Recent controversy about the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) process has centered on the role of the secure examination.1 Some physicians object to taking any examination, whereas others assert that the internal medicine and subspecialty examinations are not sufficiently focused to reflect physician practices. Others have questioned why the examination is not “open-book” to mirror a real-world practice environment. Even though all 24 certifying boards of the American Board of Medical Specialties require secure examinations for MOC, and many have required recertification for decades, the questions raised regarding ABIM examinations have relevance to all medical specialties. This Commentary intends to clarify the science and philosophy behind examination development and the current psychometric principles that guide the process.
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