American Academy of Pediatrics

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What can you expect from recertification process?

by Nancy S. Harper, M.D., FAAP

When you hear the words “Program for Maintenance of Certification in Pediatrics (PMCP),” your heart may begin to race as you think about this process, including taking a four-hour, closed-book examination. I admit I was curious to see how labor intensive it would be to complete all four parts, and I wanted to demystify the process for myself and others.

Beginning in 2010, pediatricians completing American Board of Pediatrics (ABP) recertification will be required to complete all four parts of the PMCP. Those who recertify before 2010 must complete only Parts One and Three.

Part One
To meet the requirements of Part One, evidence of professional standing, you must maintain a valid, unrestricted medical license in at least one jurisdiction in the United States, U.S. territories or Canada. (If you hold additional medical licenses, they need to meet this requirement as well.) Pay attention to your state’s maintenance requirements such as continuing medical education.

Part Two
Evidence of lifelong learning and self-assessment, Part Two, is a Web-based program accessible through the ABP Web site,, under PMCP activities. This part is more time-consuming and has two sections.

The first section is the knowledge self-assessment (KSA), which consists of  multiple-choice questions that must be completed once in a seven-year cycle. This section is tailored to simulate the recertification examination. No minimum score is required to pass. You receive a percentile score, standard deviations and a table showing your likelihood of passing the boards.

A score of 75% or better is a “good indication that satisfactory performance may be achieved on the secure examination,” although this is no guarantee, according to the ABP. You can stop and start the KSA at any time as long as you complete it before Dec. 31. I highly recommend it as a tool to study for the examination even though it is not required until 2010.

You can substitute PREP Self-Assessment for the KSA and NeoReviews for the neonatology self-assessment prepared by the ABP. However, KSA is included in the recertification fee.

The second section of Part Two is decision skills analysis (DSA), which must be completed once in seven years. It also is accessible through the ABP Web site and consists of approximately 50 clinically-based scenarios complete with history, physical exam, and laboratory or radiology findings. It is multiple choice, often with eight choices.

You also can start and stop the DSA at anytime as long as it is completed before Dec. 31. A minimum score of 80% is required to pass, but you have two tries each year to do so. I found it practical and educational.

Part Three
This part is evidence of cognitive expertise, also known as the secure examination. The 200-question, four-hour closed-book examination is administered at Prometric testing centers. PMCP-G for generalists is available from January to June and September to December. There are spring and fall windows for PMCP-S, which are subspecialty dependent.

You may experience sticker shock at the $1,250 fee, but it is less expensive than the initial certification ($1,350 for 2006), and the cost covers all four parts, including the KSA and DSA, which I found useful for studying. If you fail to pass the examination, the retake fee is $205. A warning to all: You cannot take your coffee or even mints into the examination, but it was not an unpleasant experience.

Once your license has been verified and you pay the $1,250 fee, you can choose the date and time of the exam. You are given two copies of a paper verifying that you completed the examination. One copy should be faxed or mailed to the ABP.

A week after taking the exam, I received notification to check my results on the ABP Web site. After opening “my progress report” and clicking on “details,”  I saw my score and thankfully, I passed.

Now I have another seven years to think about Part Four, evidence of satisfactory performance in practice.

Part Four
Two activities need to be completed once in seven years. For the first activity, the physician distributes surveys to peers and patients. There is no minimum score, and survey results are meant to serve as feedback to the physician for self-improvement.

The second activity is Web-based quality improvement. Currently, the only approved program is the Academy’s eQIPP at Other modules are planned, such as one on patient safety.

Activity two poses some difficulties for physicians in administrative functions or in clinics where they cannot measure improvement in areas such as diagnosis and treatment of attention-deficit/hyperactivity disorder or asthma. These issues are supposed to be addressed before 2008 for physicians not in direct patient care or specialty clinics.

Time commitment
According to the ABP, it takes less than an hour to verify licensure (Part One), four to five hours for KSA (Part Two), four to five hours for DSA (Part Two), four  hours for the examination (Part Three), less than two hours to pass out peer and patient surveys (Part Four) and 10-plus hours to complete eQIPP (Part Four). In addition, I spent at least 50 hours studying for the secure examination.

Parts One, Two and Three are available now, and Part Four will be available in 2008.

I encourage those of you recertifying before 2010 to explore Part Two on the ABP Web site and learn more about PMCP activities. There are question-and-answer sections, tutorials and other information about the four parts of PMCP-G and PMCP-S. You will need to register and update your information.

I earned 25 AMA PRA category 1 credits. Twenty-five? The anxiety alone was worth 50!

Good luck to all who are recertifying this coming year. If you have any questions, e-mail me at

Dr. Harper is a member of the AAP Section on Young Physicians executive committee.

The summer 2005 ABP newsletter reviews the Program for Maintenance of Certification in Pediatrics creation and process. Many diplomates also have received a CD with a tutorial, and the ABP Web site,, has more information.

The PMCP-G is for generalists and the PMCP-S is for subspecialists. You do not need to maintain your general pediatrics certificate to maintain your subspecialty certificate.

PMCP powerpoint presentation

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