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

O’Neill, Thomas R. PhD; Puffer, James C. MD

Academic Medicine:
doi: 10.1097/ACM.0b013e3182900de4
Research Reports

Purpose: To examine the relationship between maintenance of certification (MOC) and the clinical knowledge demonstrated by family physicians as they move further away from formal training.

Method: Performances of 10,801 examinees—2,440 seeking initial certification; 8,361 seeking MOC—on the summer 2009 American Board of Family Medicine (ABFM) certification examination were compared across 30 cohorts that represented recent residency program graduates and already-certified family physician diplomates with varying years of clinical experience. Experience was defined as the time in years since the year of initial certification. This study employed a natural-groups, cross-sectional design; however, it was used to draw longitudinal inferences.

Results: Family physicians who maintained certification performed better than recent graduates. They increased their examination scores by almost 17 points each successive time that they took the exam, with scores reaching their highest point 28 to 31 years after initial certification. Multiple comparison analyses confirmed that the trend was significant; however, subanalyses revealed that this trend remained significant only for U.S. medical graduates (USMGs) but not international medical graduates. Those family physicians that did not maintain their certification performed significantly worse than recent graduates.

Conclusions: The findings suggest that ABFM diplomates who are USMGs and maintain their certification perform better on the ABFM certification examination with additional years of experience until approximately 30 years after residency training.

Author Information

Dr. O’Neill is vice president of psychometric services, American Board of Family Medicine, Lexington, Kentucky.

Dr. Puffer is president and CEO, American Board of Family Medicine, Lexington, Kentucky.

First published online April 24, 2013

Correspondence should be addressed to Dr. O’Neill, 1648 McGrathiana Pkwy., Suite 550, Lexington, KY 40511-1247; telephone: (859) 269-5626 ext. 1225; e-mail:

© 2013 Association of American Medical Colleges