Credentialing in medicine.

This article describes the history and process of credentialing: accreditation of programs and certification of individual practitioners. Under accreditation, general (institutional) and discipline-specific requirements, both for residencies and fellowships, are considered, along with possible outcomes and the appeals mechanism for an unfavorable review. Under certification, the relationship between individual specialty boards and the American Board of Medical Specialties is defined, followed by a consideration of the principles underlying subspecialty certification and recertification. It is concluded that enforced standards of learning are one of the pillars of accountability upon which a profession must rest; that if medicine abdicates its responsibility to impose credible standards on itself, its place will be taken by very interested, but less knowledgeable, others; and that we must, therefore, rededicate ourselves to the requirement of reasonable standards as a professional obligation and use the best means possible to meet that responsibility.