1. Society for Pediatric Research: Perspective on Maintenance of Certification February 2016

2. SPR Perspective and Guiding Principles The SPR is committed to: excellence in the clinical care of children and supports programs that will assure that diplomates with limited clinical effort maintain the highest standards. continued medical education, clinical excellence, professional self- regulation, and continued improvement of the quality of health care for children. The SPR supports the missions of the American Board of Pediatrics (ABP) and the American Board of Medical Specialties (ABMS); however, there is concern that some current MOC requirements are beyond the scope of the ABP mission.

3. SPR Perspective and Guiding Principles The SPR understands and acknowledges the ABP has made some recent changes to the current MOC (since February 2015), and the SPR appreciates that the ABP is open to continued modifications. Despite some changes to MOC, the SPR supports a rigorous assessment of the current state of MOC done by a committee that broadly represents practicing pediatricians including community pediatricians, subspecialty societies, research societies and academic departments.

4. MOC and Conflict of Interest The SPR is concerned that: There is not an adequate system for identifying or managing potential fiduciary conflict of interest. We advocate for establishment of guidelines to define and manage COI in a manner transparent to all ABP Diplomates. The current system is maintained and implemented solely by the ABP, a nonprofit organization positioned to realize substantial financial benefit directly from expansion of MOC related activities. Individuals and groups that have received income via contributing to or selling MOC activities are not required to disclose a potential conflict of interest when advocating for the current MOC system.

5. The SPR membership survey- MOC process High physician burden associated with participation in MOC. SPR members feel that participation is unnecessarily cumbersome and expensive. The physician/clinician scientist is increasingly burdened by activities that do not directly contribute to improved medical knowledge or improved clinical performance. The SPR supports measures to make the work of our members effective and efficient.

6. The SPR membership survey – Part 2 MOC : Many SPR members find low value in Part 2 MOC activities due to the restriction of choices, especially for subspecialists. The SPR is concerned that there is not adequate justification for the restrictive list of approved Part 2 MOC activities. It is currently difficult to receive Part 2 MOC credits for activities deemed to be of high value to a large academic pediatric community, such as giving a state of the art lecture about a clinical topic at the PAS meeting or other such similar activities.

7. SPR Membership Survey- Part 4 MOC: The SPR has many ongoing serious concerns about Part 4 MOC and currently supports making it an optional activity. There is a perceived low benefit to the activities. There continues to be low relevance of the available activities in many specialties. Most of our members already have QI initiative requirements outside of MOC, and many of these are perceived to be more relevant because they are locally implemented and/or more flexible than the current Part 4 MOC structure. So far, the perception is that the shift towards institutional implementation of the ABP MOC Part 4 Program has NOT made these activities less cumbersome or more relevant or more valuable. The requirement by the ABP for activities perceived to be of little value should be suspended until an evaluation is completed.

8. SPR Perspective – Part 4 MOC The SPR does not currently support the idea that Part 4 MOC might be expanded to include projects aimed at improving the “Quality of Research”. This is not within the purview of the ABP. Although the SPR and its members are deeply interested in improving the quality and reproducibility of research, MOC activities to improve research do not need to be mandated by the ABP. It is essential that the ABP focus on activities that will help diplomates to be the best possible clinicians.