Intended for healthcare professionals

Education And Debate

Recertification in the United States

BMJ 1999; 319 doi: (Published 30 October 1999) Cite this as: BMJ 1999;319:1183
  1. John J Norcini, senior vice president for evaluation and research (
  1. American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106-3699, USA

    Editorial by Buckley

    From the creation of the first board (in ophthalmology) in 1917 to the late 1960s, the specialty boards in the United States focused exclusively on initial certification. With its inception in 1969, however, the American Board of Family Practice limited the validity of its certificates to seven years, and since then other boards have followed suit, some after attempting voluntary processes that ultimately failed. Of the 24 boards that are members of the American Board of Medical Specialties all have limited, or plan to limit, the duration of validity of their certificates to seven to 10 years.1

    According to Benson, the goals of recertification are to improve the care of patients, to set standards for the practice of medicine, to encourage continued learning, and to reassure patients and the public that doctors remain competent throughout their careers.2 To meet these goals, an ideal programme for recertification should have three components for evaluation.35 Firstly, to ensure that doctors are providing good care in practice an assessment of patient outcomes is needed. Secondly, to ensure that doctors are aware of recent advances in medicine and have the potential to treat the broad range of less frequent but medically important problems an evaluation of medical knowledge and judgment is needed. Thirdly, to ensure that doctors exhibit professionalism a review of credentials (for example, a valid licence and attestation of competence from the hospital or other local authorities) and the judgments of peers and patients are needed.

    Patient outcomes

    The assessment of patient outcomes is the most important component of a recertification programme. It directly reassures the public that doctors are performing well, and it is tailored to practice so it offers evaluation of what doctors actually do, rather than what they do in an artificial testing situation. …

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