• David A Cook, Eric S Holmboe, Kristi J Sorensen, Richard A Berger, and John M Wilkinson.
• Knowledge Delivery Center, Mayo Clinic, Rochester, Minnesota2Mayo Clinic Online Learning, Mayo Clinic College of Medicine, Rochester, Minnesota3Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
• JAMA Intern Med. 2015 Jan 1; 175 (1): 35-42.

ImportanceDespite general support for the goals of maintenance of certification (MOC), concerns have been raised about its effectiveness, relevance, and value.ObjectiveTo identify barriers and enabling features associated with MOC and how MOC can be changed to better accomplish its intended purposes.Design, Setting, And ParticipantsGrounded theory focus group study of 50 board-certified primary care and subspecialist internal medicine and family medicine physicians in an academic medical center and outlying community sites.ExposuresEleven focus groups.Main Outcomes And MeasuresConstant comparative method to analyze transcripts and identify themes related to MOC perceptions and purposes and to construct a model to guide improvement.ResultsParticipants identified misalignments between the espoused purposes of MOC (eg, to promote high-quality care, commitment to the profession, lifelong learning, and the science of quality improvement) and MOC as currently implemented. At present, MOC is perceived by physicians as an inefficient and logistically difficult activity for learning or assessment, often irrelevant to practice, and of little benefit to physicians, patients, or society. To resolve these misalignments, we propose a model that invites increased support from organizations, effectiveness and relevance of learning activities, value to physicians, integration with clinical practice, and coherence across MOC tasks.Conclusions And RelevancePhysicians view MOC as an unnecessarily complex process that is misaligned with its purposes. Acknowledging and correcting these misalignments will help MOC meet physicians' needs and improve patient care.

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