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Can Maintenance of Certification Work? Associations of MOC and Improvements in Physicians’ Knowledge and Practice

Price, David W., MD; Biernacki, Helene; Nora, Lois Margaret, MD, JD, MBA

doi: 10.1097/ACM.0000000000002338

Purpose To summarize the findings of studies, conducted by individuals both internal and external to the American Board of Medical Specialties (ABMS) Member Boards, of the associations of Maintenance of Certification (MOC) and improvements in physicians’ knowledge and patient care processes or outcomes.

Method The authors conducted a narrative review of studies identified by searching PubMed and Web of Science for English-language articles from the United States published between 2000 and May 2017. To be included, articles had to examine the relationship of MOC to physician knowledge, clinical practice processes, or patient care outcomes. The initial search yielded 811 articles. After two rounds of review and excluding those articles that did not fit the study criteria, 39 articles were included for analysis.

Results The 39 included studies were conducted by or included diplomates of 12 ABMS Member Boards. Twenty-two studies examined MOC processes that were developed by an ABMS Board; 17 examined interventions that were developed by nonboard entities but accepted for MOC credit by an ABMS Board. Thirty-eight studies examined a single component of MOC; 24 studied the improvement in medical practice component. Thirty-seven studies reported at least one positive outcome.

Conclusions Most of the studies included in this review highlighted circumstances in which MOC was associated with positive impacts on physician knowledge and patient care processes or outcomes. Future collaborative research is needed to improve the relevance, helpfulness, and generalizability of continuing certification to different physicians across specialties and practice settings.

D.W. Price is senior vice president, Research and Education Foundation, and executive director, Multispecialty Portfolio Program, American Board of Medical Specialties, Chicago, Illinois, and professor, Department of Family Medicine, University of Colorado School of Medicine, Denver, Colorado; ORCID:

H. Biernacki is manager, Research Operations, American Board of Medical Specialties, Chicago, Illinois.

L.M. Nora is immediate past president and chief executive officer, American Board of Medical Specialties, Chicago, Illinois.

Funding/Support: None reported.

Editor’s Note: An Invited Commentary by G.T. McMahon appears on pages 1757–1759.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Supplemental digital content for this article is available at

Correspondence should be addressed to David W. Price, American Board of Medical Specialties, 353 N. Clark St., Suite 1400, Chicago, IL 60654; e-mail:; Twitter: @ABMSCert.

© 2018 by the Association of American Medical Colleges