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How Physicians Prepare for Maintenance of Certification Exams

A Qualitative Study

Chesluk, Benjamin J. PhD; Eden, Aimee R. PhD, MPH; Hansen, Elizabeth R.; Johnson, Michele L. MBA; Reddy, Siddharta G. MPH; Bernabeo, Elizabeth C. MPH; Gray, Bradley M. PhD, MS

doi: 10.1097/ACM.0000000000002829
Research Report: PDF Only

Purpose: Little is known about how board-certified physicians prepare for their periodic Maintenance of Certification (MOC) examinations. This qualitative study explores how physicians experience MOC exam preparation: how they prepare for the exams and decide what to study and how exam preparation compares with what they normally do to keep their medical knowledge current.

Method: Between September 2016 and March 2017, the authors interviewed 80 primary care physicians who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine MOC exam. They analyzed transcripts and notes from these interviews looking for patterns and emergent themes, using the constant comparative method and a social practice theory perspective.

Results: Most interviewees studied for their MOC exams by varying from their routines for staying current with medical knowledge, both by engaging with a different scope of information and by adopting different study methods. Physicians described exam preparation as returning to a student/testing mindset, which some welcomed and others experienced negatively or with ambivalence.

Conclusions: What physicians choose to study bounds what they can learn from the MOC exam process, and therefore also bounds potential improvements to their patient care. Knowing how physicians actually prepare, and how these preparation activities compare with what they do when not preparing for an exam, can inform debates over the value of requiring such exams, as well as conversations about how physicians, certification boards, and other key stakeholders in physicians’ continuing professional development could improve the MOC process.

B.J. Chesluk is senior researcher for ethnographic research, American Board of Internal Medicine, Philadelphia, Pennsylvania.

A.R. Eden is a medical anthropologist and qualitative researcher, American Board of Family Medicine, Lexington, Kentucky.

E.R. Hansen was a qualitative research assistant, American Board of Family Medicine, Philadelphia, Pennsylvania. The author is a first-year student, University of Kentucky College of Medicine, Lexington, Kentucky.

M.L. Johnson is research program manager, American Board of Internal Medicine, Philadelphia, Pennsylvania.

S.G. Reddy is senior research associate, Assessment and Research Division, American Board of Internal Medicine, Philadelphia, Pennsylvania.

E.C. Bernabeo is a research consultant, Accreditation Council for Graduate Medical Education, Chicago, Illinois.

B.M. Gray is senior health services researcher, American Board of Internal Medicine, Philadelphia, Pennsylvania.

Supplemental digital content for this article is available at

Acknowledgments: The authors sincerely thank the physicians who generously gave their time to participate in the interviews for this study. In addition, the authors wish to thank Lorna Lynn, Lars Peterson, and Rebecca Lipner for their help in defining the project and analyzing the data.

Funding/Support: The authors acknowledge the support of the American Board of Family Medicine Foundation.

Other disclosures: When this study was conducted, the researchers were employees of either the American Board of Internal Medicine or the American Board of Family Medicine.

Ethical approval: The institutional review board at the American Academy of Family Physicians approved this study.

Correspondence should be addressed to Benjamin J. Chesluk, American Board of Internal Medicine, 510 Walnut St., Suite 1700, Philadelphia, PA 19106; telephone: 215-399-4009; email:

© 2019 by the Association of American Medical Colleges