To facilitate maintenance of certification (MOC) of hospital‐based physicians, the American Board of Internal Medicine (ABIM) developed the Hospital‐Based Practice Improvement Module (Hospital PIM). The Hospital PIM is one of a series of data‐driven, self‐evaluation instruments whose goal is to facilitate physician involvement in quality improvement (QI). The objective of this qualitative study is to understand the impact on physicians of completing the Hospital PIM for MOC.


A purposeful sample of physicians (n = 21) was interviewed using a semistructured interview guide with open‐ended questions. Data collection was terminated when theoretical saturation was reached or when no new data were revealed during the interviews. Interviews were transcribed, and data were systematically coded by 3 independent researchers. A fourth researcher reviewed all codes to maximize interrater reliability.


Constant comparative methods and content analysis of the data revealed several key themes. Overall, physicians described the Hospital PIM as a meaningful experience, even for those with high levels of QI experience. Value was described in several ways. Some physicians described a reflective process whereby the PIM facilitated awareness of their clinical environment, including various aspects not previously examined (eg, utilization of already existing standard orders). Others described the value as modest changes in practice behaviors or in their attitudes and perceptions of QI. Still others elaborated on the value of proposing or implementing a work process (eg, working in an interdisciplinary team) or change idea (eg, implementing a clinical pathway) in enhancing their understanding of QI in hospital settings. Those who were actively engaged in QI activities or who had knowledge and access of hospital QI resources reported a greater degree of value and satisfaction with the Hospital PIM than those who were not actively engaged in hospital QI activities. Finally, physicians reported that those hospitals that lack a culture of QI or do not intimately involve physicians in the QI process acted as barriers to a valuable PIM experience. Facilitators included an embeddedness of QI in the hospital culture, as well as interdisciplinary teamwork and leadership regarding QI activities.


This qualitative study identified several important factors that may lead to a meaningful experience for physicians completing the Hospital PIM. These findings will help to inform the proposed focused practice in hospital medicine as part of MOC, particularly activities geared toward quality improvement. Future studies should continue to investigate how the Hospital PIM can further facilitate and sustain physician behavior as it pertains to QI activities in the hospital setting.

Author Disclosure:

K. Caverzagie, American Board of Internal Medicine, receives salary support from ABIM; S. Reddy, none; E. Bernabeo, none; E. Holmboe, none.