title: Getting maintenance of certification to work: a grounded theory study of physicians' perceptions.
abstract: OBJECTIVE
  Despite general support for the goals of maintenance of certification (MOC), concerns have been raised about its effectiveness, relevance, and value.
  
  
  OBJECTIVE
  To identify barriers and enabling features associated with MOC and how MOC can be changed to better accomplish its intended purposes.
  
  
  METHODS
  Grounded 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.
  
  
  METHODS
  Eleven focus groups.
  
  
  METHODS
  Constant comparative method to analyze transcripts and identify themes related to MOC perceptions and purposes and to construct a model to guide improvement.
  
  
  RESULTS
  Participants 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
  Physicians 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.
authors.affiliation: 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.
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
authors.affiliation: Accreditation Council for Graduate Medical Education, Chicago, Illinois.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Holmboe
authors.affiliation: Knowledge Delivery Center, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kristi J
authors.initials: KJ
authors.lastname: Sorensen
authors.affiliation: Mayo Clinic Online Learning, Mayo Clinic College of Medicine, Rochester, Minnesota5School of Continuous Professional Development, Mayo Clinic College of Medicine, Rochester, Minnesota6Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Roch.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Berger
authors.affiliation: Department of Family Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: John M
authors.initials: JM
authors.lastname: Wilkinson
mesh_terms: D001291:Attitude of Health Personnel; D002568:Certification; D002983:Clinical Competence / Q000592:standards*; D004502:Education, Medical, Continuing; D017144:Focus Groups; D066296:Grounded Theory; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D005791:Patient Care / Q000592:standards; D058996:Quality Improvement / Q000592:standards*