Maintenance of Certification Program Part Four
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ACPM MOC Part IV Process

This seven-step component of the MOC Program applies to those diplomates whose certificate expired in 2010 or later. This component utilizes a quality improvement model with opportunities for assessment of practice performance and improvement activities available in clinical practice, teaching, research, and administration.

Enrolled diplomates will download the Diplomate Practice Assessment Plan (DPAP) and Diplomate Practice Assessment Plan (DPAP) instructions. The DPAP will walk you through the seven-step process of MOC Part IV listed below:

  1. Select the appropriate tool.
  2. Prepare for the evaluation.
  3. Complete the evaluation.
  4. Identify area(s) for improvement.
  5. Develop/implement QI plan.
  6. Measure improvement.
  7. Document process on the Diplomate Practice Improvement Plan (DPAP).

NOTE: Regardless of which MOC Part IV tool you choose, you will follow the same process.



(These are samples only. You will need to enrolland pay the registration fee in order to download original documentation.)

1. Clinical Practice Evaluation:You must select this tool if greater than 10% of professional time is spent providing direct patient care. This tool is designed to review a random selection of your patient's medical records regarding your practice of clinical preventive medicine. This tool offers two versions-Adult and Pediatric.

Clinical Practice Evaluation I (select Adult or Pediatric)

Adult - Medical Record Review

Pediatric - Medical Record Review

Clinical Practice Evaluation II - Clinical System Review

NOTE: You MUST complete BOTH parts of the CPE (CPE I-Medical Record Review and CPE II-Clinical System Review)

Non-Clinical Tools Available

NOTE: All three tools are designed for physicians spending less than 10% of their time in direct patient care. All three tools require the selection of 10 (PM and ACGME) competencies on which to be evaluated.

2. 360-Degree Feedback Evaluation: Compilation of feedback regarding fulfillment of selected competencies in a rating scale format from self, superiors, peers and subordinates.

Feedback Evaluation Form Instructions

Feedback Evaluation Form SAMPLE

3. Report Card Evaluation: This tool is a narrative-style self-assessment and feedback from supervisor regarding fulfillment of selected competencies.

Report Card Evaluations Instructions
Report Card Evaluations SAMPLE

4. Portfolio Evaluation: This tool is a compilation of diplomate-selected products/examples from practice representing fulfillment of the 10 selected competencies.

Portfolio Card Evaluations Instructions
Portfolio Card Evaluations SAMPLE

Enroll in ACPM MOC Part IV Now!

To enrollin the ACPM MOC Part IV process, you need to complete the registration form and paid your MOC Part IV Fee ($295 members/$395 non-members). After payment, you will be able to download your DPAP and the Part IV tool of your choice. NOTE: THE DOWNLOAD WILL ONLY BE AVAILABLE FOR 30 DAYS.

Once you have completed your MOC Part IV application, you can e-mail it to Haydee Barno, Director, Continuing Education or mail it to:

American College of Preventive Medicine

ATTN: MOC Part IV Department

455 Massachusetts Ave., NW, Suite 200, Washington, DC, 20001

For questions, please contact hbarno@acpm.orgor 202-466-2044x103

IMPORTANT NOTE: if you need to have your MOC Part IV Application processed, reviewed and submitted to the American Board of Preventive Medicine by January, 31st 2017, you MUST submit your application to ACPM on or before November 30, 2016.

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