Maintenance of Certification Part IV in Residency Methods and Impact on Practice

The American Board of Family Medicine (ABFM) is the first medical specialty board to require all residents participate in the maintenance of certification (MOC) process prior to sitting for board certification. This study used surveys and focus groups of family medicine residents in four university-affiliated residency programs to explore participants' perceived benefits and barriers to common methods of completing the performance improvement in practice (Part IV) MOC requirement, and the perceived impact on practice.

Residents independently selected into one of three ABFM-approved methods of meeting the Part IV requirement. Following completion of the activity, participants completed a survey and then participated in a focus group.

Residents cited time constraints as a major barrier to all Part IV methods. They also reported lack of relevance to practice, deficiencies in performance improvement skills, and access to clinical data. Ease of use was a benefit of online modules, but residents did not perceive them as relevant to practice or leading practice change. Portfolio and self-directed activities were perceived as most relevant to practice and improved patient care, and involved more team-based experiences. Most participants would not participate in Part IV if not required.

Group quality improvement projects through the portfolio-approved and self-directed activities seemed to be the most positively reported way to complete the ABFM requirement. Regardless of method, time constraints and quality improvement expertise are significant barriers to completion of the requirement. Residency programs will need to grapple with these barriers to maximize benefits to residents as they prepare to become board certified.