abdullah, J Salazar, C Gause, S Gadepalli, T Biester, K Azarow, R Hirschl

Date: 2016

Publisher: JAMA Surgery

Volume/Edition: 151 (8)

Publication Type: Journal

Article:

This retrospective review reinforces previous research regarding maintaining current knowledge and competency, recognizing the relevance of simulation programs.

Effects of a Web-based Educational Module on Pediatric Emergency Medicine Physicians’ Knowledge, Attitudes, and Behaviors Regarding Youth Violence

Author(s): T Madsen, A Riese, E Choo, M Ranney

Date: 2014

Publisher: Western Journal of Emergency Medicine

Volume/Edition: 15 (5)

Publication Type: Journal

Article:

A web-based educational module was developed focusing on the needs of victims of youth violence. This study evaluated the intervention of the educational module and showed that the module affected physicians’ knowledge of, and response to, cases involving youth violence.

Dreyfus and Dreyfus and Indicators of Behavioral Performance: A Study of Measurement Convergence

Author(s): B Williams, P Byrne, N Williams, M Williams

Date: 2017

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 37(1)

Publication Type: Journal

Article:

Data in this study was collected using three hundred sixty-degree (360˚) feedback from physicians. This study evaluates competency-based medical education and continuing professional development using the Dreyfus and Dreyfus five-stage model of skill acquisition.

Quality Metrics Currently Used in Academic Radiology Departments: Results of the QUALMET Survey

Author(s): E Walker, J Petscavage-Thomas, j Fotos, M Bruno

Date: 2017

Publisher: British Journal of Radiology

Volume/Edition: 90(1071)

Publication Type: Journal

Article:

This survey study presented the results of a survey of 112 radiology departments across the United States regarding quality indicators, including Maintenance of Certification (MOC) participation. MOC participation was found to be varied and a requirement of employment for nearly half of the respondents. The discussion notes that MOC is currently the best measure of a radiologist staying current with recommended practices.

Professional Self-regulation in a Changing World Old Problems Need New Approaches

Author(s): R Baron

Date: 2015

Publisher: Journal of the American Medical Association

Volume/Edition: 313 (18)

Publication Type: Journal

Article:

This commentary article discusses origins of the specialty boards, the role of the American Medical Association, and self-regulation, with a focus on the American Board of Internal Medicine (ABIM).

Of the Profession, by the Profession, and for Patients, Families, and Communities ABMS Board Certification and Medicine’s Professional Self-regulation

Author(s): L Nora, M Wynia, T Granatir

Date: 2015

Publisher: Journal of the American Medical Association

Volume/Edition: 313 (18)

Publication Type: Journal

Article:

This commentary article discusses the background and future challenges of the American Board of Medical Specialties (ABMS) and Board Certification.

Ensuring Physicians’ Competence — Is Maintenance of Certification the Answer?

Author(s): J Iglehart, R Baron

Date: 2012

Publisher: New England Journal of Medicine

Volume/Edition: 367 (26)

Publication Type: Journal

Article:

This article discusses the background of Maintenance of Certification (MOC) programs and how programs are being revised to better accommodate diplomate needs and concerns.

American Board of Radiology Maintenance of Certification Program: Evolution to Better Serve Stakeholders

Author(s): P Wallner, D Shrieve, L Kachnic, L Wilson, S Hahn, K Alektiar, M Guiberteau

Date: 2016

Publisher: International Journal of Radiation Oncology, Biology, Physics

Volume/Edition: 94 (1)

Publication Type: Journal

Article:

This commentary reflects on the self-management of medical education and how historically it was recognized that more oversight was needed. This article is also an update report on how the American Board of Radiology (ABR) is staying current and adapting to diplomate needs.

Impact of One Versus Two Content-Specific Modules on American Board of Family Medicine Certification Examination Scores

Author(s): T O'Neill, M Peabody

Date: 2017

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 30(1)

Publication Type: Journal

Article:

This study contributed to the cumulative research determining if physicians are good at self-assessment/recognizing knowledge gaps and the bias that can result in examination scores because of allowing self-selection of content in portions of the examination.

MyPOD: an EMR-Based Tool that Facilitates Quality Improvement and Maintenance of Certification

Author(s): L Berman, B Duffy, B Brenn, C Vinocur

Date: 2017

Publisher: Journal of Medical Systems

Volume/Edition: 41(3)

Publication Type: Journal

Article:

Participation in Maintenance of Certification (MOC) by the American Board of Surgery (ABS) requires quality assessment efforts. This article discusses a quality improvement effort to review an electronic medical records tool called My Personal Outcomes Data (MyPOD) that tracked surgical outcomes at the Nemours-AI duPont Hospital for Children. The effort compared MyPOD and the National Surgical Quality Improvement Program (NSQIP) databases and revealed many adverse events were not being reported by surgeons. This project showed problems that can occur with self-reporting and how it can be improved upon through using MOC requirements.

Quality of Care Provided by Board-Certified Versus Non-Board-Certified Psychiatrists and Neurologists

Author(s): A Wallace, B McFarland, N Selvam, G Sahota

Date: 2017

Publisher: Academic Medicine

Volume/Edition: 92(1)

Publication Type: Journal

Article:

This article describes use of quality measures to compare quality of care between Board-certified and non-Board-certified psychiatrists and neurologists.

ABAI’s MOC Assessment of Knowledge Program Matures: Adding Value with Continuous Learning and Assessment

Author(s): D Bernstein, S Wasserman, W Thompson, T Freeman

Date: 2017

Publisher: Journal of Allergy and Clinical Immunology: In Practice

Volume/Edition: 5(1)

Publication Type: Journal

Article:

This article describes the American Board of Allergy and Immunology’s (ABAI) efforts to improve part III of their Maintenance of Certification (MOC) program, the assessment of knowledge, judgment, and skills, while focusing on adult learning theory methods and reducing burden on diplomates.

Survey of Family History Taking and Genetic Testing in Pediatric Practice

Author(s): R Saul, T Trotter, K Sease, B Tarini

Date: 2017

Publisher: Journal of Community Genetics

Volume/Edition: 8(2)

Publication Type: Journal

Article:

This article discusses a survey done to determine the importance of primary care physicians understanding how to put genomics into their practice, and how undergraduate medical education, graduate medical education, and Maintenance of Certification (MOC) can be expanded to include genomic education.

A New Era in Quality Measurement: The Development and Application of Quality Measures

Author(s): T Adirim, K Meade, K Ministry

Date: 2017

Publisher: Pediatrics

Volume/Edition: 139(1)

Publication Type: Journal

Article:

This article discusses the development and types of quality measures. Quality measures are used in Maintenance of Certification (MOC) programs.

MO-G-204-02: Assessing Cognitive Expertise of Medical Physics Diplomates

Author(s): G Ibbott

Date: 2016

Publisher: Medical Physics

Volume/Edition: 43 (6)

Publication Type: Journal

Article:

This learning objectives article discusses American Board of Radiology (ABR) Maintenance of Certification (MOC) requirements.

MO-G-204-01: Current MOC Requirements with An Emphasis On Recent Changes

Author(s): M Herman

Date: 2016

Publisher: Medical Physics

Volume/Edition: 43 (6)

Publication Type: Journal

Article:

This learning objectives article discusses American Board of Radiology (ABR) Maintenance of Certification (MOC) requirements.

MO-G-204-00: The American Board of Radiology Maintenance of Certification Process

Author(s): G Frey

Date: 2016

Publisher: Medical Physics

Volume/Edition: 43 (6)

Publication Type: Journal

Article:

This learning objectives article discusses American Board of Radiology (ABR) Maintenance of Certification (MOC) requirements.

Pediatric Residency Education and the Behavioral and Mental Health Crisis: A Call to Action

Author(s): J McMillan, M Land, L Leslie

Date: 2016

Publisher: Pediatrics

Volume/Edition: 139(1)

Publication Type: Journal

Article:

This article addresses the importance of focusing on behavioral and mental health in pediatric resident training and the efforts being made by the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Medical Specialties (ABMS), and the American Board of Pediatrics (ABP) to improve this area of need. This article also identifies how Maintenance of Certification (MOC) will be used to improve learning.

Reliable Pregnancy Testing Before Intravenous Cyclophosphamide: A Quality Improvement Study

Author(s): K Hayward, W Haaland, J Hrachovec, M Leu, H Cllifton, N Rascoff, C Crowell

Date: 2016

Publisher: Pediatrics

Volume/Edition: 138 (6)

Publication Type: Journal

Article:

This article discusses a quality improvement study to improve rates of pregnancy screening in adolescent females.

Do Maintenance of Certification Activities Promote Positive Changes in Clinical Practice?

Author(s): L Heitlinger

Date: 2016

Publisher: Journal of Pediatric Gastroenterology and Nutrition

Volume/Edition: Dec

Publication Type: Journal

Article:

This brief article discusses quality improvement activities and their relevance to diplomates participating in maintenance of certification (MOC) programs.

Knowing What We Don’t Know — Improving Maintenance of Certification

Author(s): R Baron, C Braddock

Date: 2016

Publisher: New England Journal of Medicine

Volume/Edition: Nov

Publication Type: Journal

Article:

This perspective article discusses certification in a historical context, and also discusses future changes the American Board of Internal Medicine (ABIM) is planning.

The Role of Internal Medicine Subspecialists in Patient Care Management

Author(s): J Vandergrift, B Gray, J Reschovsky, E Holmboe, R Lipner

Date: 2016

Publisher: American Journal of Managed Care

Volume/Edition: 22 (11)

Publication Type: Journal

Article:

This survey collected responses from internal medicine subspecialists in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program regarding how they perceived the time they spent on certain clinical roles. A significant amount of subspecialists identified care management as a significant role.

The American Board of Radiology Radiation Oncology Maintenance of Certification Part 3 Modular Examination: Evaluation of the First Administration

Author(s): P Wallner, A Gerdeman, J Willis, A Zietman

Date: 2016

Publisher: Practical Radiation Oncology

Volume/Edition: 6 (6)

Publication Type: Journal

Article:

The American Board of Radiology administered a new modular examination in 2015. This is an evaluation and report of this administration.

keywords: examination, MOC part III, areas of clinical interest, examination development, survey

The Predictive Validity of the National Board of Osteopathic Medical Examiners’ COMLEX-USA Examinations With Regard to Outcomes on American Board of Family Medicine Examinations

Author(s): T O'Neill, M Peabody, H Song

Date: 2016

Publisher: Academic Medicine

Volume/Edition: 91 (11)

Publication Type: Journal

Article:

This longitudinal study relates to the value of MOC in its role within a physician’s career. This study contributed to research on the predictive validity of examinations. In this regard, how performance on the National Board of Osteopathic Medical Examiners’ Comprehensive Osteopathic Medical Licensing Examination of the United States of America, predicted performance on the MC-FP examination. Alignment within the licensing and certification process can have predictive value in determining probability of success as well as possible physician workforce concerns.

Using Maintenance of Certification as a Tool to Improve the Delivery of Confidential Care for Adolescent Patients

Author(s): M Riley, S Ahmed, J Lane, B Reed, A Locke

Date: 2016

Publisher: Journal of Pediatric & Adolescent Gynecology

Volume/Edition: Aug 2016

Publication Type: Journal

Article:

Physician Attitudes About Maintenance of Certification: A Cross-Specialty National Survey

Author(s): D Cook, M Blachman, C West, C Wittich

Date: 2016

Publisher: Mayo Clinic Proceedings

Volume/Edition: 91 (10)

Publication Type: Journal

Article:

Criteria for Good Assessment: Consensus Statement and Recommendations From the Ottawa 2010 Conference

Author(s): J Norcini, B Anderson, V Bollela, V Burch, M Joao Costa, R Duvivier, T Roberts

Date: 2011

Publisher: Medical Teacher

Volume/Edition: 33 (3)

Publication Type: Journal

Article:

Influences on Medical Students Self-Regulated Learning After Test Completion

Author(s): S Agrawal, G Norman, K Eva

Date: 2012

Publisher: Medical Education

Volume/Edition: 46

Publication Type: Journal

Article:

Assessment of the American Board of Ophthalmology’s Maintenance of Certification Part 4 (Improvement in Medical Practice)

Author(s): R Wiggins, R Etz

Date: 2016

Publisher: JAMA Ophthalmology

Volume/Edition: 134(9)

Publication Type: Journal

Article:

This retrospective analysis contributes further to the value of participating in MOC part IV projects. Although most participants felt the activity was valuable, it was recognized that improvements in technology and data collection methods could contribute significantly to meaningful QI efforts.

The Value of Maintenance of Certification

Author(s): H Beaver

Date: 2016

Publisher: JAMA Ophthalmology

Volume/Edition: 134 (9)

Publication Type: Journal

Article:

More Than Reducing Complexity: Canadian Specialists’ Views of the Royal College’s Maintenance of Certification Framework and Program

Author(s): T Horsley, K Moreau, J Lockyer, J Zeiter, L Varpio, C Campbell

Date: 2016

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 36 (3)

Publication Type: Journal

Article:

Commentary on the Potential of the MOCA Minute Program

Author(s): R Bjork

Date: 2016

Publisher: Anesthesiology

Volume/Edition:

Publication Type: Journal

Article:

This commentary discusses the Maintenance of Certification in Anesthesiology (MOCA) Minute initiative, relevance, and related benefits.

Association Between Participation in an Intensive Longitudinal Assessment Program and Performance on a Cognitive Examination in the Maintenance of Certification in Anesthesiology Program®

Author(s): H Sun, Y Zhou, D Culley, A Harman, D Warner

Date: 2016

Publisher: Anesthesiology

Volume/Edition:

Publication Type: Journal

Article:

This observational study reinforces previous research on the relevance of the MOC examination in association with lifelong learning. In this case, participation in the MOCA Minute program was evaluated. The MOCA Minute program has tremendous value in assessing improvements in physician learning and knowledge retention.

The ABMS MOC Part III Examination: Value, Concerns, and Alternative Formats

Author(s): R Hawkins, M Irons, C Welcher, M Pouwels, E Holmboe, E Reisdorff, J Gold

Date: 2016

Publisher: Academic Emergency Medicine

Volume/Edition:

Publication Type: Journal

Article:

The American Board of Emergency Medicine ConCert™ Examination: Emergency Physicians’ Perceptions of Learning and Career Benefits

Author(s): C Marco, R Wahl, F Counselman, B Heller, A Harvey, K Joldersma, E Reisdorff

Date: 2016

Publisher: Academic Emergency Medicine

Volume/Edition:

Publication Type: Journal

Article:

Physician Preparation for the American Board of Emergency Medicine ConCert Examination

Author(s): C Marco, R Wahl, F Counselman, B Heller, T Kowalenko, A Harvey, E Reisdorff

Date: 2016

Publisher: Academic Emergency Medicine

Volume/Edition: 23(2)

Publication Type: Journal

Article:

This survey study reinforced previous studies associating examinations with maintaining knowledge. This study showed that physicians go through significant preparation for examinations, and that while Board certification may be a condition of employment and a significant motivating factor, the MOC examination preparation also contributes to maintenance of knowledge over time.

Comparison of Certification and Recertification Examinee Performance on Multiple-Choice Items in Forensic Psychiatry

Author(s): D Juul, J Vollmer, L Shen, L Faulkner

Date: 2016

Publisher: Journal of the American Academy of Psychiatry and the Law Online

Volume/Edition: 44(1)

Publication Type: Journal

Article:

Predictors of Performance on the Maintenance of Certification in Anesthesiology Program® (MOCA®) Examination

Author(s): H Sun, D Culley, C Lien, D Kitchener, A Harman, D Warner

Date: 2015

Publisher: Journal of Clinical Anesthesia

Volume/Edition: 27 (1)

Publication Type: Journal

Article:

Informal Peer Interaction and Practice Type as Predictors of Physician Performance on Maintenance of Certification Examinations

Author(s): M Valentine, S Barsade, A Edmondson, A Gal, R Rhodes

Date: 2014

Publisher: JAMA Surgery

Volume/Edition: 149 (6)

Publication Type: Journal

Article:

Community Size and Organization of Practice Predict Family Physician Recertification Success

Author(s): B Schulte, D Mannino, K Royal, S Brown, L Peterson, J Puffer

Date: 2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27 (3)

Publication Type: Journal

Article:

Do Family Physicians Choose Self-assessment Activities Based on What They Know or Don’t Know?

Author(s): L Peterson, B Blackburn, A Bazemore, T O'Neill, R Phillips

Date: 2014

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 34 (3)

Publication Type: Journal

Article:

Attending Physician Adherence to a 29-Component Central Venous Catheter Bundle Checklist During Simulated Procedures

Author(s): J Barsuk, E Cohen, D Nguyen, D Mitra, K O'Hara, Y Okuda, D Wayne

Date: 2016

Publisher: Critical Care Medicine

Volume/Edition:

Publication Type: Journal

Article:

Practical Applications for Maintenance of Certification Products in Child and Adolescent Residency Training

Author(s): L Williams, A Dingle, L Young-Walker, N John, J Hunt

Date: 2016

Publisher: Journal of General Internal Medicine

Volume/Edition: 40(2)

Publication Type: Journal

Article:

This survey study examined knowledge of Maintenance of Certification (MOC) and usefulness of MOC activities using MOC Performance-in-Practice products. The majority of respondents indicated knowledge regarding MOC varied between first and second year fellows, but respondents did indicate MOC products were useful in training.

Minimally Invasive Surgery Fellowship Graduates: Their Demographics, Practice Patterns, and Contributions

Author(s): A Park, E Sutton, B Heniford

Date: 2015

Publisher: Surgery

Volume/Edition: 158(6)

Publication Type: Journal

Article:

This survey study showed that the majority of surgery fellowship graduates are participating in Maintenance of Certification (MOC) activities.

Role for Assessment in Maintenance of Certification: Physician Perceptions of Assessment

Author(s): J Lockyer, T Horsley, J Zeiter, C Campbell

Date: 2015

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 35 (1)

Publication Type: Journal

Article:

Completing Self-assessment Modules During Residency Is Associated With Better Certification Exam Results

Author(s): L Peterson, B Blackburn, M King

Date: 2014

Publisher: Family Medicine

Volume/Edition: 46 (8)

Publication Type: Journal

Article:

A Significant Number of Charter Diplomates Participate in American Board of Family Medicine (ABFM) Maintenance of Certification

Author(s): J Puffer

Date: 2015

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 28 (4)

Publication Type: Journal

Article:

The American Board of Surgery Maintenance of Certification Program: The First 10 Years

Author(s): M Malangoni, C Shiffer

Date: 2015

Publisher: Bulletin of the American College of Surgeons

Volume/Edition:

Publication Type: Journal

Article:

Family Physicians’ Scope of Practice and American Board of Family Medicine Recertification Examination Performance

Author(s): L Peterson, B Blackburn, M Peabody, T O'Neill

Date: 2015

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 28 (2)

Publication Type: Journal

Article:

Forecasting the Effect of the Change in Timing of the ABR Diagnostic Radiology Examinations: Results of the ACR Survey of Practice Leaders

Author(s): E Bluth, L Muroff, J Cernigliaro, A Moore, G Smith, J Flug, A Roberts

Date: 2015

Publisher: Journal of the American College of Radiology

Volume/Edition: 12 (5)

Publication Type: Journal

Article:

Maintenance of Certification and Pediatrics Milestones-Based Assessment: An Opportunity for Quality Improvement Through Lifelong Assessment

Author(s): V Moyer

Date: 2014

Publisher: Academic Pediatrics

Volume/Edition: 14 (2 Suppl)

Publication Type: Journal

Article:

Quality Improvement in the Age of Electronic Health Records: The North Carolina Improving Performance in Practice Program

Author(s): S Batish

Date: 2013

Publisher: North Carolina Medical Journal

Volume/Edition: 74 (2)

Publication Type: Journal

Article:

This commentary describes the challenges and successes of practices that have participated in the Improving Performance in Practice (IPIP) program of the South East Area Health Education Center (SEAHEC) with the aim of effectively using electronic health records (EHR) to improve outcomes for patients with chronic disease. Physicians participating in the IPIP program are eligible for ABMS Maintenance of Certification® (ABMS MOC®) Part IV credit.

Conducting a Successful Practice Quality Improvement Project for American Board of Radiology Certification

Author(s): C Lee, V Wadhwa, J Kruskal, D Larson

Date: 2015

Publisher: Radiographics

Volume/Edition: 35 (6)

Publication Type: Journal

Article:

Continuous Certification Within Residency: An Educational Model

Author(s): S Rachlin, A Schonberger, N Nocera, J Acharya, N Shah, J Henkel

Date: 2015

Publisher: Academic Radiology

Volume/Edition: 22 (10)

Publication Type: Journal

Article:

ABFM to Simplify MOC for Family Physicians and Make It More Meaningful: A Family Medicine Registry

Author(s): R Phillips

Date: 2015

Publisher: Annals of Family Medicine

Volume/Edition: 13 (3)

Publication Type: Journal

Article:

Characteristics of Internal Medicine Physicians and Their Practices that have Differential Impacts on Their Maintenance of Certification

Author(s): R Lipner, B Brossman

Date: 2015

Publisher: Academic Medicine

Volume/Edition: 90 (1)

Publication Type: Journal

Article:

Board Certification in Internal Medicine and Cardiology: Historical Success and Future Challenges

Author(s): R Baron, H Krumholz, M Jessup

Date: 2015

Publisher: Trends in Cardiovascular Medicine

Volume/Edition: 25 (4)

Publication Type: Journal

Article:

Follow-up on ABIM Maintenance of Certification

Author(s): P O'Gara, W Oetgen

Date: 2015

Publisher: Journal of the American College of Cardiology

Volume/Edition: 65 (2)

Publication Type: Journal

Article:

Aiming Higher to Enhance Professionalism: Beyond Accreditation and Certification

Author(s): M Chassin, D Baker

Date: 2015

Publisher: Journal of the American Medical Association

Volume/Edition: 313 (18)

Publication Type: Journal

Article:

Measuring Reflection on Participation in Quality Improvement Activities for Maintenance of Certification

Author(s): C Wittich, D Reed, H Ting, R Berger, M Blachman, J Mandrekar, T Beckman

Date: 2014

Publisher: Academic Medicine

Volume/Edition: 89 (10)

Publication Type: Journal

Article:

Point: Twin Dogmas of Maintenance of Certification

Author(s): S Jha

Date: 2015

Publisher: Journal of the American College of Radiology

Volume/Edition: 12 (5)

Publication Type: Journal

Article:

Practice Improvements Based on Participation in Simulation for the Maintenance of Certification in Anesthesiology Program

Author(s): R Steadman, A Burden, Y Huang, D Gaba, J Cooper

Date: 2015

Publisher: Anesthesiology

Volume/Edition: 122(5)

Publication Type: Journal

Article:

ABFM’s Heart Failure Self-Assessment Module Simulation Actions Vis-A-Vis Guideline Recommendations

Author(s): M Hagen

Date: 2012

Publisher: Annals of Family Medicine

Volume/Edition: 10 (4)

Publication Type: Journal

Article:

This article provides an overview of the results from chronic heart failure (CHF) self-assessment modules (SAM) and simulations that were introduced in 2006. Results indicated that knowledge gaps were present regarding the use of American College of Cardiology Foundation and American Heart Association guidelines, but also that the knowledge assessment items themselves could better reflect the decision to use the guidelines. Overall, SAMs and use of simulation are valuable tools in the identification of knowledge gaps that may occur in patient management.

Criterion-Referenced Examinations: Implications for the Reporting and Interpretation of Examination Results

Author(s): K Royal, J Puffer

Date: 2013

Publisher: Annals of Family Medicine

Volume/Edition: 11 (2)

Publication Type: Journal

Article:

This update from American Board of Family Medicine (ABFM) explains the basis for the criterion-referenced examinations used for the ABFM certification/Maintenance of Certification (MOC) examination. The article discusses different methods of reporting examination results and further explains the psychometric model, Item Response Theory (IRT), used to develop and score the present examination.

Maintenance of Certification, Medicare Quality Reporting, and Quality of Diabetes Care

Author(s): R Phillips, B Blackburn, L Peterson, J Puffer

Date: 2015

Publisher: American Journal of Medical Quality

Volume/Edition:

Publication Type: Journal

Article:

This study analyzed whether the quality improvement and feedback aspects of Maintenance of Certification (MOC) can be associated with improved outcomes in the Physician Quality Reporting System (PQRS). PQRS is an initiative created by the Centers for Medicare and Medicaid Services (CMS) in which participating physicians are eligible for a bonus on Medicare payments. The study compared completion of either Performance in Practice Modules (PPM), Physician Quality Reporting System (PQRS), or PPM and PQRS combined. Results indicated that the combined PPM and PQRS group showed cross-program improvement and suggested improved outcomes when performance measures and quality measures are aligned.

Specialty Board Certification in the United States: Issues and Evidence

Author(s): R Lipner, B Hess, R Phillips

Date: 2013

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 33 (S1)

Publication Type: Journal

Article:

This literature review examined the effectiveness of certification and Maintenance of Certification (MOC) programs by evaluating peer-reviewed literature on certification and MOC for perceptions of physicians, patients, and hospitals, as well as examining approaches to learning, and impacts of certification on quality of care. This review showed that overall certification and MOC is valued, but that more research on programs, and more focus on appropriate study design, is needed.

Hospital and Emergency Department Factors Associated with Variations in Missed Diagnosis and Costs for Patients Age 65 Years and Older with Acute Myocardial Infarction Who Present to Emergency Departments

Author(s): M Wilson, J Welch, J Schuur, K O'Laughlin, D Cutler

Date: 2014

Publisher: Academic Emergency Medicine

Volume/Edition: 21 (10)

Publication Type: Journal

Article:

This observational study evaluated over 300,000 Medicare records to determine quality and cost predictors related to acute myocardial infarction (AMI) diagnosis, including certification by the American Board of Emergency Medicine (ABEM). Although the study data used had limited clinical information, ABEM certification was associated with better patient outcomes and lower rates of missed AMI diagnosis. Overall, this study is valuable in recognizing predictors of improved quality of care for older patients, and associated costs.

Engagement of Groups in Family Medicine Board Maintenance of Certification

Author(s): D Fisher, C Brenner, M Cheren, K Stange

Date: 2013

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 26 (2)

Publication Type: Journal

Article:

This article described the development of an initiative undertaken to assist physicians in completing part IV Maintenance of Certification (MOC) requirements, and the study results of the intiative’s participants. Results showed that practice coaching is a key element of successful intrapractice and interpractice group collaborations as quality improvement (QI) needs were supported, and physicians were able to appreciate meaningful learning opportunities through the part IV projects.

Maintenance of Certification: What Everyone Needs to Know

Author(s): G Callender, B Kaplan, R White, D Brenin, A Chagpar, K Dalal, V Klimberg

Date: 2015

Publisher: Annals of Surgical Oncology

Volume/Edition: 22 (4)

Publication Type: Journal

Article:

This editorial gives a brief description of the American Board of Surgery (ABS) Maintenance of Certification (MOC) program and outlines an overall perspective on the importance of MOC to the practice of medicine. The article primarily focuses on MOC, Part  2 (Lifelong learning and self-assessment), by outlining the requirements and giving a detailed account of how a surgeon can complete the 3 year requirements and devise a plan for ongoing participation in self-assessment activities in order to overcome the barrier of the last minute rush to complete the credit cycle.

Maintenance of Certification 2.0-Strong Start, Continued Evolution

Author(s): M Irons, L Nora

Date: 2015

Publisher: New England Journal of Medicine

Volume/Edition: 372 (2)

Publication Type: Journal

Article:

This perspective provides background and describes the evolution of the American Board of Medical Specialties Maintenance of Certification® (ABMS MOC®) program that was adopted in 2000 by ABMS members, medical specialty boards. The authors cite evidence to support MOC by referencing studies that show that MOC can improve physicians performance and patient outcomes.  The need for periodic reevaluation of the program is stressed in order to meet the ongoing needs of physicians and community. Perceived burdens of MOC from the physician perspective are discussed as well as  the recently approved 2015 ABMS standards developed as a result of a current review of the MOC program.

Integrating Maintenance of Board Certification and Health Systems’ Quality Improvement Programs

Author(s): H Ting, K Nowicki, S Starr, J Deming, C Wittich, A Hartl, R Berger

Date: 2013

Publisher: Harvard Business Review Blog Network

Volume/Edition:

Publication Type: Journal

Article:

This article is a blog post that describes MAYO clinic’s 2009 efforts to partner with the American Board of Family Medicine (ABFM), the American Board of Internal Medicine (ABIM), and the American Board of Pediatrics (ABP) to create a pilot program: the Multi-Specialty Portfolio Program (MSPP) for Part IV Maintenance of Certification (MOC). The pilot involved adapting the traditional MOC Part IV process (that usually focuses more on individual QI projects) and allowed Mayo to oversee and award Part IV MOC to its physicians engaged in frontline as well as institutional efforts to improve patient outcomes, safety, and service. The article highlights the success of Mayo Clinic’s efforts and discusses the expansion of the MSPP to include other specialty boards and health care organizations. The authors conclude with suggestions for the future model of MOC.

Impact of a Performance Improvement CME Activity on the Care and Treatment of Patients with Psoriasis

Author(s): D Gist, R Bhushan, E Hamarstrom, P Sluka, C Presta, J Thompson, R Kirsner

Date: 2015

Publisher: Journal of the American Academy of Dermatology

Volume/Edition: 72(3)

Publication Type: Journal

Article:

This study aimed at investigating the impact of a Performance Improvement (PI) activity on dermatologists’ practice specific to psoriasis treatment. The activity was approved for American Board of Dermatology (ABD) Maintenance of Certification (MOC) Part IV credit. Almost 200 physician participants audited their patient charts, reflected on results, benchmarked against peers, engaged in an educational activity, developed an improvement plan, and audited a different set of patient charts to assess changes to practice. Study results revealed significant improvement in patient counseling on cardiovascular disease and shared decision making relevant to the treatment plan. Similarly, study results revealed an overall improvement of history taking. It should be noted that participants self-selected patient charts, that chart data was self-reported, and that there was no control group.

 

Counterpoint: Maintenance of Certification: Focus on Physician Concerns

Author(s): M Guiberteau, G Becker

Date: 2015

Publisher: Journal of the American College of Radiology

Volume/Edition:

Publication Type: Journal

Article:

The article reviews American Board of Radiology (ABR) Maintenance of Certification (MOC) program. Specifically, it discusses program evolution, program perception by radiologists, and opportunities for program improvement. The ABR MOC allows radiologists to personalize the program per their scope of practice. The ABR continuously strives to improve the program. Specifically, it is investigating innovative ways to assess cognitive expertise; it provides MOC credit for quality improvement (QI) activities in which radiologists are already participating; and it allows participation in group QI. The ABR is committed to seeking diplomate feedback to ensure an open dialogue and further improvements to the program.

Maintenance of Certification Part IV Quality-Improvement Project for Hypertension Control: A Preliminary Retrospective Analysis

Author(s): V Kolasinski, D Price

Date: 2015

Publisher: The Permanente Journal

Volume/Edition: 19 (2)

Publication Type: Journal

Article:

This study evaluates the impact of an American Board of Medical Specialties Maintenance of Certification® (ABMS MOC®) program, Part IV project, designed to improve outcomes regarding blood pressure control in hypertensive patients and also assesses whether or not physician participation in MOC Quality Improvement (QI) adds perceived burden to participating practices. Results showed physician participants improved the care of their patients without perceived increase of burden to their practice.

Emergency Department Quality Improvement Activity: An Inventory from the American Board of Emergency Medicine Maintenance of Certification Program

Author(s): T Kowalenko, M Carius, R Korte, M Miller, E Reisdorff

Date: 2015

Publisher: Academic Emergency Medicine

Volume/Edition: 22 (3)

Publication Type: Journal

Article:

This descriptive report focuses on the quality improvement (QI) activities that emergency physicians (EP) participate in to fulfill the requirements of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program. A variety of QI activities are discussed and a summary of type, number and cumulative frequency of activities is reported with the intent of informing the emergency medicine community about the current trends in QI programming.

Performance on the Maintenance of Certification for Family Physicians (MC-FP) Examination: Comparison of Initial Certifiers with Experienced Physicians

Author(s): M Peabody, T O'Neill, J Puffer

Date: 2015

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 28 (2)

Publication Type: Journal

Article:

This report addresses the perceived bias that clinical knowledge declines as a physician moves further away from formal training. The authors specifically focus on the American Board of Family Medicine’s Maintenance of Certification for Family Physicians (MC-FP) examination, discuss various ways to analyze the exam scores, and offer a perspective that suggests that most veteran family physicians are able to maintain and expand their knowledge base over time.

Patient Care Outcomes of the SEAHEC Improving Performance in Practice (IPIP) Experience

Author(s): A Meyer, K Donahue, S Batish, T Gentry, A Adams, A Brown, M Baumann

Date: 2013

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 26(1)

Publication Type: Journal

Article:

This pre-post study describes the effects of the collaboration between the South East Area Health Education Center (SEAHEC) and Improving Performance in Practice (IPIP) on the improvement in quality markers in chronic disease states in a single southeastern North Carolina family practice. Authors describe the process for making changes within the practice and highlight the effectiveness of the learning collaborative, a key component of the IPIP program. Physicians participating in the IPIP program are eligible for ABMS Maintenance of Certification® (ABMS MOC®) Part IV credit.

Engagement of Family Physicians in Maintenance of Certification Remains High

Author(s): J Puffer, A Bazemore, C Jaen, I Xierali, R Phillips, S Jones

Date: 2012

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 25 (6)

Publication Type: Journal

Article:

This article is an analysis of participation rates of American Board of Family Medicine (ABFM) diplomates who certified or recertified in 2004, one year after Maintenance of Certification (MOC) was introduced at ABFM. Within this second cohort, 86 percent successfully met all MOC requirements, compared to 75 to 80 percent of family physicians who would recertify before MOC was introduced in 2003. This data suggests that voluntary participation in MOC remains high and exceeds historical levels for family physicians. This may be partially due to the fact that family medicine has required periodic recertification since 1969 and it is part of the culture.

Emergency Physicians Maintain Performance on the American Board of Emergency Medicine Continuous Certification (ConCert) Examination

Author(s): C Marco, F Counselman, R Korte, C Russ, C Whitley, E Reisdorff

Date: 2014

Publisher: Academic Emergency Medicine

Volume/Edition: 21 (5)

Publication Type: Journal

Article:

This retrospective, longitudinal study examined the trends in emergency physician (EP) knowledge over a 24-year period using performance on the ConCert examination. This study analyzed examination score trends for those taking the examination for the first time during recertification cycles. Trends showed slight differences in examination scores between certification cycles, but remained generally consistent. A reason for this consistency is that ConCert examinations are structured in a standardized way for difficulty, but also this consistency reflects the nature of the EP’s constant exposure to a quickly changing and varied medical environment which includes a continuous exchange of knowledge. Some limitations to this study included:

  • self-selection bias
  • variations in equating earlier examination scores
  • exclusion of examinees who failed the examination
  • small differences between groups (such as geographic distribution)

Nevertheless, this study showed that overall EPs maintained knowledge over time as evidenced by examination performance.

Quality Improvement in Childhood Obesity Management through the Maintenance of Certification Process

Author(s): J Huang, S Chun, A Sandhu, L Terrones

Date: 2013

Publisher: Journal of Pediatrics

Volume/Edition: 163 (5)

Publication Type: Journal

Article:

The article provides an evaluation of the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a project that provides American Board of Pediatrics (ABP) Maintenance of Certification (MOC) part IV credit. The evaluation showed that participants improved their knowledge of childhood obesity as a result of the project. Limitations included selection bias and a lack of follow-up on patients to determine outcomes. However, this part IV project did result in improvements in physician performance related to following guidelines, increased knowledge, self-efficacy for screening, and greater pediatric obesity prevention and management.

Factors Associated With American Board of Medical Specialties Member Board Certification Among US Medical School Graduates

Author(s): D Jeffe, D Andriole

Date: 2011

Publisher: Journal of the American Medical Association

Volume/Edition: 306 (9)

Publication Type: Journal

Article:

This retrospective study analyzed characteristics and variables of those with Board Certification who graduated from medical schools within the United States. The majority of graduates were certified by American Board of Medical Specialties (ABMS) Member Boards. Differences were identified in certification examination pass rates between older and younger graduates, certification rates among minorities, and certification rates based on total debt across specialties. Gender did not play a huge role in determining certification in the majority of specialties. Limitations identified in this study included the inability to make causal inferences from results due to the observational study design, and lack of follow-up on graduates who had not yet been Board Certified. The study provides an overview of graduates who become Board Certified and graduates who may encounter a delay in Board Certification.

The American Board of Family Medicine Certification Examination: A Proxy for Quality

Author(s): J Puffer

Date: 2011

Publisher: Family Medicine

Volume/Edition: 43 (6)

Publication Type: Journal

Article:

This commentary provides a discussion on dual accreditation in family medicine by the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) and how this affects certification by the American Board of Family Medicine (ABFM). Studies discussed show that more osteopathic family medicine residents in ACGME-accredited programs have opted to be certified by the AOA and not the ABFM. The commentary maintains that if this trend continues it may inhibit the ability to accurately assess osteopathic programs, but that the 2011 changes in the ABFM certification examination will continue as a consistent assessment measure.

Engagement of Family Physicians Seven Years into Maintenance of Certification

Author(s): J Puffer, A Bazemore, W Newton, L Makaroff, I Xierali, L Green

Date: 2011

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 24 (5)

Publication Type: Journal

Article:

This policy brief provided a reflection on the American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) program after seven years. The ABFM started its MC-FP program in 2003. Seven years later, the majority of those physicians who began MC-FP were actively engaged in their programs, indicating a strong commitment to professionalism within the specialty. The author anticipates greater impact on cost and quality as a result of significant family physician participation in MC-FP.

Do Professional Development Programs for Maintenance of Certification (MOC) Affect Quality of Patient Care?

Author(s): J Galliher, B Manning, S Petterson, L Dickinson, E Brandt, R Phillips, W Pace

Date: 2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27 (1)

Publication Type: Journal

Article:

This retrospective study examined the relationship between physicians’ completion of American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) modules and the quality of medical care delivered. The study focused on patients with an established diagnosis of type 2 diabetes mellitus and involved analyses of data obtained from electronic health records. Study results revealed somewhat improved diabetes care as a result of physician participation in the MOC process.

The Evolution of Maintenance of Certification for Family Physicians (MC-FP) Part IV, Performance in Practice

Author(s): N Lainhart, M Hagen

Date: 2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27 (4)

Publication Type: Journal

Article:

This article provides historical background on the evolution of performance in practice modules (PPM) required of the American Board of Family Medicine (ABFM) diplomates participating in Maintenance of Certification (MOC). It follows the progression of the ABFM professional development program from 1976 through 2014 with special emphasis on “performance in practice” and the resources and tools that were developed to improve quality of care.

More Than a List of Values and Desired Behaviors: A Foundational Understanding of Medical Professionalism

Author(s): M Wynia, M Papadakis, W Sullivan, F Hafferty

Date: 2014

Publisher: Academic Medicine

Volume/Edition: 89 (5)

Publication Type: Journal

Article:

This article is a detailed perspective on how the American Board of Medical Specialties (ABMS) Standing Committee on Ethics and Professionalism developed an operational definition of professionalism that relates to both initial certification and ABMS Maintenance of Certification® (ABMS MOC®). Authors explain that medical professionalism is best considered a normative belief system about how to best deliver health care rather than a set of behaviors. Authors discuss key implications for this new definition of professionalism.

Lifelong Learning and Self-Assessment is Relevant to Emergency Physicians

Author(s): J Jones, R Smith-Coggins, J Meredith, R Korte, E Reisdorff, C Russ

Date: 2013

Publisher: Journal of Emergency Medicine

Volume/Edition: 45 (6)

Publication Type: Journal

Article:

This study prospectively reviewed the 2011 survey results provided by American Board of Emergency Medicine (ABEM) certified emergency physicians who completed the 2011 Lifelong Learning and Self-assessment (LLSA) as a continuing medical education (CME) activity. This study is the first of its kind by ABEM to review the effectiveness of the Maintenance of Certification (MOC) program. Authors conclude the results of this survey demonstrate two key points: 1) that emergency physicians view these articles as relevant to the clinical practice of Emergency Medicine, and 2) participating in the LLSA is reported to have changed clinical practice.

One Rural Federally Qualified Health Center’s Journey with North Carolina’s Improving Performance in Practice (IPIP) Program

Author(s): K Schwartz

Date: 2012

Publisher: North Carolina Medical Journal

Volume/Edition: 73 (6)

Publication Type: Journal

Article:

A brief description of Roanoke Chowan Community Health Center’s link with the North Carolina Improving Performance in Practice (IPIP) Program and how their combined efforts helped kick-start an effective quality improvement (QI) program. The author describes the process used for standardizing an electronic medical record (EMR) template for patients with diabetes and discusses the center’s conversion to a new electronic health record (EHR) in 2011. Also, documented improvement in several diabetes and hypertension measures is highlighted. Physicians participating in IPIP were eligible for MOC Part IV credit.

More Extensive Implementation of the Chronic Care Model is Associated with Better Lipid Control in Diabetes

Author(s): J Halladay, D DeWalt, A Wise, B Qaqish, K Reiter, S Lee, K Donahue

Date: 2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27(1)

Publication Type: Journal

Article:

Using a sample of practices involved in the North Carolina Improving Performance in Practice (IPIP) Program (a statewide quality improvement (QI) project in North Carolina), this study examined whether the extent of implementation of four key drivers of practice change was associated with improved population-level outcomes for diabetes care. Findings showed statistically significant improvements in the proportion of patients who met the LDL threshold. The results for hemoglobin A1C and blood pressure values were not significant. Authors suggest that improved outcomes for patients with diabetes may be associated with a practice’s ability to implement key drivers of practice change. Physicians participating in IPIP were eligible for Maintenance of Certification (MOC) Part IV credit.

Dimensionality of the Maintenance of Certification for Family Physicians Examination: Evidence of Construct Validity

Author(s): K Royal, J Puffer

Date: 2013

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 26 (3)

Publication Type: Journal

Article:

This descriptive narrative focuses on the American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) examination and the efforts made to ensure the dimensionality of the examination. It highlights the analysis that was performed to confirm that the test was properly designed to measure one aspect at a time and also measures what it is designed to measure. The authors discuss the implications for construct validity and that the examination accurately measures the ability of family physicians to make appropriate clinical decisions.

Effectiveness of an Asthma Quality Improvement Program Designed for Maintenance of Certification

Author(s): L Vernacchio, M Francis, D Epstein, J Santangelo, E Trudell, M Reynolds, W Risko

Date: 2014

Publisher: Pediatrics

Volume/Edition: 134 (1)

Publication Type: Journal

Article:

This study is an evaluation of a program developed by Pediatric Physicians’ Organization at Children’s (PPOC), affiliated with Boston Children’s Hospital. The program derived data from three cohorts, involving physicians and patients, spanning three years. Practice-based registries of pediatric asthma patients were developed and used a learning collaborative model. Each meeting brought together multiple practice teams covering multiple topics in asthma care. The three cohorts each experienced improvements in the care of asthma including asthma action plans, Asthma Control Tests, medications, and visits. Patient outcomes were also affected as asthma exacerbations declined in all three cohorts. This study is subject to several limitations such as sample size, lack of comparison groups, and a need for a common definition of quality improvement in research. The learning collaborative model counted towards fulfilling Maintenance of Certification (MOC) requirements and resulted in learning and sharing among medical teams.

Family Physicians’ Quality Interventions and Performance Improvement Through the ABFM Diabetes Performance in Practice Module

Author(s): L Peterson, B Blackburn, J Puffer, R Phillips

Date: 2014

Publisher: Annals of Family Medicine

Volume/Edition: 12(1)

Publication Type: Journal

Article:

This study is a validation of the Family Medicine Maintenance of Certification program, Part IV (MC-FP). The MC-FP Performance in Practice Module (PPM) uses National Quality Forum-endorsed measures, as part IV of the MC-FP requires measurement of the quality of care provided. Data was collected from PPMs of over 8,000 quality improvement projects over a seven-year period. This study showed that family physicians did substantially increase examination procedures pertaining to diabetes control and successfully applied quality improvement practices using quality measures. Limitations to this study included self-reported data, potential selection bias (of patients), and inability to link related American Board of Family Medicine (ABFM) data for comparison. Despite these limitations, patient outcomes showed significant improvements in hemoglobin control and blood pressure control, as well as an increase in retina and foot examinations.

Knowledge Assessment Responses in the ABFM Self-Assessment Modules (SAMs)

Author(s): M Hagen

Date: 2012

Publisher: Annals of Family Medicine

Volume/Edition: 10 (6)

Publication Type: Journal

Article:

This is a summary of diplomates’ knowledge assessment performance on American Board of Family Medicine (ABFM) self-assessment modules (SAMs). SAMs are organized by competencies and consist of closed and open ended questions as well as a clinical simulation. The focus on knowledge assessment allows the diplomates to receive feedback and critiques after their first pass attempt on the exam. ABFM can collect this information and use it to analyze where the most success occurs in each competency during first pass attempts. The performance feedback diplomates receive after first pass attempts allows them to be more successful on second attempts, as well as decreases the time needed for completion of the SAMs

Predictors of Physician Performance on Competence Assessment: Findings From CPEP, the Center for Personalized Education for Physicians

Author(s): E Grace, E Wenghofer, E Korinek

Date: 2014

Publisher: Academic Medicine

Volume/Edition: 89 (6)

Publication Type: Journal

Article:

In this study, researchers analyzed data of physicians who were referred to the Center for Personalized Education for Physicians between 2000 and 2010 to determine predictive factors of unsafe assessment outcome. They found that Board-certified individuals were less likely than uncertified individuals to have poor assessment outcomes. Similarly, compared to physicians who have not warranted Board action (suspension, revocation, limitation, or stipulation), physicians with Board action were more likely to be deemed unsafe. The analysis also found that older physicians were more likely to have unsafe assessment outcomes. Physicians in solo practice settings were more likely to be deemed unsafe, compared to physicians in other settings. Compared to physicians whose practice scope did not match their training, termed practice drift, those whose practiced in the area in which they received training were less likely to have unsafe assessment outcomes. This study shows what the impact of being Board-certified, having Board action, a physician’s age, practice setting, and staying in their area of training on assessment outcomes.

Medical Specialty Boards Can Help Measure Graduate Medical Education Outcomes

Author(s): L Peterson, P Carek, E Holmboe, J Puffer, E Warm, R Phillips

Date: 2014

Publisher: Academic Medicine

Volume/Edition: 89 (6)

Publication Type: Journal

Article:

This commentary highlights the need for graduate medical education programs to measure program outcomes and show accountability for their federal funding. Authors suggest that American Board of Medical Specialties (ABMS) Member Boards and the Accreditation Council for Graduate Medical Education (ACGME) should broaden their long standing relationship to further develop shared roles and data-sharing mechanisms to better inform residencies and the public about graduate medical education training outcomes. Specifically, since Part IV Maintenance of Certification (MOC) generally involves assessment of the quality of care delivered in practice, ABMS Member Boards could share data with the ACGME and residency programs to provide direct feedback on practice outcomes of graduates. This commentary offers a general summary of the MOC process and the data synthesis involved.

Transforming Quality of Care in North Carolina

Author(s): W Newton, D Bradley

Date: 2013

Publisher: North Carolina Medical Journal

Volume/Edition: 74 (2)

Publication Type: Journal

Article:

This issue brief describes the current state of health care in North Carolina and provides a general review of strategies for improving health care quality. The brief also addresses three fundamental questions:

1) can quality of health care be measured and improved?
2) what does the landscape in North Carolina look like now?
3) what should North Carolina’s priorities be for improving quality of acre moving forward?

The article mentions North Carolina Improving Performance in Practice program. Physicians participating in Improving Performance in Practice program were eligible for Part IV MOC credit.

Maintenance of Certification: Beauty Is in the Eyes of the Beholder

Author(s): R Centor, D Fleming, D Moyer

Date: 2014

Publisher: Annals of Internal Medicine

Volume/Edition:

Publication Type: Journal

Article:

This article is a commentary on Baron and Johnson’s history of and rationale for the creation of the American Board of Internal Medicine (ABIM) and recent changes to its Maintenance of Certification (MOC) program. Authors relate that many internists find the MOC process frustrating and highlight the ever-growing demands to already overburdened physicians. However, the authors also acknowledge program benefits, as well as the complexities and challenges associated with a comprehensive professional assessment program.

Getting Maintenance of Certification to Work: A Grounded Theory Study of Physicians’ Perceptions

Author(s): D Cook, E Holmboe, K Sorenson, R Berger, J Wilkinson

Date: 2014

Publisher: JAMA Internal Medicine

Volume/Edition: 175 (1)

Publication Type: Journal

Article:

This article describes a grounded theory focus group study that addressed Maintenance of Certification (MOC) barriers and ways to overcome them. Study participants included Board certified primary care, internal medicine, and family medicine physicians. Researchers found that physicians perceive MOC as a complex activity, often unrelated to practice. Researchers identified six areas in which MOC needs to change in order to become more meaningful. The study is limited due to the use of a single institution and its qualitative nature. Nevertheless, it indicates that the MOC program can be improved to better meet physicians’ needs.

Improving Quality of Care and Guideline Adherence for Asthma Through a Group Self-Assessment Module

Author(s): K Elward, B Blackburn, L Peterson, M Greenawald, M Hagen

Date: 2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27(3)

Publication Type: Journal

Article:

This study aimed to assess whether the American Board of Family Medicine (ABFM), Maintenance of Certification (MOC) for Family Physicians (MC-FP) group self-assessment modules may increase knowledge and adherence to asthma clinical guidelines. Researchers argued that while the adherence to the guidelines is low, improved compliance may raise the quality of care. Study results showed that both quality of asthma care and adherence to clinical guidelines improved as a result of participation in the group self-assessment activity. Quality measures, such as diagnosis by severity and use of action plans (except from prescribing of controlled medications), showed improvement six months after module completion. The knowledge and adherence to clinical guidelines increased immediately and was sustained at six months. While the study sample was limited to one state, and while not all control group subjects finished the study, this study indicates that group self-assessment modules may be effective in improving adherence to clinical guidelines and improving quality of care.

Improving Quality of Care for Diabetes Through a Maintenance of Certification Activity: Family Physicians’ Use of the Chronic Care Model

Author(s): L Peterson, B Blackburn, R Phillips, J Puffer

Date: 2015

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 34 (1)

Publication Type: Journal

Article:

The authors introduce their study with a brief description of the current state of diabetes and the call for improving the quality of care for this chronic condition. Their objective was to determine associations between family physician characteristics and actions taken during engagement with Maintenance of Certification, Part IV diabetes modules. Their findings showed that all physician and patient quality measures improved.

Association Between Imposition of a Maintenance of Certification Requirement and Ambulatory Care-Sensitive Hospitalizations and Health Care Costs

Author(s): B Gray, J Vandergrift, M Johnston, J Reschovsky, L Lynn, E Holmboe, R Lipner

Date: 2014

Publisher: Journal of the American Medical Association

Volume/Edition: 312 (22)

Publication Type: Journal

Article:

The goal of this quasi-experimental study was to evaluate the association between the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program and outcomes of care. Researchers compared two groups of physicians, those certified by ABIM and participating in MOC, and those certified and not participating in MOC. Preventable hospitalizations and health care costs of Medicare beneficiaries served as outcome measures. Study results revealed no significant association between physician participation in MOC and hospitalization rates; however, a small reduction of health care costs was detected. It should be noted that the study is limited to the Medicare population, and, in addition to other factors, there are limitations associated with preventable hospitalization rates as outcome measures.

Certifying the Good Physician: A Work in Progress

Author(s): T Lee

Date: 2014

Publisher: Journal of the American Medical Association

Volume/Edition: 312 (22)

Publication Type: Journal

Article:

In this article, the author reviews the evolution of physician assessment. With progress in medicine and changes in health care, a good physician is characterized as someone who continuously seeks professional development and improvement. Board Certification has been regarded as an acceptable professional credential for most of the century. However, it has been evolving and has endured its share of complexity. Some of the most frequent criticisms related to American Board of Medical Specialties (ABMS) Maintenance of Certification® (ABMS MOC®) program are time, cost, and relevance to physician practice. The balance between meeting physician needs and providing adequate accountability to the public remains difficult. Nevertheless, there is a need to continue to evaluate and evolve MOC.

The Reliability of American Board of Family Medicine Examinations: Implications for Test Takers

Author(s): K Royal, J Puffer

Date: 2012

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 25(1)

Publication Type: Journal

Article:

This article describes the theory behind examination validation. It addresses American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) examination validity, mainly focusing on its reliability estimate measured at 0.94 in 2009. When important decisions are to be made based on group test scores, recommended reliability estimate is 0.90.

Family Physician Participation in Quality Improvement

Author(s): L Peterson, C Jaen, R Phillips

Date: 2013

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 26(6)

Publication Type: Journal

Article:

American Board of Family Medicine (ABFM) conducted a survey which revealed that over a third of family physicians are participating in quality improvement activities. Participation in quality improvement is central to fulfilling ABFM Maintenance of Certification (MOC) Part IV requirements. Quality improvement is crucial to patient outcomes and health care cost reduction. Similarly, new health care delivery models and payment methods are tied to health care quality improvement.

The American Board of Internal Medicine: Evolving Professional Self-Regulation

Author(s): R Baron, D Johnson

Date: 2014

Publisher: Annals of Internal Medicine

Volume/Edition:

Publication Type: Journal

Article:

The authors reviewed the history of the American Board of Internal Medicine (ABIM) and the evolution of the certification process for internists. Changes in the certification process are reflective of the changes and growing complexity in health care. The authors acknowledge physician frustration and assure that the ABIM continuously strives to increase the value of the program to physicians.

Natural History of Practice Transformation: Development and Initial Testing of an Outcomes-Based Model

Author(s): K Donahue, W Newton, A Lefebvre, M Plescia

Date: 2013

Publisher: Annals of Family Medicine

Volume/Edition: 11(3)

Publication Type: Journal

Article:

This article describes the development of a two-phased practice transformation model, where quality improvement consultants worked with practices in designing custom interventions that would help improve the quality of care. In this process, three practice types were identified: transformed, activated, and engaged practices. A little less than half of the practices demonstrated improvement in one year. Authors concluded that practice transformation is a long-term process, where engagement, rate of improvement, and sustainability are influenced by certain motivators and support structures. Participating practices were those from North Carolina Improving Performance in Practice program. Physicians participating in the program were eligible for Maintenance of Certification (MOC) Part IV credit. It should be noted that the study is limited to a small sample size, volunteer participants, data collection methodology, and variability of the interventions among the practices.

The American Board of Pathology’s Maintenance of Certification Program Update

Author(s): R Johnson

Date: 2014

Publisher: Archives of Pathology and Laboratory Medicine

Volume/Edition: 138

Publication Type: Journal

Article:

This article is an update on current American Board of Pathology Maintenance of Certification (MOC) program requirements and policies. Currently, there are close to 5000 physicians participating in the program. The Board is working with other organizations to align reporting requirements and make the program more relevant to physician practice, and ultimately increasing the value of the program. Pathologists holding non-time-limited certificates are strongly encouraged to participate in MOC.

Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons From North Carolina Improving Performance in Practice

Author(s): W Newton, A Lefebvre, K Donahue, T Bacon, A Dobson

Date: 2010

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 30(2)

Publication Type: Journal

Article:

This paper describes the early phase of a quality improvement project, the North Carolina Improving Perofrmance in Practice (NC IPIP) program, and how it helped to develop a community–based regional strategy that succeeded in improving care in different regions in the state, drove its spread across the state, and established sustainable infrastructure. The paper discusses the recruitment and experience of two waves of practices that participated in the program and reveals some improvement results from asthma and diabetes data collected during the initial stage. Maintenance of Certification (MOC) credit was offered as an incentive for physicians to participate in the NC IPIP project. The paper discusses key lessons learned, limitations, and cautions against generalizing results as their study reflects a “custom fit” strategy rather than a standard intervention.

Designing a Large-Scale Multilevel Improvement Initiative: The Improving Performance in Practice Program

Author(s): P Margolis, D DeWalt, J Simon, S Horowitz, R Perelman, B Bagley, P Miles

Date: 2010

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 30(3)

Publication Type: Journal

Article:

This report describes the design, development and spread strategy of the Improving Performance in Practice (IPIP) program through 2010. IPIP is a large system intervention led by a collaboration of the primary care medical certifying boards and professional societies that seek to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels to accelerate quality improvement in the care of chronic illness and preventive services. The authors site the Maintenance of Certification (MOC) program and its call for documentation regarding physician’s actual performance in practice in addition to individual knowledge as the impetus for the design, development, and evaluation of IPIP.

Collaboration in Pennsylvania: Rapidly Spreading Improved Chronic Care for Patients to Practices

Author(s): P Bricker, R Baron, J Scheirer, D DeWalt, J Derrickson, S Yunghans, R Gabbay

Date: 2015

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 30(2)

Publication Type: Journal

Article:

This research outlines the components of Pennsylvania’s IPIP program and Pennsylvania Chronic Care initiative led by the PA Governor’s Office of Health Care Reform. It presents 6 months results from 155 PA practice sites that have undergone practice transformation through the IPIP project. Early performance data indicate substantial improvement in care processes and show steady improvement in performance measures for diabetes and asthma. It also discusses the intent of the PA Chronic Care Initiative to spread to more practices and focus on more aspects of primary care, including prevention. Physicians participating in IPIP project are eligible for MOC Part IV credit.

ABFM Examination Asthma Item Performance and Asthma Prevention Quality Indicators in Kentucky

Author(s): W Sumner, T O'Neill, P Owens, M Schootman, M Hagen

Date: 2012

Publisher: Journal of the Kentucky Medical Association

Volume/Edition: 110

Publication Type: Journal

Article:

Researchers in this study examined Kentucky family physicians’ performance on asthma related content included in the 2009 ABFM examination and its correlation with adult asthma hospitalization rates in the state. They found an inverse relationship between the two variables which highlights the importance of Maintenance of Certification (MOC) Part III.

The Relationship Between the Nature of Practice and Performance on a Cognitive Examination

Author(s): J Norcini, R Lipner

Date: 2000

Publisher: Academic Medicine

Volume/Edition: 75 (10)

Publication Type: Journal

Article:

This study further examines the relationship between the nature of practice and performance on the 1997 or 1999 critical care medicine recertification examination. The researchers specifically focused on questions pertaining to cardiovascular and pulmonary disease. Additionally, they asked participants to provide information about the amount of time and difficulty of care they provide to patients with these problems. They found that for cardiovascular disease there was a significant relationship between volume and complexity with test scores for both years. However, for pulmonary disease, only volume had a significant relationship with test scores in the 1997 group. Although, both factors were significant in 1999. While keeping the limitations in mind, these results suggest the examination performance is related to performance of the practice of care and not merely testing a physicians ability to recall facts.

Evaluating the Systematic Validity of a Medical Subspecialty Examination

Author(s): M Raddatz, M Royal, J Pennington

Date: 2012

Publisher: ERIC database

Volume/Edition: conference presentation

Publication Type: Journal

Article:

To evaluate the systematic validity of a medical subspecialty examination, researchers compared scores between two groups: physicians taking the exam for initial certification who had completed a fellowship program and those that had not. Additionally, they compared practice pathway board candidates scores to all other candidates, both who had and had not completed a fellowship. Researchers found systematic validity, because test functioned the same way across different groups.

Policies and Practices Related to the Role of Board Certification and Recertification of Pediatricians in Hospital Privileging

Author(s): G Freed, R Uren, E Hudson, I Lakhani, J Wheeler, J Stockman

Date: 2006

Publisher: Journal of the American Medical Association

Volume/Edition: 295 (8)

Publication Type: Journal

Article:

This study surveyed 200 hospitals to find out if they required their pediatricians and pediatric subspecialists to be board certified at initial privileging or at some point during their tenure. Out of the 200 surveyed, 159 hospitals completed the telephone interview, with a response rate of 82%. One hundred and twenty-four hospitals did not require pediatricians to be board certified at the initial privileging but, 111 did require they be certified at some time throughout their tenure.

Use of Board Certification and Recertification of Pediatricians in Health Plan Credentialing Policies

Author(s): G Freed, D Singer, I Lakhani, J Wheeler, J Stockman

Date: 2006

Publisher: Journal of the American Medical Association

Volume/Edition: 295 (8)

Publication Type: Journal

Article:

This study researches the credentialing policies health plans use in regards to board certification and recertification. The study specifically focuses on general pediatricians and pediatric subspecialists. Out of the roughly 200 respondents, a vast majority did not require general pediatricians to be board certified at the point of initial credentialing. Furthermore, less than half require general pediatricians ever to be board certified. For subspecialists, only 15% required certification at initial contract and 26% required certification at some point. Additionally, a majority of respondents said they would allow subspecialists to bill as subspecialist even if their certification as since expired. The authors believe that these results raise issues surrounding whether or not health plans can effectively guarantee the competency of their physicians.

Teaching and Evaluating Point of Care Learning with an Internet-Based Clinical Question Portfolio

Author(s): M Green, S Reddy, E Holmboe

Date: 2009

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 29(4)

Publication Type: Journal

Article:

In this article, researchers developed and tested an alternative approach to the Maintenance of Certification (MOC) open-book multiple choice exams. Their method, an internet-based point of care learning portfolio, tested positively among participants. The majority of participants preferred the new method and believed it was more consistent to how they practice medicine. As a result, ABIM began offering this portfolio as an elective option in MOC.

Gaps in Quality of Diabetes Care in Internal Medicine Residency Clinics Suggest the Need for Better Ambulatory Care Training

Author(s): L Lynn, B Hess, W Weng, R Lipner, E Holmboe

Date: 2012

Publisher: Health Affairs

Volume/Edition: 31 (1)

Publication Type: Journal

Article:

In this study, researchers compared the quality of diabetes care being delivered by residency clinics versus practicing physicians. To make this comparison, researchers used the American Board of Internal Medicine’s Diabetes Practice Improvement Modules. These modules, which include medical chart reviews, patients surveys and practice system analysis, are used to help physicians identify areas that need improvement. After analyzing the data, researchers came to the conclusion that residency clinics are not providing high-quality diabetes care. This could likely be the result of the design of residency clinics. By nature, care-coordination is a struggle because residents and faculty only spend on average a few hours at the site a week. This article showcases how ABIM’s modules serve as an important tool in identifying quality gaps.

Variations in Growth of Infants With a Single Ventricle

Author(s): J Anderson, S Lyer, D Schindlow, R Williams, J Varadarajan, M Horsley, C Lannon

Date: 2012

Publisher: Journal of Pediatrics

Volume/Edition: 161 (1)

Publication Type: Journal

Article:

This article examines the interstage growth variation in infants with hypoplastic left heart syndrome. Researchers collected data from National Pediatric Cardiology Quality Improvement Collaborative participants on their practices related to nutrition. They found significant variation in nutritional care provided and the interstage growth among the different locations. They believe standardization of care may be needed in this area. It has previously been shown that both improvements in surgical technology and medical management has led to better clinical outcomes. This study supports Maintenance of Certification (MOC) framework by indicating the importance of practice performance assessment (MOC Part IV) to patient care.

Systematic Review: The Relationship Between Clinical Experience and Quality of Health Care

Author(s): N Choudry, R Fletcher, S Soumerai

Date: 2005

Publisher: Annals of Internal Medicine

Volume/Edition: 142

Publication Type: Journal

Article:

In this paper, researchers conducted a systematic review to evaluate the relationship between years of experience practicing and performance outcomes. Their review findings suggest that physicians who have been practicing longer have less factual knowledge, follow standard care practices less often, and may have worse patient outcomes. Overall, there appears to be a risk that more experience in the field may be associated with lower quality of care delivered. The researchers suggest one of the reasons for this discrepancy is that many physician “toolkits” are used during training and not regularly updated. The Maintenance of Certification (MOC) program could play a large role in filling this void and ensuring that longer practicing physicians are still being exposed to new practice innovations.

Family Physicians’ Completion of Scoring Criteria in Virtual Patient Encounters

Author(s): W Sumner II, T O'Neill, G Roussel, J Xu, D Ivins, M Hagen

Date: 2011

Publisher: Academic Emergency Medicine

Volume/Edition: 2011

Publication Type: Journal

Article:

In this study, researchers reviewed criterion completion rates for asthma related virtual patient cases included in the ABFM examination. They found improvements in the completion of important asthma management criteria which could be the result of change of physicians treatment protocol or physicians learning from past Maintenance of Certification (MOC) exercises such as the multiple-choice sections. The researchers believe the likely explanation is that the multiple-choice section served as a trigger for certain actions. This shows the potential for the MOC program to change physicians’ behaviors.

The Certification Status of Generalist Physicians and the Mortality of Their Patients After Acute Myocardial Infarction

Author(s): J Norcini, R Lipner, H Kimball

Date: 2001

Publisher: Academic Medicine

Volume/Edition: 76 (10)

Publication Type: Journal

Article:

In this study, researchers compare the patient outcomes for certified and non-certified physicians. To determine this, the research team collected data regarding hospitalizations in which the patient was directly admitted for acute myocardial infarctions. When holding all other factors constant, the researchers found significantly lower rates of mortality resulting from treatment administered by a certified physicians. This offers further support for the validity of the certification program.

Toward Better Care Coordination Through Improved Communication with Referring Physicians

Author(s): B Hess, L Lynn, E Holmboe, R Lipner

Date: 2009

Publisher: Academic Medicine

Volume/Edition: 84(1 supplement)

Publication Type: Journal

Article:

In this study, researchers analyzed the results of the Communication with Referring Physicians practice improvement module (CRP-PIM) included in the American Board of Internal Medicine Maintenance of Certification (MOC) program. This module was created to improve communication between consulting and referring physicians. To complete the PIM, consulting physicians had to finish a practice system survey and then were evaluated by their referring physicians. Upon receiving the report, the consulting physicians choose areas for improvement. This article demonstrates the usefulness of the PIM’s included in MOC.

Improved Outcomes in a Quality Improvement Collaborative for Pediatric Inflammatory Bowel Disease

Author(s): W Crandall, P Margolis, M Kappelman, E King, J Pratt, B Boyle, R Colletti

Date: 2012

Publisher: Pediatrics

Volume/Edition: 129 (4)

Publication Type: Journal

Article:

This study centers on six ImproveCare Now Network sites implementing new strategies to improve care delivery and outcomes for children with inflammatory bowel disease. The network established standardized diagnosis and care recommendations and used additional tools such as previsit planning templates and a Model IBD Care Guideline. Researchers ultimately found that changes in the overall delivery of care likely resulted in improved outcome measures as opposed to one particular intervention. The collaborative improvement network efforts align with acceptable Maintenance of Certification (MOC) Part IV methodology and highlight the importance of both system based practice and practice based learning and improvement.

The Role of Physician Engagement on the Impact of the Hospital-Based Practice Improvement Module (PIM)

Author(s): K Caverzagie, E Bernabeo, S Reddy, E Holmboe

Date: 2009

Publisher: Journal of Hospital Medicine

Volume/Edition: 4(8)

Publication Type: Journal

Article:

Researchers in this study analyzed the results of implementing a Hospital Practice Improvement Module (PIM) with physicians who are engaged in hospital-based quality improvement (QI) activities. They found a majority of participants concluded that the module was a valuable experience. However, the physicians level of engagement in the QI project largely impacts their engagement in the PIM. The researchers did note that initial engagement was not a predicting factor, but the factor was their level of engagement throughout the span of the QI activities. Overall, the researchers suggest that the Hospital PIM is a helpful part of Maintenance of Certification (MOC).

Clinical Inactivity Among Pediatricians: Prevalence and Perspectives

Author(s): G Freed, K Dunham, K Switalski

Date: 2009

Publisher: Pediatrics

Volume/Edition: 123 (2)

Publication Type: Journal

Article:

Researchers in this study investigated the prevalence of clinical inactivity among pediatricians. They discovered that among those surveyed, over 10% had been clinically inactive for at least 12 months. This translates to approximately 1 in 8 pediatricians suspending care for a year or more. The researchers raise questions about the impact this gap could have on care quality. Maintenance of Certification (MOC) could serve as an effective tool to ensure quality even after gaps in practicing.

Comparative Trial of a Web-Based Tool to Improve the Quality of Care Provided to Older Adults in Residency Clinics: Modest Success and a Tough Road Ahead

Author(s): E Holmboe, B Hess, L Conforti, L Lynn

Date: 2012

Publisher: Academic Medicine

Volume/Edition: 87 (5)

Publication Type: Journal

Article:

With an aging population and a shrinking geriatrics workforce, it is important to assess the quality of care that internal medicine and family medicine residents can provide to older Americans. Researchers in this study investigated the impact of utilizing the American Board of Internal Medicine Care of the Vulnerable Elderly Practice Improvement Module among internal medicine and family medicine residencies. The PIM consisted of a medical record audit, microsystem survey and patient survey. Upon receiving the results, the residents set goals to improve the quality of care they were delivering. Performance improved in clinics using the ABIM CoVE PIM for important performance measures. The overall quality level of care for older adults in residency clinics remained poor. It is worthwhile to mention that the intervention targeted especially poor performance areas and that QI is an itterative process, where a single intervention may not be enough to change patient outcomes. This study sheds light on the importance of Maintenance of Certification (MOC) as a continuous professional development model with repetative engagement in practice performance assessment, MOC Part IV.

A Three-Part Model for Measuring Diabetes Care in Physician Practice

Author(s): R Lipner, W Weng, G Arnold, F Duffy, L Lynn, E Holmboe

Date: 2007

Publisher: Academic Medicine

Volume/Edition: 82 (10 supplement)

Publication Type: Journal

Article:

This study examines the American Board of Internal Medicine’s Diabetes Practice Improvement Module (PIM). Specifically, it compares the composite measures validity and reliability to individual items. The three components include: patient surveys, audit of medical records, and a questionnaire pertaining to the office’s practice system. The findings suggest that composites were more reliable measures than individual measures. This supports the practice of aggregating items into composites in Maintenance of Certification (MOC) as opposed to single items.

Performance on the American Board of Family Medicine (ABFM) Certification Examination: Are Superior Test-Taking Skills Alone Sufficient to Pass?

Author(s): T O'Neill, K Royal, J Puffer

Date: 2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 24 (2)

Publication Type: Journal

Article:

This study looked to examine claims that the certification program is testing one’s ability to take tests rather than a physician’s skill level of practicing medicine. To test this theory, four nonphysicians, all of which were experts in the area of certification testing, completed the 2009 ABFM board examination certification. Ultimately, none of the four individuals were able to score high enough to meet the minimum reportable score and only one participant outperformed any physicians. These results show that medical training is needed to be able to pass the examination and that test takers can not rest solely on cues.

NICU Practices and Outcomes Associated With 9 Years of Quality Improvement Collaboratives

Author(s): N Payne, M Finkelstein, M Liu, J Kaempf, P Sharek, S Olsen

Date: 2010

Publisher: Pediatrics

Volume/Edition: 125 (3)

Publication Type: Journal

Article:

In this study, researchers examined outcomes from 8 NICUs regarding quality improvement collaboratives sponsored by the Vermont Oxford Network. Quality improvement collaboratives are conducted through teams implementing evidence-based practices. In their 9 year study, researchers found reduced nosocomial infection rates, increased survival rates, and sustained implementation of respiratory PBPs in the participating NICUs. However, they did not see an improvement in the BPD or BPD-free survival rate. Overall, the study highlights the benefits that could come about from participating in QI, which resonates with Maintenance of Certification (MOC) Part IV requirement.

Family Physician Participation in Maintenance of Certification

Author(s): I Xierali, J Rinaldo, L Green, S Petterson, R Phillips, A Bazemore, J Puffer

Date: 2011

Publisher: The Annals of Family Medicine

Volume/Edition: 9 (3)

Publication Type: Journal

Article:

This study examines the characteristics of family physicians that are participating in the Maintenance of Certification (MOC) program. Researchers found that over 90% of physicians eligible to participate in MOC are in fact participating. However, those that work in poor, underserved areas, graduated from an international medical school, or who are solo practitioners are more likely to allow for a lapse in certification. Additionally, researchers found that women are more likely than men to not have a gap in certification. Overall, this research shows that physicians are participating in the program in substantial numbers.

Nosocomial Infection Reduction in VLBW Infants with a Statewide Quality-Improvement Model

Author(s): D Wirtschafter, R Powers, J Petit, H Lee, W Boscardin, M Subeh, J Gould

Date: 2011

Publisher: Pediatrics

Volume/Edition: 127 (3)

Publication Type: Journal

Article:

Researchers in this study were evaluating the effectiveness of the California Perinatal Quality Care Collaborative (CPQCC) quality-improvement model using a toolkit in decreasing rates of neonatal nosocomial infection. The researchers found that nosocomial infection rate decreased. Overall, the study found that the intervention approach, using a toolkit and attending a workshop or webcast, was effective in improving care outcomes. This mirrors the goal of Maintenance of Certification (MOC) Part IV, practice performance assessment.

Specialty Board Certification and Clinical Outcomes: The Missing Link

Author(s): L Sharp, P Bashook, M Lipsky, S Horowitz, S Miller

Date: 2002

Publisher: Academic Medicine

Volume/Edition: 77 (6)

Publication Type: Journal

Article:

In this study, researchers conducted a literature review examining the relationship between board certification and clinical outcomes. They collected 33 studies that meet their criteria, over which over half support a positive relationship between certification and positive clinical outcomes. However, they did note that very few published studies were appropriate for their analysis.

Statewide NICU Central-Line Associated Bloodstream Infection Rates Decline after Bundles and Checklists

Author(s): J Schulman, R Stricof, T Stevens, M Horgan, K Gase, L Saiman

Date: 2014

Publisher: Pediatrics

Volume/Edition: 127 (3)

Publication Type: Journal

Article:

In this study, 18 NICUs in New York state implemented evidence-based central-line insertion and maintenance bundles to standardize care. Providers participated in conference calls, workshops, and used checklist templates to establish standardized care. Researchers compared the effect from pre-intervention data and found a significant decline in NICU CLABSIs. However, the researchers found that site of care remains a concern for CLABSI risk. This study supports the goals of Maintenance of Certification (MOC) Part IV to improve quality of care.

Anesthesiologist Board Certification and Patient Outcomes

Author(s): J Silber, S Kennedy, O Even-Shoshan, W Chen, R Mosher, A Showan, D Longnecker

Date: 2002

Publisher: Anesthesiology

Volume/Edition: 96 (5)

Publication Type: Journal

Article:

In this article, researchers investigated mortality rates between procedures administered with the assistance of a board certified anesthesiologist and a non-certified anesthesiologists. After reviewing Medicare claims records, the research team ultimately observed greater rates of death with non-certified providers which suggests their is support for the validity of the certification program. The study aimed to assess the impact of anesthesiologist board certification status on patient outcomes. Pennsylvania Medicare claims data, specifically, records for patients that underwent general surgical or orthopedic procedures between 1991 and 1994 was used for that purpose. Patient severity and case mix, as well as hospital characteristics were taken into consideration. Two main outcomes were mortality within 30 days of admission, and the failure to rescue rate. Study findings revealed that midcareer anesthesiologists lacking certification, as well as the hospitals where they practiced were associated with worse patient outcomes. However, authors point out, that poor outcomes may be associated with the hospitals where anesthesiologists practice, and not necessarily their manner of practice.

An Analysis of the Knowledge Base of Practicing Internists As Measured by the 1980 Recertification Examination

Author(s): J Norcini, R Lipner, J Benson, G Webster

Date: 1985

Publisher: Annals of Internal Medicine

Volume/Edition: 102(3)

Publication Type: Journal

Article:

In this study, researchers reviewed the performance of candidates for the American Board of Internal Medicine’s 1980 Recertification Examination compared to those taking the ABIM’s 1979 Certifying Examination. They used a common-item linear equating procedure to compare the medical knowledge of both groups. Overall, they found their knowledge base was roughly on the same level between the two groups. They did note that performance on the test did decline with an increase in age but difference in performance measures were not impacted until the age of 60. The second study in the article addresses concerns that the recertification is not tailored to meet the needs of internists who have become very specialized in practice. The research team analyzed the performance on the 1980 Recertification Examination according to subspecialty concentration for ten different content areas. Their analysis confirmed that subspecialists do better than general internists on items related to their specialty. Furthermore, those interested in the subspecialty but not certified, performed better than those with no expressed interest. The researchers include that certification should be designed to test both general internal medicine as well as relevant subspecialties.

Maintenance of Certification and Its Association with the Clinical Knowledge of Family Physicians

Author(s): T O'Neill, J Puffer

Date: 2013

Publisher: Academic Medicine

Volume/Edition: 88 (6)

Publication Type: Journal

Article:

Researchers in this study compared the performances of recent residency graduates on the initial certification examination to already-certified family physician diplomates participating in the Maintenance of Certification (MOC) program. Additionally, they compared diplomates with gaps in their certification to those that had not allowed for a lapse. They found a significant trend that physicians who maintained their certification performed better than both initial certifiers and diplomates who allowed a gap in their certification status. These results suggest that maintaining certification is important component to improving clinical knowledge.

Identification of Knowledge Gaps in Neurosurgery Using a Validated Self-assessment Examination: Differences Between General and Spinal Neurosurgeons

Author(s): J Sheehan, R Starke , N Pouratian , Z Litvack

Date: 2013

Publisher: World Neurosurgery

Volume/Edition: 80(5)

Publication Type: Journal

Article:

This study describes knowledge gap assessment for general and sub-specialty neurosurgeons. Data from the self-assessment in neurological surgery (SANS) general and spine examinations (used in the ABNS Maintenance of Certification (MOC) program) was analyzed. Study results revealed different educational needs for general and spine neurosurgeons. The findings provide valuable insight relevant to CME design, as well as general and subspecialty CME curriculum in anticipation of improved patient care.

Setting a Fair Performance Standard for Physicians’ Quality of Patient Care

Author(s): B Hess, W Weng , L Lynn, E Holmboe, R Lipner

Date: 2010

Publisher: Journal of General Internal Medicine

Volume/Edition: 26(5)

Publication Type: Journal

Article:

This article describes the process of developing a composite performance measure, intended to serve as an acceptable standard in diabetes care. This is a retrospective study involving a study sample of nearly 1000 physicians certified by the American Board of Internal Medicine (ABIM). Individual clinical and patient experience measures representing evidence based care were adopted from ABIM diabetes PIM and used to develop the composite measure. Physician expert panel spanning the spectrum of the internal medicine practice established acceptable threshold for each measure and evaluated the importance of each measure in contributing to the overall diabetes care. They computed the composite measure and assessed its reliability (reproducibility), as well as classification accuracy subsequently. The study suggests that performance assessment is strengthened, when using a composite (as opposed to individual) performance measures. This study shows the commitment of ABIM to standard setting for physician performance.

The Association Between Physicians’ Cognitive Skills and Quality of Diabetes Care

Author(s): B Hess, W Weng , E Holmboe, R Lipner

Date: 2012

Publisher: Academic Medicine

Volume/Edition: 87(2)

Publication Type: Journal

Article:

This study explored the relationship between general internist Maintenance of Certification (MOC) examination scores and their clinical performance on a diabetes composite measure, assessed through ABIM diabetes PIM. For the PIM, participating physicians were required to abstract between 10 and 25 patient charts and distribute the same amount of patient surveys. Study results revealed a strong link between the examination scores and diabetes composite measure, indicating the importance of the cognitive skills to patient care. Participants chose to complete the PIM and they selected the patients for their performance evaluation themselves. However, the link between a comprehensive composite measure of diabetes care and MOC examination scores provides insight to the value of the examination in ABIM MOC program and in patient care.

The Role of Physician Specialty Board Certification Status in Quality Movement

Author(s): T Brennan, R Horwitz, F Duffy, C Cassel, L Goode, R Lipner

Date: 2004

Publisher: Journal of the American Medical Association

Volume/Edition: 292(9)

Publication Type: Journal

Article:

The article provides an opinion on the role of board certification in the national quality movement, largely prompted by the IOM report “To Err is Human.” The report focused on medical errors/patient safety and encouraged quality improvement through systems of care, opportunities for reliably measuring individual physician quality being limited. Unfortunately, Board certification hasn’t been considered as having a role in individual physician quality improvement, even though published evidence on the value of certification/Maintenance of Certification (MOC) suggest the correlation between examination scores and other physician quality measures, correlation of certification status and practice outcomes, and the internal validity of the very testing process. By means of practice performance assessment and cognitive examination, certification and MOC evaluate physician habits of practice and medical knowledge, both key in preventing mistakes. Gallup survey findings suggest that general public highly values certification/maintenance of certification.

Perspectives and Preferences Among the General Public Regarding Physician Selection and Board Certification

Author(s): G Freed, K Dunham, S Clark, M Davis

Date: 2010

Publisher: Journal of Pediatrics

Volume/Edition: 156(5)

Publication Type: Journal

Article:

Literature has shown that consumers are interested in health care quality reports, but they don’t necessarily know where to look for such information, or how to use it. Board certification and Maintenance of Certification (MOC), a voluntary public process, is one of the mechanisms for physician assessment. However, there is a lack of information on the public view of such a process, as well as the rigor that it entails. Most of the past studies concern adults choosing their health providers. This study attempts to identify parental attitudes regarding board certification and other factors influencing the choice of physicians for their children. Several hundred parents and non parents are surveyed in this study on a number of health related topics, with a significant portion of items focused on physician Board certification. The findings complement those of previous research, where patients are more likely to choose Board certified physicians and that they want information on certification status. Further, public expects hospitals and health plans to use Board certification as an indicator of competence.

Ratings of Residents’ Clinical Competence and Performance on Certification Examination

Author(s): J Norcini, G Webster, L Grosso, L Blank, J Benson

Date: 1987

Publisher: Journal of Medical Education

Volume/Edition: 62(6)

Publication Type: Journal

Article:

The study described in this article provides evidence to support the validity of board certification examination scores. Once residents apply to take internal medicine certification exam, residency program directors submit evaluations of their competence and its various components to the ABIM. These ratings were compared with performance on the Board certification examination. Study findings indicate that program director ratings and examination scores rank residents similarly. While the ratings of the individual components of clinical competence and ratings of general competence moderately correlated with examination performance, individual components correlated very highly with each other. Components that were less dependent on medical knowledge showed weaker correlation with examination performance.

Relationships of Ratings of Clinical Competence and ABIM Scores to Certification Status

Author(s): J Shea, J Norcini, H Kimball

Date: 1993

Publisher: Academic Medicine

Volume/Edition: 68(10)

Publication Type: Journal

Article:

The aim of this study was to compare the performance of Board certified internists who attempted certification in a subspecialty, and those who did not. Study participants were followed for 5 years. Besides comparison between the groups, participant performance was compared within the subset of the subspecialties. Overall clinical competence ratings by residency program directors and certification examination scores served as performance measures. Study findings suggest that the candidates who passed the subspecialty examination were perceived as most clinically competent at the end of their residency training. Similarly, examinees who earned a subspecialty certification scored highest on their initial certifying examination. There was no significant variation among the program director ratings within the subset of the examinees who obtained certification in both internal medicine and a subspecialty. Similarly, differences in average performance on an initial internal medicine examination were minimal among the members of this subset. In this retrospective study, scores were combined across the cohorts and not equated. Similarly, ratings by residency directors assessed participant performance indirectly. Nevertheless, study results point to differences among the performance of certified internists and certified subspecialists.

Certification and Specialization: Do They Matter in the Outcome of Acute Myocardial Infarction

Author(s): J Norcini, H Kimball, R Lipner

Date: 2000

Publisher: Academic Medicine

Volume/Edition: 75(12)

Publication Type: Journal

Article:

This study examined the differences among certified and non-certified cardiologists, internists, and family practitioners in light of their AMI patient mortality. The Pennsylvania Health Care Cost Containment Council data for AMI admissions and AMA Masterfile for specialty Board certification status and year of graduation from medical school were analyzed for this purpose. The AMI patient outcome data was risk adjusted. Besides patient and physician characteristics, hospital characteristics and hospital location were taken into consideration.  Study findings suggest that lower mortality is associated with treatment by cardiologists that cared for larger numbers of patients, were closer to their year of graduation from medical school, and were Board certified. Certification was associated with 15% reduction in AMI patient mortality. Limitations associated with physician attribution, risk adjustment procedures and lack of information on physician-patient relationships apply.

A Statewide, Population-based, Time Series Analysis of the Outcome of Ruptured Abdominal Aortic Aneurysm

Author(s): R Rutledge, D Oller, A Meyer, J Johnson

Date: 1996

Publisher: Annals of Surgery

Volume/Edition: 223

Publication Type: Journal

Article:

There were several aims addressed in this study: to perform the first, statewide, population based time-series analysis of the frequency of ruptured abdominal aortic aneurysm (RAAA); to determine the outcomes of RAAA; and to assess the association of patient, physician and hospital factors with survival after RAAA. For the purposes of the study, data was obtained from four different data sources; therefore, study results are subject to database limitations. Nevertheless, one of the main hypotheses of the study, increased physician expertise and experience would positively affect the outcome of RAAA patients, was generally confirmed. Results show that physicians lacking board certification have lower survival of patients with RAAA, although the effect was relatively modest. Similarly, association between physician experience with RAAAs and patient survival is found to be statistically significant.

Who Claims to be a Pediatrician?

Author(s): G Freed, R Uren, R Hudson, I Lakhani, American Board of Pediatrics Research Advisory Committee

Date: 2007

Publisher: Journal of Pediatrics

Volume/Edition: 150(6)

Publication Type: Journal

Article:

Since physicians have an opportunity to list themselves as specialists without proof of training or certification, there is a chance for misrepresentation. It becomes especially important, considering recent attention to patient safety and public’s preference for Board certification. The purpose of this study was to identify the proportion of physicians that aren’t Board certified, but declare being pediatricians. For the purpose of this study, state licensure roster was compared to a listing of ABP for physicians, designated as pediatricians in eight states. Physicians that appeared as non-certified pediatricians received a mail survey, which attempted to determine their training and practice characteristics. Survey results revealed that a portion of respondents claimed to be pediatricians without completing pediatric residency.  A study like this informs patients, when seeking out doctors for their children.

Confirming the Validity of the General Pediatrics Certification Examinations: A Practice Analysis

Author(s): L Althouse, Y Du, H Ham

Date: 2009

Publisher: Journal of Pediatrics

Volume/Edition: 155(2)

Publication Type: Journal

Article:

Practice analysis was used in this study to validate the ABPeds initial certification and Maintenance of Certification (MOC) examinations. During phase one of the study, thirteen board-certified, actively practicing subject matter experts rated the importance and frequency in practice of 35 competency knowledge domains. During phase two, a random sample of 1000 actively certified GPs selected from the ABP database were asked to rate the importance (on a 5-point Likert scale) of detailed content outline for each competency domain reviewed by the experts in phase 1, and to also provide information about their practice. Survey response rate was approximately 51%. The phase 2 study participants recommended using essentially the same blueprint for both initial and MOC examinations. However, study findings prompted minor changes to examination content, suggesting a close match between current pediatric practice and examination content specifications. While the practice analysis reflects self reported rather than actual practice patterns, study results confirm that examination blueprint aligns with the knowledge necessary for competent general pediatric practice.

Improving Asthma Care Through Recertification: A Cluster Randomized Trial

Author(s): J Simpkins, G Divine, M Wang, E Holmboe, M Pladevall, L Williams

Date: 2007

Publisher: Annals of Internal Medicine

Volume/Edition: 167

Publication Type: Journal

Article:

This article describes a cluster randomized trial, aiming to assess whether completion of asthma specific PIM has impact on patient outcomes. In completing a PIM, physicians evaluate their management of a specific disease condition, develop and implement a plan to improve the care for that condition, and measure the impact of the implemented plan on subsequent care. Patient level data concerning sociodemographics, processes of care, medication dispensing, asthma control and symptoms and perception of general health are assessed using patient surveys and electronic claims data. Study results show that there is no improvement in the primary outcome, dispensing of the inhaled corticosteroids (ICSs). However, there is an improvement in patient self reported asthma severity in patients treated by intervention group physicians, when compared with the control group. Study findings, therefore, suggest that recent recertification requirements implemented by the ABIM may improve the disease outcomes. Some limitations apply, e.g., participant ability to choose the process measure to improve, generally low patient response rates on surveys, etc.

Association Between Licensure Examination Scores and Practice in Primary Care

Author(s): R Tamblyn, M Abrahamowicz, W Dauphinee, J Hanley, J Norcini, N Girad, C Brailovsky

Date: 2002

Publisher: Journal of the American Medical Association

Volume/Edition: 288(23)

Publication Type: Journal

Article:

The goal of this study was to find out whether there was a lasting relationship between certification examination scores and practice performance, and whether licensing examinations taken at the end of the medical school were predictive of future practice. Nearly a thousand family physicians that passed certification examination between 1990 and 1993 and entered practice in Quebec, Canada, participated in the study. Data on physician practice performance for 3.4 million patients was accessed through the linked databases in the universal health care system of Quebec; patients seen in the first 4 to 7 years of physicians’ practice were followed. Study findings (although subject to database limitations) showed that relationships between certification examination scores were indeed maintained through the first 4 to 7 years of practice, and that examinations taken in the final year of medical school were significant predictors of practice performance.

Effect of Board Certification on Antihypertensive Treatment Intensification in Patients with Diabetes Mellitus

Author(s): A Turchin, M Shubina, A Chodos, J Einbinder, M Pendergrass

Date: 2008

Publisher: Circulation

Volume/Edition: 117

Publication Type: Journal

Article:

This is a retrospective study, which explores the association between the time of the last physician board certification and antihypertensive treatment intensification in diabetes mellitus patients. Study findings show that treatment intensification decreases, as the time from last physician certification increases. While past and present blood pressures, nature of physician-patient relationship, and the number of acute conditions addressed during the visit show a strong effect in the probability of treatment intensification, physician age does not. No direct comparison of medication doses is performed, and any medication change is considered treatment intensification. Study relies on medical record accuracy and the sensitivity of computerized technology (84%) used to analyze the data. However, it includes over 8000 hypertensive diabetes patients as participants, and it shows quantitative relationship between board certification and a process measure of quality of care.

Certifying Examination Performance and Patient Outcomes Following Acute Myocardial Infarction

Author(s): J Norcini, R Lipner, H Kimball

Date: 2002

Publisher: Medical Education

Volume/Edition: 36

Publication Type: Journal

Article:

The study explores whether successful completion of certifying examination is associated with patient mortality and length of stay following acute myocardial infarction. Results suggest that mortality is decreased for patients receiving care from board certified cardiologists. Doctor  characteristics, e.g. patient volume, year of attempted certification, are not related to mortality, according to study results. Further, findings demonstrate that patients treated by certified doctors do not spend significantly less time in hospital. Nevertheless, results suggest that examination performance is related to patient outcomes.

Who is Maintaining Certification in Internal Medicine – and Why? A National Survey 10 Years After Initial Certification

Author(s): R Lipner, W Bylsma, G Arnold, G Fortna, J Tooker, C Cassel

Date: 2006

Publisher: Annals of Internal Medicine

Volume/Edition: 144(1)

Publication Type: Journal

Article:

A mail survey consisting of 20 questions was distributed to physicians certified in internal medicine in 1990, 1991, and 1992, in order to determine the reasons for maintaining certification. The response rate was slightly over 50% and results revealed that for more than a half of respondents certification was required by at least one of their employers. However, only a third of the respondents that were engaged in/have completed the Maintenance of Certification (MOC) process indicated it as a reason for recertification; for this cohort, it was part of the professional development. The most common reasons diplomates provided for participating in MOC were to maintain or enhance their professional image, update their knowledge base, or maintain or improve patient care quality. Those that did not participate most frequently indicated that the process took too much time. Other reasons offered for not participating were the expense of MOC, unreasonable requirements, not relevant to practice (primarily for specialists not participating in general internal medicine MOC, and not required by their employer). Most respondents indicated that patients and peers value certification, and that physicians working in direct healthcare should be certified. The survey was completed by volunteers, therefore, those with less favorable attitude towards MOC might have responded at a higher rate. Further, since it involved self reporting, the results might lack accuracy. Lastly, misconceptions about program requirements might also have led to inaccurate responses.

Teaching Internal Medicine Residents Quality Improvement Techniques Using the ABIM’s Practice Improvement Modules

Author(s): J Oyler, L Vinci, V Arora, J Johnson

Date: 2008

Publisher: Journal of General Internal Medicine

Volume/Edition: 23

Publication Type: Journal

Article:

The article describes the use of ABIM Clinical Preventative Services Practice Improvement Module (CPS PIM) for teaching Internal Medicine residents quality assessment and improvement techniques, and the effect it has on resident confidence in QI skills. The quality assessment and improvement curriculum, based on ABIM CPS PIM is incorporated  in 2 required 1-month ambulatory rotations during the postgraduate year 2. Residents complete chart reviews in order to assess practice, and design group interventions that would help correct the deficiencies. To evaluate the effect of the curriculum, a self-assessment tool evaluating QI skills is administered. The ABIM’s CPS PIM provides a standardized, web based, evidence based, affordable and efficient tool to teach residents the QI basics. Group projects empower learners to reflect on the quality data, and to produce changes in their continuity clinic experience. The results of the intervention suggest that resident confidence in QI skills improves, as a result of this curriculum. Not only are residents able to make significant changes in practice, but also, disseminate the findings in scholarly work, e.g. an internal resident research day, or a hospital quality fair. Challenges to implementing the PIM include time, funding, and faculty with QI experience.

Predictive Validity of Certification by the American Board of Internal Medicine

Author(s): P Ramsey, J Carline, T Inui, E Larson, J LoGerfo, M Wenrich

Date: 1989

Publisher: Annals of Internal Medicine

Volume/Edition: 110

Publication Type: Journal

Article:

The article describes a study exploring predictive validity of American Board of Internal Medicine (ABIM) certification, where two groups of physicians: 1) internists certified by the ABIM, who successfully achieved certification 5 to 10 years prior; and 2) those that completed training 5 to 10 years prior, but did not successfully achieve or attain certification were compared relative to performance on peer and patient evaluations and medical record audit. The peer survey assessed clinical skills, clinical reasoning, communication skills and humanistic qualities. The patient questionnaire measured satisfaction with physician services and information relevant to risk assessment and counseling aspects of preventative care. Ratings of clinical skills by professional peers were significantly higher for certified internists. Multivariate analysis showed ABIM certification status was significantly associated with performance on these measures of clinical competence. Lastly, study findings show that certified physicians provide a more comprehensive preventative care.

Patient Outcomes for Segmental Colon Resection According to Surgeon’s Training, Certification, and Experience

Author(s): J Prystowsky, G Bordage, J Feinglass

Date: 2002

Publisher: Surgery

Volume/Edition: 132

Publication Type: Journal

Article:

This is a retrospective study, which examined whether colon resection outcomes were associated with: 1) general surgery certification, 2) colorectal subspecialty certification, 3) university/non-university residency training site, and 4) years of experience since general  certification. Over 15, 000 patients having undergone colorectal resection by more than 500 surgeons from 1994-1997 were examined. Outcome measures were: 1) mortality, 2) complications and 3) hospital length of stay. Study findings revealed that general surgery certification and years of experience were associated with lower morbidity and mortality, while subspecialty certification and residency training site were non-significant predictors of the outcomes. Limitations of the study include: 1) retrospective design; 2) quality of diagnostic coding with ICD-9 codes; 3) lack of adjustment for hospital-level factors; 4) only select outcomes were examined (but mortality was a key outcome); and 5)ABS recertification or National Practitioner Data Bank reporting were not included as variables.

Delivery of Preventive Services to Older Adults by Primary Care Physicians

Author(s): H Pham, D Schrag, J Hargraves, P Bach

Date: 2005

Publisher: Journal of the American Medical Association

Volume/Edition: 294

Publication Type: Journal

Article:

This study, using Medicare claims data, explored an association between physician and practice characteristics, and the  quality of preventive care received by Medicare patients. Over 3,000 physicians providing care to over 24, 000 Medicare patients (65 and older), who participated in an ongoing practice survey study, were included in the analyses. Physician variables included training, certification, qualifications, and gender, and practice variables included practice type, size, sources of revenue, and access to information technology. Study results were adjusted for patient demographics, comorbidity, and community characteristics. Large variations in the quality of care were found, based on physician characteristics. Patients treated in group practices were more likely to receive preventative services than those treated in solo/2 person practices or institution-based practices. Also, board certified physicians were more likely to deliver some, but not all, preventative services. Information technology, availability of clinical guidelines, or physician reminders showed only a limited improvement in delivery of preventative care services. It is important to note that physicians lacking board certification made up only 15% of participants; lastly, claims data may not necessarily capture all preventive care services rendered, and there was no certainty that physicians, analyzed in this study, were always the main sources of primary care for the beneficiaries.

Physicians Disciplined by a State Medical Board

Author(s): J Morrison, P Wickersham

Date: 1998

Publisher: Journal of the American Medical Association

Volume/Edition: 279

Publication Type: Journal

Article:

This study examined physician disciplinary action in California between October 1995 and April 1997. A total of 375 physicians were disciplined for 465 offenses by the California State Medical Board during the 18-month period. Findings revealed that one third of all cases were relevant to negligence or incompetence. Disciplined physicians were more likely to be male, in practice for over 20 years and not have board certification. This article cited previous studies that showed that board certified physicians were less likely to be disciplined by the state medical board.

The Importance of Surgeon Volume and Training in Outcomes for Vascular Surgical Procedures

Author(s): W Pearce, M Parker, J Feinglass, M Ujiki, M Manheim

Date: 1999

Publisher: Journal of Vascular Surgery

Volume/Edition: 29(5)

Publication Type: Journal

Article:

This study attempted to assess the impact of surgeon volume on outcome after carotid endarterectomy, lower extremity bypass grafting, and abdominal aortic aneurysm repair. The study was based on hospital discharge data for all non federal hospitals of Florida from 1992-1996. The data was obtained from Florida agency for Health Care Administration and contained attending physician and surgeon identifiers. Deaths were determined from discharge status coding and vascular surgeon certification status obtained from the American Board of Medical Specialties. In order to predict outcomes for each procedure, the year of discharge, length of stay, patient age, sex and emergency admission status were considered; similarly, hospital bed size, teaching status, and ownership characteristics. Study findings revealed that longer hospital stay was associated with worse outcomes, and complications determined longer hospital stays. In case of carotid endarterectomy, hospital size, the volume of the procedures performed in that hospital, surgeon caseload and certification in vascular surgery were all responsible for successful outcomes. Similar findings were revealed relevant to abdominal aortic aneurysm repairs. However, the records did not provide adequate basis to determine the quality of care relevant to lower extremity bypass grafting, except that surgeon volume was associated with the rates of MI, CVA, and death. It is important to note that study findings are subject to database limitation. There is a chance that associated clinical variables not evident from the records might have affected the outcomes. In summary, vascular surgery is most likely to generate good outcomes, if it is performed in a hospital that has high volumes, and by surgeons that operate frequently and have qualification in general vascular surgery.

Characteristics Associated with Physician Discipline: A Case-control Study

Author(s): N Kohatsu, D Gould, L Ross, P Fox

Date: 2004

Publisher: Archives of Internal Medicine

Volume/Edition: 164

Publication Type: Journal

Article:

The aim of this study was to see if there was an association between certain physician characteristics and the likelihood of medical board imposed discipline. The study was conducted in California and involved physicians disciplined by the state medical board between 1998 and 2001. Physicians in the specialties of obstetrics and gynecology, general practice, psychiatry, and family practice were more likely to be disciplined than those in internal medicine, while those practicing pediatrics and radiology were less likely to be disciplined than internists. Increasing age, male sex, and international medical education were associated with a higher risk of discipline. Since the study was restricted to one specific state, the results may have been biased due to the prevalent practice styles, patient populations and legal framework. Similarly, social and cultural factors relating to physician-patient interactions were not taken into consideration. Nevertheless, board certification was associated with a significantly lower risk of discipline (53% of disciplined physicians were board certified, compared to 73% of control group physicians).

Disciplinary Action Against Physicians: Who is Likely to Get Discipline?

Author(s): A Khaliq, H Dimassi, C-Y Huang, L Narine, R Smego

Date: 2005

Publisher: American Journal of Medicine

Volume/Edition: 118

Publication Type: Journal

Article:

Researchers attempted to identify the characteristics of physicians disciplined by State Medical Boards, and to assess the risk of disciplinary action over time. For that purpose, publicly available data for physicians licensed in Oklahoma was obtained and analyzed for disciplinary action in 2001. Study findings showed that the rate of disciplinary action increased over time, with each successive 10 year period since licensure. Increased risk of disciplinary action was associated with being a man, non-white, and non-board certified, and practicing family medicine, general practice, psychiatry, obstetrics gynecology, and emergency medicine. The hazard ratio for adverse licensure action for non-board certified compared to board certified physicians was 3.3 (p<0.001) by univariate analysis and 2.2 (p<0.001) by multivariate analysis. The most common disciplinary action involved quality of care issues, medication/prescription violations, incompetence, and negligence/malpractice. More than half of the complaints were brought forward by general public; significantly less came from the Federation of State Medical Boards, Medicare, insurance companies and law enforcement agencies; and least, from other physicians, office staff, national practitioner data bank, pharmacies and pharmacists, and hospital personnel. Study findings are subject to database accuracy.

Heart Disease and Hospital Deaths: An Empirical Study

Author(s): J Kelly, F Hellinger

Date: 1987

Publisher: Health Services Research

Volume/Edition: 22

Publication Type: Journal

Article:

The study examines mortality rates of heart patients that survive their first day in the hospital. Three groups of patients diagnosed with atherosclerosis are examined: 1) those that undergo a CABG operation, 2) those that undergo a cardiac catheterization, but not CABG, and 3) those that experience the AMI, but don’t receive any treatment. Treating physician characteristics are board certification status and the volume of similar patients. Hospital characteristics include the presence of coronary care unit, teaching status, size, and volume of similar patients. Other factors taken into consideration are severity of illness, patient age, sex, and comorbidities. The findings reveal that AMI patients are more likely to survive if their attending physicians treat high volumes of AMI patients, and when they are board certified in family or internal medicine. CABG/cardiac catheterization patients are more likely to survive in hospitals that handle high volumes of such procedures. Further, AMI patients in teaching facilities are less likely to die, just as in facilities that have a cardiac care unit. Finally, age and comorbidity variables performed as expected.

Physician and Hospital Factors Associated with Mortality of Surgical Patients

Author(s): J Kelly, F Hellinger

Date: 1986

Publisher: Medical Care

Volume/Edition: 24

Publication Type: Journal

Article:

The aim of this study was to examine the deviation of hospital mortality relevant to the volume of specific surgical procedures performed in a hospital, the volume of these procedures performed by patient’s primary surgeon, physician board certification, and other factors, such as severity of illness, patient age, hospital teaching status, size and location. Researchers obtained data from discharge abstract records, as well as American Hospital Association’s Annual Survey of Hospitals for 1977 and American Medical Association’s Masterfile of U.S. Physicians. Study findings revealed that surgical patient mortality was lower in hospitals with a larger volume of specific surgical procedures and in those with a medical school affiliation. Mortality was not associated with the volume of procedures performed by surgeons, but was lower for doctors who were board certified. For patients operated on for peptic ulcer disease, the mortality rate was 2% lower if their surgeon was board certified. Similar associations were seen for stomach cancer and abdominal aneurysm surgery, but the reported coefficients were not statistically significant.

Patients’ Perception of Hospital Care in the United States

Author(s): A Jha, E Orav, J Zheng, A Epstein

Date: 2008

Publisher: New England Journal of Medicine

Volume/Edition: 359

Publication Type: Journal

Article:

This article reviews patient perceptions of hospital care in the United States, based on HCAHPS data, provided by 60% of U.S. hospitals. The study examines whether key characteristics of hospitals thought to enhance patient experiences are indeed associated with better experiences for patients, and whether performance on HCAHPS is related to quality of care. The findings reveal that most patients are generally satisfied with the care they receive; however, there is room for improvement. Areas for improvement include those of nursing care, communication about medications, pain control and provision of clear discharge instructions. Hospitals with higher nurses to patient-days show better patient experiences. Similarly, hospitals performing better on HCAHPS are more likely to provide better quality of care across measures of clinical quality (for example management of acute myocardial infarction and pneumonia).

Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries

Author(s): E Holmboe, Y Wang, T Meehan, J Tate, S Ho, K Starkey, R Lipner

Date: 2008

Publisher: Archives of Internal Medicine

Volume/Edition: 168(3)

Publication Type: Journal

Article:

The study examines the association between physician cognitive skills, measured by the ABIM Maintenance of Certification (MOC) examination, and physician practice performance, defined by a set of CMS quality measures for patients with diabetes, patients requiring mammography screening, and patients with cardiovascular disease. Study findings for 3602 general internists suggest that top scoring (top quartile on the MOC examination) physicians are more likely to perform processes of care for diabetes patients (HbA1C and lipid screening and retinal examinations) and patients requiring mammography screening. However, the results indicate no significant association between lipid screening and examination scores for patients with cardiovascular disease (potentially explained by concomitant care by a cardiologist). Physician cohort is restricted to those certified between 1990 and 1995.

Promoting Physicians’ Self-assessment and Quality Improvement: The ABIM Diabetes Practice Improvement Module

Author(s): E Holmboe, T Meehan, L Lynn, P Doyle, T Sherwin, F Duffy

Date: 2006

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 26(2)

Publication Type: Journal

Article:

This is a review of a beta test of the ABIM diabetes practice improvement module, used in recertification program of general internists and endocrinologists. Participant feedback reveals that physicians found self-assessment using the PIM to be a valuable experience. There was wide variability in the performance of some target clinical goals. They were able to identify areas for improvement through medical record audit and responded that the information was useful in implementing change in their practices. There was also wide variability in ratings on the patient surveys; specifically, the helped identify areas for improvement relevant to patient- education. It is important to note that the pilot sample size was small (16 completed PIM data entry/14 completed all PIM steps), and that physicians were self selected. There was no set sampling strategy for medical record audit, and participants chose different interventions for quality improvement in their respective practices.

Assessing Quality of Care: Knowledge Matters

Author(s): E Holmboe, R Lipner, A Greiner

Date: 2008

Publisher: Journal of the American Medical Association

Volume/Edition: 299(3)

Publication Type: Journal

Article:

This article discusses the relationship between medical knowledge and quality,specifically, how secure examination component of specialty board certification is an important complement to performance measures. Over the last couple decades there has been a significant development in understanding of how physicians integrate medical knowledge and clinical skills in the clinical judgment process. In order to properly manage a condition, conduct testing, or assign therapy, physicians have to adequately process information, and therefore, exercise sound clinical judgment. Researchers suggest that among other things, medical errors happen due to problems with clinical judgment. Knowledge ages over time, and when a new body of knowledge emerges, ideally, physicians should incorporate it into clinical reasoning. Rigorous testing, specifically via secure examination, provides an opportunity for assessing, whether physicians are successful in incorporating new information over time. Relying on quality measurement alone will not address many aspects of care and, in particular diagnostic reasoning, errors in which are associated with adverse outcomes. While examination raises anxiety, requires preparation and generates costs, knowledge is one of the foundational clinical practice competencies, and therefore requires proper attention.

Physician Credentials and Practices Associated with Childhood Immunization Rates: Private Practice Pediatricians Serving Poor Children in New York City

Author(s): K Hanson, G Butts, S Friedman, G Fairbrother

Date: 2010

Publisher: Journal of Urban Health

Volume/Edition: 78

Publication Type: Journal

Article:

The article describes a study that compares children’s immunization rates at 60 private physician practices in poor neighborhoods of New York. Half of the physicians participating in the study are board certified, and half are a part of the Medicaid Preferred Physicians and Children (PPAC) program. Study results demonstrate higher immunization rates among PPAC physicians and better rates among those that are board certified. Study limitations include a small study sample, self reporting of credentials, affiliations and practices, and a focus on a subset of foreign-trained physicians serving a large number of high-risk children, therefore study results may not be generalized to all pediatricians/primary care providers. Nevertheless, board certification, one of the conditions for enrolling in PPAC, is associated with immunization performance, according to the findings.

Maintenance of Certification of Family Physicians (MC-FP) Self-assessment Modules (SAMs): The First Year

Author(s): M Hagen, D Ivins, J Puffer, J Rinaldo, G Roussel, W Summer, J Xu

Date: 2008

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 19(4)

Publication Type: Journal

Article:

The article summarizes the feedback of a family physician cohort (over 7000 physicians) that went through the first year of activities (Part II self-assessment modules (SAMs)) for the ABFM Maintenance of Certification (MOC) program, newly implemented in 2004. Free text comments from activity evaluations were analyzed and revealed generally favorable responses relevant to diabetes and hypertension SAMs. The SAMs were rated highly with regard to the relevance and usefulness of information provided, the knowledge assessment and the overall module value. More than half of respondents shared that the experience would lead to changes in practice. It shoud be noted that the SAMs were modified over the course of the year; the participants engaged in the activity at different times throughout that year, which was not taken into consideration, when analyzing study results. Changes in practice are self-reported.

The Relationship Between Physicians’ Qualifications and Experience and the Adequacy of Prenatal Care and Low Birthweight

Author(s): J Haas, J Orav, L Goldman

Date: 1995

Publisher: American Journal of Public Health

Volume/Edition: 85(8.1)

Publication Type: Journal

Article:

This study explored the relationship between physicians’ qualifications and experience, and the recommended number of prenatal visits and low birthweight for women in Massachusetts in 1990. Prior research demonstrates a relationship between the process of prenatal care and neonatal mortality and low birth weight; low birth weight is associated with increased neonatal morbidity and mortality. Board certification was used as a measure of physicians’ qualification. Study findings, based on 80,537 deliveries show that non-board-certified physicians are significantly less likely to provide the recommended number of prenatal visits and are more likely to deliver low birthweight infants. The results also suggest a positive association between physicians’ time in practice and practice volume, and the quality of prenatal care and birth outcomes. Study limitations include the possibility that more motivated patients may select “better” physicians, which may have contributed to the outcome. Also, there were no specific data available on detailed clinical information about the actual prenatal services. In addition, physicians recorded on the birth certificates of infants might have not necessarily been the ones to provide the most of the prenatal care.

Patient-centered Processes of Care and Long-term Outcomes of Myocardial Infarction

Author(s): A Fremont, P Cleary, J Hargraves, R Rowe, N Jacobson, J Ayanian

Date: 2001

Publisher: Journal of General Internal Medicine

Volume/Edition: 16

Publication Type: Journal

Article:

The aim of this study was to determine whether patient experiences with nontechnical aspects of care, i.e., patient education and discharge planning, were associated with long term outcomes. Acute myocardial infarction patients hospitalized in 23 New Hampshire hospitals received a survey at 1, 3, and 12 months post discharge, which aimed to assess the experience of care; other clinical measures were obtained from discharge abstracts. There was no data available on non-respondents, or patients that died during 12 months after their hospitalization, and the study sample was concentrated in a few hospitals of a single state. Yet, study findings revealed that negative hospital experiences were associated with worse long term outcomes, specifically, worse health status and more symptoms. The authors conclude that patient experiences of care and patient reported measures provide important information about clinical quality of care, and serve as more than just an indicator of patient satisfaction.

Characteristics of General and Subspecialty Pediatricians Who Choose Not to Recertify

Author(s): G Freed, K Dunham, L Althouse

Date: 2008

Publisher: Pediatrics

Volume/Edition: 121(4)

Publication Type: Journal

Article:

This study attempted to discover why general and subspecialty pediatricians, whose certificates expired, did not plan to participate in maintenance of certification. A complete list of U. S. pediatricians with lapsed certification as specialists and/or subspecialists that did not recertify in 2004-2005 was obtained from the ABP database. Separate questionnaires were developed for generalists and subspecialists, and they focused on the reasons for participation/nonparticipation. Study findings demonstrated that more than half of the participating generalists and almost all subspecialists intended to recertify. More than half of the participants indicated that the main reason for future participation in Maintenance of Certification (MOC) was the chance to update the knowledge. A significant portion of participants indicated hospital privileging requirements as another reason. For those that did not intend on participating in MOC, the main reasons cited were the expense and the time associated with the process. Other reasons for generalists were perceived lack of relevance to their current practice, and for subspecialists, a change in career path that did not necessitate participation in MOC. About a third of participants that did not intend to recertify shared that they didn’t want to take a secure examination. In general, participants believed that specialists providing patient care should maintain certification, and that patients and peers felt that there was professional value in participation in MOC. It is important to note that in this study, there was a lack of physician representation in some subspecialties, and that international medical graduates were least likely to respond.

Self-assessment of Practice Performance: Development of the ABIM Practice Improvement Module (PIM)

Author(s): F Duffy, L Lynn, H Didura, B Hess, K Caverzagie, L Grosso, E Holmboe

Date: 2008

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 28

Publication Type: Journal

Article:

The article describes how the American Board of Internal Medicine (ABIM) develops Practice Improvement Modules (PIMs) and reviews the experiences of the first time users of the Preventative Cardiology PIM (PC-PIM). In this study, the PC-PIM serves as a self administered tool to assess the quality of practice using performance measures; also, to obtain feedback from patients. Study findings suggest opportunities to enhance PIM-like activities deployed in Maintenance of Certification (MOC) programs. Meaningful gaps in physician clinical performance were identified, including difficulty in the application of quality improvement methods to impact system change and improve performance. The authors suggest that future efforts should focus on identification of factors that could help physicians apply QI method in their practices and of educational interventions that might be beneficial. Patient surveys were useful in identifying improvement needs in practice communication and in physicians’ ability to self-assess their patients’ healthcare needs. Of note, the performance of physicians enrolled in ABIM’s MOC and participating in this study was better than that reported in recent research; several reasons are offered for the noted difference.

Professionalism in Medicine: Results of a National Survey of Physicians

Author(s): E Campbell, S Regan, R Gruen, T Ferris, S Rao, P Cleary, D Blumenthal

Date: 2007

Publisher: Annals of Internal Medicine

Volume/Edition: 147(11)

Publication Type: Journal

Article:

A national survey assessing physician professionalism queried physicians specializing in internal medicine, family practice, pediatrics, surgery, anesthesiology, and cardiology. Physician respondents generally agreed with published norms regarding professionalism principles and behaviors (although approximately a quarter disagreed with the need for recertification). However, self-reported behaviors were not consistent with their expressed beliefs, particularly in the areas related to professional self-regulation, conflict of interest, and resource use. As examples, reported behaviors were consistent with beliefs regarding honesty with patients and protecting patient confidentiality, but not necessarily with reporting of an incompetent/impaired colleagues to the authorities and management of financial conflict of interest. A number of respondents indicated they would accommodate a patient that badly wanted a test, even knowing it was unnecessary. Also, a gap was found between physician attitudes toward quality improvement and  participation in related activities. It is important to note that conformance to norms varied  across participating physician subgroups (specialties). While the authors did not identify a specific means or method for doing so, they suggested exploration of ways to improve  physician professionalism that should reflect physician specialty and practice context.

Comparison of Quality of Care in the Veterans Health Administration and Patients in a National Sample

Author(s): S Asch, E McGlynn, M Hogan, R Hayward, P Shekell, L Rubenstein, E Kerr

Date: 2004

Publisher: Annals of Internal Medicine

Volume/Edition: 141

Publication Type: Journal

Article:

Previous research demonstrated that a sample of patients from 12 communities in the United States received just over half (55%) of the recommended healthcare in preventive, acute and chronic care contexts (McGlynn, 2003). This study compared the quality of outpatient and inpatient care among a national sample of patients drawn from 12 communities, and VHA patients from 12 healthcare systems of southwestern and midwestern United States. Specifically, 348 quality indicators targeting 26 conditions were measured. While the study did not account for all medical care, and just for its specific aspects, it found that adherence to recommended processes of care in 2 VHA regions exceeded that in the national sample in several categories (overall quality, 67% vs. 51%; chronic disease care, 72% vs. 59%, and preventive care, 64% vs. 44%). Differences in performance were largest in areas that were targeted by VHA performance measurement (66% vs. 43%). Although other variables may have contributed to the outcome, study results suggest that the implementation of performance measurement and monitoring are strongly related to the quality of healthcare provided.

Physician Board Certification and the Care and Outcomes of Elderly Patients with Acute Myocardial Infarction

Author(s): J Chen, S Rathore, Y Wang, H Krumholtz, M Radford

Date: 2006

Publisher: Journal of General Internal Medicine

Volume/Edition: 21

Publication Type: Journal

Article:

The study examined the relationship between board certification, quality of care and outcomes in elderly patients hospitalized with acute myocardial infarction (AMI). Study findings revealed that physicians board certified in Internal Medicine, Family Medicine and Cardiology provided a slightly higher quality of care, as assessed by guideline recommended treatments for AMI. Despite higher uses of ASA and B-blockers in managing AMIs, there was no difference in mortality between board certified and non-certified physicians. Study limitations included the inability to determine that decisions regarding patient care were made solely by the attending physicians examined in this study, and the accuracy of board certification status as listed in the AMA Physician Masterfile. Although the study demonstrates a modest correlation between board certification and quality of the treatment of a life threatening disease the authors pointed out that even board-certified physicians had considerable room to improve the quality of care provided.