The purpose of the Performance Improvement (PI) component of Family Medicine Certification is to demonstrate that you are able to reflectively look at your practice, identify opportunities to improve the care of patients, or the processes of care delivery, and then to develop and implement an intervention that would address the performance gap. Using a Plan-Do-Study-Act process of quality improvement, these activities will facilitate your use of data to determine if the intervention you designed resulted in the improvement.

For clinically active physicians, meaningful participation in and completion of one PI Activity, every three-year stage allows you to successfully meet the requirements of the Family Medicine Certification process.

If you have declared yourself clinically inactive in your MyABFM Portfolio, you are not required to complete a PI Activity, though you may choose to do so as part of fulfilling your 50-point activity requirement in each three-year stage.  

How Do I Start My PI Activity?

To begin a new PI Activity, resume an in-progress PI or to review the complete list of available PI Activities, please log into your MyABFM Portfolio and select Performance Improvement Activities. 

PI Activity Points

There are a variety of PI activities that have been developed by ABFM as well as external providers. If you are designated as clinically active, completing any of these activities will provide your 20 points towards you overall 50-point requirement. If you are designated clinically inactive in your MyABFM Portfolio, you are not required to complete a non-clinical PI activity, though you may choose to as part of fulfilling your 50-point activity requirement in each three-year stage. 

Complete These Activities for 20 Activity Points & PI Credit

When you successfully complete any of following activities, you will earn 20 activity points towards your overall 50-point activity requirement and also fulfill your PI requirement.

  • COVID-19 Self-Directed Clinical ACTIVITY

The COVID-19 Self-Directed Clinical activity allows Diplomates to direct a custom rapid cycle quality improvement effort, regardless of whether they provide continuing care. This activity provides a mechanism for meeting the PI requirement by telling us about the unprecedented and rapid changes that you had to make in the ways that you deliver care, regardless of practice type or scope. This PI can address many different dimensions of care—not just clinical quality measures but process effectiveness and efficiency, patient satisfaction, safety and the other characteristics that the practice has identified. Log into your MyABFM Portfolio to get started.


  • Health Disparities/Equity Self-Directed Clinical activity

The Health Disparities/Equity Self-Directed Clinical activity allows you to complete a custom quality improvement effort for any type or scope of practice in which you work. This activity provides a mechanism for meeting the PI requirement by telling us about how you have assessed and improved the way that your practice addresses social determinants of health; health equity (broadly defined); and/or systemic ways in which you assure that patient access, experience and care are equitable. This activity can address many different dimensions of care – such as assessing race/ethnicity, socioeconomic status, sexual orientation/gender identity, disability, rural, or the underserved. You can then plan an intervention to close gaps in care such as disparate outcomes of common screening activities (cancer, HIV) and conditions (quality measures for hypertension, diabetes, etc.). Built on the model of ABFM’s Self-Directed activity, you can choose your own approach. Sample resources are available for use if you find these helpful to beginning this effort.
  • ABFM-Developed PI Activities

The ABFM-developed PI Activities platform presents a broad range of topic areas and provides resources for you to develop individual performance improvement interventions. These activities are available in a number of topic areas to fit your practice setting and can be completed individually or in a small group of family physicians.
•    Acute Care  
•    Asthma  
•    Behavioral Health  
•    Cardiovascular  
•    Chronic Care  
•    Diabetes 
•    Efficiency and Cost Reduction  
•    Emergency Department/Urgent Care  
•    Hospice and Palliative Care  
•    Hospitalist  
•    Hypertension  
•    Patient Safety  
•    Pediatrics  
•    Preventative Care  
•    Sports Medicine

  • Transforming Clinical Practice Initiative (TCPi)

ABFM Prime Support and Alignment Network in collaboration with the University of Colorado, Department of Family Medicine’s e-Learning Team have developed three TCPi performance improvement activities that focus on key TCPi concepts: TCPi Person-and-Family-Centered Care Design, TCPi Cost and Value of Care, and TCPi Care Coordinator Across the Medical Neighborhood. If you would like to participate in one or more of these new TCPi performance improvement activities, please access in your MyABFM Portfolio

  • Precepting performance improvement program

The Precepting Performance Improvement Program allows academic units (family medicine departments, residency programs, etc.) to sponsor Performance Improvement projects completed by community physicians who precept residents or students at a level of 180 hours during their three-year stage. This option, developed through collaboration with the Society of Teachers of Family Medicine, allows you to receive PI activity credit for improving your teaching skills and to have this reported through your academic sponsor (clerkship director, residency director, etc.) Visit for more information. 

  • ABFM Self-Directed PI Project: Clinical Pathway

The Self-Directed Clinical activity allows an individual and up to 9 additional physicians to report customized improvement efforts, regardless of the scope of care that is delivered. The application process has been streamlined (averaging ~20 minutes to complete) to require only the necessary information to demonstrate the cycle of measure, intervention and re-measure, and attest to the level of participation in the effort. 

  • Organizational PI Projects

The Organizational PI activity option allows groups of more than 10 physicians to work on an improvement project for Performance Improvement credit. If you are participating in an Accountable Care Organization (ACO), Clinically Integrated Network (CIN), health system network, or similarly constructed group of physicians who are working on improving care together, your organization can apply to be a sponsor for reporting your efforts to ABFM for your PI credit. This pathway is also open for any organization that wishes to develop and conduct a PI project either in person or web-based with a group of family physicians. The application process requires a non-refundable $100 fee for each application submitted to ABFM, regardless of the number of physicians participating. The application is available at:!/public/login 

    Organizational PI Pathway [PDF, 1MB]

  • Residency Performance Improvement Program (ResPIP)

The ResPIP pathway is a means for residency programs to develop and oversee the successful completion of clinical practice Performance Improvement projects for residents and faculty that meet the ABFM Family Medicine Certification requirements. Approved sponsors will be able to submit each activity to ABFM. The application process requires a non-refundable $300 fee. Visit for more information. 

  • AAFP PI-CME Activities

The American Academy of Family Physicians creates and approves activities that provide 20 activity points, PI credit and offer CME. Learn more about these activities at

  • ABP Practice Improvement Modules (PIMs)

The American Board of Pediatrics (ABP) has developed several PI options, known as Practice Improvement Modules (PIMs). PIMs are self-paced activities that can be completed individually or in a small group. These are available in an array of topic areas that could be applicable to your practice.

All of the ABP-developed PIMs are acceptable options to complete for activity and PI credit, with one exception, the Virtual QI Learning PIM. By choosing to complete the Virtual QI Learning PIM, you will earn 20 activity points towards your overall 50-point activity requirement, but it will not fulfill your minimum PI requirement.  

  • ABMS Reciprocal Activities

If you have completed a Performance Improvement activity with one of the 23 other ABMS Member Boards, you can submit your certificate of completion from that board to request reciprocal credit for completing that activity. If the activity complies with the ABFM guidelines, you will receive 20 Family Medicine Certification points and meet the PI activity requirement. For more information and to get started, please visit your MyABFM Portfolio.  

  • ABMS Portfolio Program

ABFM participates in the Multi-Specialty Portfolio Program sponsored by the American Board of Medical Specialties (ABMS). This program sets standards for identifying, creating opportunities for, and evaluating meaningful participation in quality improvement, patient safety, and continuous professional development activities. Portfolio Program Sponsors develop and offer initiatives that align with organizational improvement priorities such as improved communication, efficiency, and patient safety. Portfolio Program Sponsors include leading hospitals, health systems, professional societies, and community health care organizations across the country. To find a list of ABMS Portfolio Program Sponsors visit

Complete These Activities for 20 activity points

Additional alternative PI Activities are available that will provide you with 20 points towards your 50-point activity requirement but will not fulfill your PI requirement. The breadth of these activities allows you to choose options that are relevant to your specific practice environment. To review a complete list of approved alternative performance improvement activities, please log into your MyABFM Portfolio

Meaningful Participation

Through demonstrating meaningful participation in PI you will gain the most benefit for your practice. ABFM defines meaningful participation as the following:

  • Reviewing practice data and identifying a gap in care or clinical processes that you wish to improve
  • Engaging in planning and execution of your PI project
  • Actively participate in implementing change in your practice setting that are designed to improve your quality of care for patients
  • Review and analyze your post-intervention data to assess the impact on care delivery and outcomes
  • Actively collaborate with your peers where applicable