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Maintenance of certification: historical context
  1. Joshua A Hirsch1,
  2. Philip M Meyers2
  1. 1NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Neurosurgery, Columbia University, Neurological Institute of New York, New York, New York, USA
  1. Correspondence to Dr Joshua A Hirsch, NeuroEndovascular Program, Massachusetts General Hospital, 55 Fruit Street, Gray 241B, Boston, MA 02114, USA; hirsch{at}

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Maintenance of certification (MOC) is a multi-part process meant to help physicians develop medical knowledge and skills over time. Once a concept or a promise, MOC is now a reality, even for those with lifetime board certification. Over the past several years there has been increasing discussion among members of the Society of NeuroInterventional Surgery (SNIS) about MOC and how the SNIS could become more involved with the MOC process. In the course of discussion, the authors of this review realized that their knowledge about MOC, its conception and process was incomplete. This background material aims to harness and thereby help direct the energy of the SNIS membership into thinking through potential roles that they and their organization might play to support MOC-related efforts.


In 2006, all Member Boards of the American Board of Medical Specialties (ABMS) received approval of their MOC program plans. Included in MOC is continuous quality improvement to maintain the public trust in the healthcare system.1 To better understand the development of the MOC, it is important to appreciate its roots in the initial development of medical boards about 100 years ago.

ABMS is a not-for-profit organization comprising 24 medical specialties (ie, ‘Member Boards’). The primary function of the ABMS is to assist its Member Boards to develop and implement educational and professional standards that evaluate and certify physician specialists in their respective fields. ABMS provides oversight to the certification of physicians in the USA.2

The ABMS can trace its roots to the rise and growth of the medical specialty board movement in the early 20th century. The Flexner report of 1910 addressed the need for standardization of medical care.1 ,3 ,4 While scientific medical care was advancing, there was no system to assure the public that a physician claiming to be …

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