title: Attitudes and Experiences of Early and Midcareer Pediatricians With the Maintenance of Certification Process.
abstract: Maintenance of certification (MOC) value and relevance have been recent topics of controversy and discussion in medicine. Systematically assessing pediatrician's attitudes and experiences to encourage and inform future modifications is important.
  
  
  
  We surveyed 866 pediatricians in 2014 who graduated from residency 10 to 12 years ago and are part of a larger longitudinal study. Cross-sectional quantitative and qualitative data on understanding, attitudes, barriers, and needs specific to MOC part 2 (self-assessment/continued learning activities) and part 4 (quality improvement projects) were analyzed. McNemar tests compared responses on questions specific to part 2 with those specific to part 4. Multivariable logistic regression considered differences in participants who did and did not have positive part 4 attitudes.
  
  
  
  A total of 77.8% completed the survey. Comparing part 4 to part 2, there was less understanding of requirements (59.9%, 72.9%, P < .001), more agreement that relevant available activities is a barrier (67.6%, 44.0%, P < .001), stronger agreement that more choices would be helpful (72.8%, 53.8%, P < .001), and less perceived impact on patient care or lifelong learning (12.5%, 47.2%, P < .001). Participants reporting that part 4 improves care were less likely to agree that time to fulfill requirements (adjusted odds ratio = 0.30, 95% confidence interval 0.18-0.51) and relevant available activities (adjusted odds ratio = 0.22, 95% confidence interval 0.13-0.39) were barriers. Qualitative analysis revealed themes including time, cost, and relevance.
  
  
  
  Pediatricians expressed significant frustration with the MOC process, poor understanding of requirements, and barriers with the process, especially for part 4. Increasing diplomate education on the process and increasing available and relevant activities may be important to optimize physician's continuous learning.
authors.affiliation: Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Riley Hospital for Children at IU Health, Indianapolis, Ind. Electronic address: bjbyrne@iu.edu.
authors.forename: Bobbi J
authors.initials: BJ
authors.lastname: Byrne
authors.affiliation: Department of Research, American Academy of Pediatrics, Elk Grove Village, Ill.
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: Frintner
authors.affiliation: Division of Med-Peds, Department of Internal Medicine, Detroit Medical Center and Children's Hospital of Michigan, Wayne State University, Detroit, Mich.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Abraham
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Starmer
mesh_terms: D001291:Attitude of Health Personnel; D002568:Certification / Q000458:organization & administration*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D006801:Humans; D007396:Internship and Residency; D008137:Longitudinal Studies; D000072143:Pediatricians / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States
keywords: American Board of Pediatrics; early career pediatrician; maintenance of certification; midcareer pediatrician