The Evolution of Maintenance of Certification for Family Physicians (MC-FP) Part IV, Performance in Practice.

With the first recertification examination offered by the American Board of Family Medicine (ABFM) in 1976, the board required a patient record review to assess performance in practice. The initial records reviews required physicians to assess 4 patient records in each of 5 disease categories; these audits were independently scored by the family medicine department at the University of Iowa for the first several years. In 1983, the requirement was changed to assess 3 patient records in each of 2 disease categories. For the reviews, physicians audited individual patient charts and recorded approximately 100 items for each. In turn, the board analyzed these data, then provided their individual performance data and peer comparisons to Diplomates, as well as a reference guide (which was a monograph that comprised a current review of the particular audit categories selected) and feedback with suggestions for improving performance. This process remained largely unchanged for 20 years.