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Invited Commentaries

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

Heitlinger, Leo A.

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Journal of Pediatric Gastroenterology and Nutrition: May 2017 - Volume 64 - Issue 5 - p 655
doi: 10.1097/MPG.0000000000001489
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See “Outcomes From Pediatric Gastroenterology Maintenance of Certification Using Web-based Modules” by Sheu et al on page 671.

Since the original pediatric gastroenterology certification examination by the American Board of Pediatrics, now more than 25 years ago, the process by which diplomates have maintained their credentials has evolved, but not without controversy. The current process includes maintenance of licensure, lifelong learning activities, a secure examination, and quality improvement initiatives. In the early stages of the current process, diplomates complained that the secure examination was burdensome and that the quality improvement activities offered were not relevant to their practice.

Although some large organizations developed quality improvement modules for physicians in their organizations and Improve Care Now, an IBD consortium, was available to join, these offerings were not available to everyone and were costly to implement. Several years ago, in order to provide quality improvement activities for diplomates that were relevant at an affordable price point, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition began to offer several modules (endoscopy, colonoscopy, informed consent) that were specific to pediatric gastroenterology.

In this issue of the Journal of Pediatric Gastroenterology and Nutrition, Sheu et al (1) report the results of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition modules offered to their members for use to complete the quality improvement requirements of the American Board of Pediatrics sub-board. The tools used for data collection are available in the appendix and are simple, effective, and meet the needs of those enrolled in maintenance of certification. The study demonstrates that at least for the period of observation that patient care is improved by participation of the diplomates enrolled in the activity. The question of how sustainable the practice changes will be is beyond the scope of the article and requires further investigation. This article adds to the literature that support that quality improvement improves care and that these activities in particular appear to be relevant to the practice of diplomates and their desire to maintain certification (2–5).


1. Sheu J, Chun S, O’Day E, et al. Outcomes from pediatric gastroenterology maintenance of certification using web-based modules. J Pediatr Gastroenterol Nutr 2017; 64:671–678.
2. Huang JS, Chun S, Sandhu A, et al. Quality improvement in childhood obesity management through the maintenance of certification. J Pediatr 2013; 163:1313.e1–1316.e1.
3. Madsen TE, Riese A, Choo EK, et al. Effects of a web-based educational module on pediatric emergency medicine physicians’ knowledge, attitudes and behaviors regarding youth violence. West J Emerg Med 2014; 15:615–622.
4. Arca MJ, Enders J, Christensen M, et al. Operationalizing quality improvement in a pediatric surgical practice. J Pediatr Surg 2014; 49:202–206.
5. Petereson LE, Blackburn BE, Puffer JC, et al. Family physicians’ quality interventions and performance improvement through the ABFM diabetes performance in practice module. Ann Fam Med 2014; 12:17–20.
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