Study Summarizes the Rationale and Purpose of Continuing Certification

As certifying boards continue to evolve their certification programs to focus on more frequent, learner-engaged assessments, a recently published comprehensive report synthesizes findings from over 600 studies to describe the foundational evidence behind the need for continuous certification. ABFM partnered with the American Board of Internal Medicine, the American Board of Medical Specialties, and faculty from the University of Pittsburgh Department of Psychology to synthesize the evidence that supports the need for the continuing assessment of physicians’ clinical knowledge. The report, entitled Conceptual Foundations for Designing Continuing Certification Assessments for Physicians, reveals four central themes and supports the move to a model of longitudinal assessment.

1. Cognitive Skills Need to Be Kept Current
   Family physicians often ask why they need board certification, and why it’s necessary to take an exam instead of self-monitoring. The evidence is clear that with the explosion of new clinical knowledge and approaches to care and the natural decline in cognitive skills that occur over time, constant vigilance with lifelong learning is necessary for physicians to remain current and to provide the highest quality of evidence-based care.
2. Individual Self-Assessment Is Not Enough
   Abundant evidence confirms that physicians often don’t know what they don’t know, and that they overestimate retention of information learned.  This forms the basis for the need for more structured and formalized ways for physicians to identify their knowledge gaps in order to plan CME and other forms of self-study that include appropriate attention to closing knowledge gaps.  This is where ABFM self-assessment activities, such as KSAs, CKSAs, and the National Journal Club come into the equation as providing that mechanism for knowledge assessment and targeted ways to address knowledge deficits.
3. Testing Enhances Learning and Retention
   While not often popular, testing has been well demonstrated to be a powerful device for learning and retaining cognitive knowledge. Not always appreciated is the fact that testing also supports application of complex problem solving, as well as enhances the practice of retrieval from memory. These outcomes are boosted by having tests spaced over time. Across all adult learning, longitudinal assessment has been shown to result in greater retention of knowledge as compared to the rote memorization that often precedes one-day examinations spaced 10 years apart. ABFM’s new longitudinal assessment alternative to the one-day exam also supports “learning while testing.”
4. Goals and Consequences Motivate
   Finally, research has found that physicians learn and retain more when they know they will be tested. The expectation that physicians will be required to periodically demonstrate their cognitive expertise over the course of their career increases their motivation to study and update their knowledge competency over time.

As continuing certification continues to evolve, it is more critical than ever to scrutinize the assumptions and evidence behind our approaches if we are to fulfill our obligations to both the public and the Diplomates participating in increasingly learner-engaged processes.

– Andrew Bazemore, MD, MPH
SVP, Research and Policy

In 2019, the Vision for the Future of Certification Commission defined expectations for a specialty credential on which the public can depend. Two foundational changes were recommended: intention to ensure that certification provides value to Diplomates, patients, and others; and recognition that professional self-regulation is a collective responsibility requiring collaboration among multiple organizations. The newly revised ABMS Standards for Continuing Certification build on the findings highlighted in this report, as well as the recommendations from the Vision Commission, to develop a set of changes expected of all certifying boards that seek to enhance the value of the process for continuously certifying physicians. To learn more about this and other research from ABFM, visit our research website.