Part 4: Improvement in Medical Practice
Last verified on December 18, 2023
Participation Reporting and Frequency
Part 4 of Continuing Certification (MOC) requires that diplomates have completed at least one Practice Quality Improvement (PQI) Project or Participatory Quality Improvement Activity within the last three calendar years. A PQI Project or Activity may be conducted repeatedly or continuously to meet PQI requirements.
Diplomates should retain documentation of their PQI Project or Activity, but submission of such materials to the ABR is required ONLY if a diplomate is audited. Routine submission of such proof of participation to the ABR is neither required nor accepted.
Quality Improvement Definition
The ABR defines “quality improvement” as a systematic approach to the study of healthcare and/or a commitment to continuously improve performance and outcomes in healthcare. The ABR honors each diplomate’s privilege to choose PQI activities or projects that are pertinent to his or her own practice and that meet the spirit of this definition.
Practice Quality Improvement Options
PQI activity involves continuous engagement of healthcare professionals in efforts anticipated to lead to better health outcomes for patients and better system performance, leading to improved patient care and/or enhanced professional development.
The ABR recognizes two categories of activities that demonstrate a diplomate’s commitment to and participation in quality improvement and that satisfy ABR Continuing Certification (MOC) Part 4 requirements:
Option 1: Practice Quality Improvement (PQI) Projects
A PQI Project is either designed by the diplomate using any standard quality improvement methodology, such as the Plan-Do-Study-Act (PDSA) cycle approach, or is developed by a group practice, a department at a healthcare or academic institution, a healthcare system, or a society at the local, regional, or national level. A project developed by these entities (including individuals) for their own use need not go through the formal ABR qualification process.
Examples include the following:
PQI Project Resources
- Improving report turnaround time
- Improving patient access (next available appointment)
- Optimizing radiation dose/exam or frequency of repeat exams
- Improving timeout process for procedures
- Decreasing wrong patient/wrong procedure events
- Standardizing reports
- Reducing MRI safety events
- Improving critical results notification
- Improving handoffs of care
The ABR has worked with societies to develop a wide selection of qualified PQI projects with templates to guide diplomates through initiation and completion. Many societies are also working to develop centralized databases for these projects, which ultimately can be used to benchmark a participating diplomate’s practice with national performance data. For diplomate convenience, qualified society projects are listed on the ABR website with links to the respective societies. For a list of these projects, click here
Approved projects are also available through the ABMS Multi-Specialty MOC Portfolio Approval Program
. For a list of approved portfolio sponsors, please visit the ABMS Multi-Specialty MOC Portfolio Program
A template for performing and recording PQI Projects is also available:
PQI Project Recording Template
Option 2: Participatory Quality Improvement Activities
Participatory Quality Improvement Activities include those in which a diplomate is engaged by choice as a volunteer or by duty during his or her workday, and which may be reasonably expected to contribute directly to or increase the likelihood of advancement or improvement of quality and/or safety in healthcare at the local or national level.
Documentation of individual active participation
in any of the activities in the table on this page
meets the criteria for Continuing Certification (MOC) Part 4 requirements.
Practice Quality Improvement FAQs
Does the ABR need to approve my PQI Project or Participatory Activity before I can count it toward fulfillment of the Part 4 PQI requirement?
No. The ABR does not need to approve PQI Projects and Participatory Activities at any time for them to count toward the ABR’s requirements.
What paperwork do I need to send to the ABR to document my participation in a PQI Project or Participatory Activity?
You do not need to submit anything to the ABR unless you are selected for a Continuing Certification (MOC) audit. If selected for an audit, the ABR will provide you with the necessary information to document your PQI Project or Participatory Activity.
Can I use the same PQI Project or Participatory Activity repeatedly to meet the PQI requirement?
Yes. You may use the same PQI Project or Participatory Activity multiple times toward the fulfillment of the PQI requirement as long as you are still fulfilling the required elements as outlined on the ABR website.