ABSTRACT
"Credentialing" is used as an umbrella term for the accreditation of programs and the licensure and certification of individual practitioners. Credentialing is a powerful tool that must not become so politically, emotionally, or bureaucratically entangled that it fails to serve the best interests of patients. Quality in education, like quality in research and patient care, requires time for reflection, preparation, assessment, and adjustment in addition to the activity itself. The expansion of clinical effort driven by managed care has reduced the time needed to protect these aspects of quality. Quantity, beyond a certain critical mass, undermines quality. The expected increase in numbers of medical students and residents will in itself extend the time required for performance evaluation, as will the increasing complexity of the accreditation and certification processes. Most objections to Maintenance of Certification (MOC) have come from practitioners, whose major concern is the content of the evaluation, since many professionals have limited their area and style of practice.
