Do Recertification Scores Really Matter?

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Physicians have long debated the value of Maintenance of Certification (MOC) exams. Are they just another hoop to jump through? Or do they actually help us become better clinicians?

A recent study in JAMA Internal Medicine adds new weight to the importance of ongoing assessment and lifelong learning: physicians who performed better on the ABIM Longitudinal Knowledge Assessment (LKA) averaged better patient outcomes, such as reduced hospital readmission rates and post hospitalization mortality rates. This is a big deal—and it has potential implications for every specialty. Let’s break down what this means and why it matters.

New Data: Higher ABIM LKA Scores Associated with Improved Patient Outcomes

The ABIM recently analyzed the performance of internists on its Longitudinal Knowledge Assessment (LKA), an ongoing alternative to the traditional MOC exam.

This new study, published in JAMA, found that hospitalized Medicare patients treated by physicians who scored higher on the ABIM LKA had better outcomes on average. Specifically, those patients had 8% lower seven-day mortality and 5% lower seven-day readmission rates compared to patients treated by lower-scoring physicians.

The study analyzed data from over 4,000 hospitalists and 260,000 hospitalizations. These findings support the idea that performance on ongoing knowledge assessments like the LKA may be associated with clinical quality and patient care.

Lifelong Learning Is a Patient Safety Imperative

While it can often feel like a hoop to jump through, this study suggests that recertification scores do matter and are a safeguard to ensuring good medical practice. Medicine changes and guidelines evolve. Physicians who fail to take these changes seriously run the risk of practicing outdated medicine.

Although this particular study focused on internists and hospitalists participating in ABIM’s LKA, its message resonates beyond internal medicine. The core insight—that physicians who stay up-to-date through structured, ongoing learning may deliver better patient outcomes—is very possible to apply to other medical specialties, too.

In other words: maintenance of certification is not simply about memorizing facts for an exam. It’s about having the most up to date knowledge to treat your patients.

Longitudinal Assessments Are Working

The ABIM’s LKA is part of a growing shift toward longitudinal assessment models—ongoing, lower-stakes exams that provide real-time feedback and help physicians engage with material over time.

We may not yet have formal studies linking longitudinal assessment scores to patient outcomes in every field, but the trend is emerging, and specialty boards are taking note of it. For example, the American Board of Pediatrics and American Board of Family Medicine have begun adopting more flexible, continuous learning models, rather than a single day MOC.

MOCA-Peds, the longitudinal assessment used by the American Board of Pediatrics, has shown similar success. The majority of surveyed pediatricians that engaged with this format found it to be more manageable, clinically relevant, and effective at reinforcing knowledge.

To provide you with a better sense of what longitudinal assessments have to offer, let’s look a bit more closely at some of their features compared to traditional MOCs.

Traditional Recertification vs Longitudinal Assessment

Traditional recertification exams are high-stakes, infrequent, and often stressful, requiring cramming and in-person testing. They provide limited feedback and may not reflect daily clinical practice.

Longitudinal assessments are lower-stakes, continuous, and more flexible. They use proven learning strategies like spaced repetition, offer immediate feedback, and are more aligned with real-world clinical decision-making. They not only assess knowledge but actively support ongoing learning—making them a smarter, more sustainable model for lifelong professional growth.

Here’s a table summarizing the key differences between traditional vs longitudinal assessments:

	Traditional Recertification Exam	Longitudinal Assessment (e.g., LKA)
Format	One-time, high-stakes exam every 7–10 years	Ongoing, low-stakes questions (e.g., quarterly)
Test Environment	In-person, proctored testing center	Remote, open-book, self-paced
Preparation Style	Studying for weeks or months leading up to the exam	Continuous learning over time
Stress Level	High: pass/fail pressure builds over years	Lower: questions are spread out with feedback
Feedback Provided	Little to none: results given at the end	Immediate feedback with references for each question
Performance Tracking	One-time score, often with limited insight	Ongoing performance trends and gap identification
Flexibility	Rigid scheduling, travel may be required	Fits into your clinical workflow and based around your schedule

My Recertification Process

As a full-time practicing physician with teaching, clinical and administrative duties, I can appreciate firsthand how time-consuming and overwhelming recertifying can feel. The requirements for ABFM differ slightly every few years, but diplomates are required to answer quarterly exam questions (part of the longitudinal assessment), complete various certification activities, earn CME credits, and pay licensure and certification fees.

Having guided various candidates through the new certification process after completing it myself, here are a few tips:

1. Pace yourself.

One mistake I’ve seen people make is saving everything for the last month. With the longitudinal format, you don’t have to do that—and you really shouldn’t. Try not to view each question as something punitive, but as the learning opportunity it’s meant to be.

For example, if you get a hyponatremia question wrong early in the process, make it a point to learn it then and there. Pull up the relevant guidelines on diagnosis and management. Double-check the sodium correction thresholds, and consider using it as a teaching case in your clinic or on wards the next day. This sort of reinforcement learning isn’t rushed and will stick with you more than any passive review.

2. Let real life guide your studying.

Whenever I encounter something I haven’t seen in a while—like myasthenia gravis or porphyria in clinic or during teaching rounds—I jot it down to revisit later. This allows me to solidify knowledge through a few minutes of focused learning after a patient encounter. I keep a notebook of interesting cases and encourage my students, residents, and those I tutor to do the same. Studying feels less abstract when it’s rooted in real-life patients that you encounter.

3. Make learning part of your workflow.

I’ll be real here. Cramming worked well enough for me to get through high school and even college. Medical school and beyond was a different story. Finding small, consistent ways to incorporate a bit of learning throughout my week has really benefited me during my medical career.

I find various ways to make learning a part of my day. On my drive into work, I sometimes listen to medical podcasts like “Curbsiders” or “Core IM.” (Though I will admit to blasting Taylor Swift on occasion.)

I also have the ABFM mobile app on my phone that has Continuous Knowledge Self-Assessment (CKSA) experience, which is a good way to rack up points for my recertification. It’s not something I open every minute of every day, but even a few times a week can improve your knowledge and get you one step closer to completing the recertification process.

This is especially helpful during downtime when I’m already at work or in between meetings. I just keep a question bank tab open and knock out a handful of questions when I can. Over time, these short bursts of learning add up, and they’re far more manageable than marathon study sessions.

4. Track your progress.

One great feature of longitudinal assessment is the feedback you get. When I noticed that I consistently missed infectious disease questions, I aimed to block off 15 minutes once or twice a week to dive into ID, looking at practice questions, ID maps, and high yield topics. Now, ID is one of my strongest subjects. I even host a mini ID study session for my students.

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The Bottom Line

At the end of the day, recertification shouldn’t just be about passing a test—it should make you a sharper clinician. For me, the process of recertifying—while challenging—has helped refresh my knowledge and made me more confident in areas I hadn’t thought about in a while.

And now, when I support others through their recertification prep, I try to remind them that this isn’t about perfection. It’s about gradual progress and building habits that keep practicing docs up-to-date. And that keeps our patients safe!

For more (free!) content, check out these other posts on the Rosh Review blog:

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By Mike Ren, MD

Mike is a driven tutor and supportive advisor. He received his MD from Baylor College of Medicine and then stayed for residency. He has recently taken a faculty position at Baylor because of his love for teaching. Mike’s philosophy is to elevate his students to their full potential with excellent exam scores and successful interviews at top-tier programs. He holds the belief that you learn best from those close to you in training. Dr. Ren is passionate about his role as a mentor and has taught for much of his life–as an SAT tutor in high school, then as an MCAT instructor for the Princeton Review. At Baylor, he has held review courses for the FM shelf and board exams as Chief Resident. For years, Dr. Ren has worked closely with the Office of Student Affairs and has experience as an admissions advisor. He has mentored numerous students entering medical and residency and keeps in touch with many of them today as they embark on their road to aspiring physicians. His supportiveness and approachability put his students at ease and provide a safe learning environment where questions and conversation flow. For exam prep, Mike will help you develop critical reasoning skills, and as an advisor, he will hone your interview skills with insider knowledge to commonly asked admissions questions.