ABPN PIP (Improvement in Medical Practice): Clinical and Feedback Modules Explained

Q: Do I have to wait a minimum time between Step A and Step C?

ABPN sets only a maximum (24 months) . It asks you to "allow ample time" for all three steps . Step B has to be a real, implemented plan, so a same-week reassessment is not defensible on audit.

The Performance in Practice (PIP) activity, which ABPN also labels “Improvement in Medical Practice,” is the quality-improvement component of ABPN Continuing Certification (CC). In older ABMS language it is “MOC Part IV” [1][6]. Clinically active diplomates must complete one PIP activity per 3-year CC block, choosing either a Clinical Module (a chart review of your own patients) or a Feedback Module (surveys from patients, peers, residents, or a supervisor) [1][5].

Everything below was checked against abpn.org on 2026-08-21; the governing documents are the June 2025 CC Booklet [5] and the Fall 2025 PIP Handout [6]. For the full set of CC requirements see Continuing Certification overview and ABPN CME requirements.

The PIP requirement at a glance

Rule	What ABPN says	Source
How many	One PIP activity per 3-year block, regardless of how many certificates you hold	[5]
Who	Diplomates who are “clinically active and/or engaged in consultative care”	[1][5]
Choice	ONE Clinical Module OR ONE Feedback Module	[1][6]
Structure	Step A (initial assessment), Step B (identify and implement improvement), Step C (reassessment)	[1]
Time between A and C	Step C must occur “within 24 months of initial assessment”	[2][3]
Must be ABPN-approved	Yes: “The Self-Assessment CME (SA CME), PIP, and Patient Safety activities must be ABPN-approved”	[5]
Carry-over	No. Credit must be earned inside the current 3-year cycle; excess or early credit does not roll forward	[5][9]
Data sent to ABPN	None. “ABPN does not collect patient or peer data.” You document locally and attest in the Physician Portal	[1][5]

Step A and Step C must both fall inside the same 3-year block and no more than 24 months apart, so do not start the PIP in the last year of a block.

Who is exempt: Clinical Activity Status

ABPN uses the ABMS definitions and asks every diplomate to self-report a status in the Physician Portal [5][11]:

Status	Definition (ABPN wording)	PIP required?
Clinically Active	“Any amount of direct and/or consultative patient care has been provided in the preceding 24 months. This includes the supervision of residents.”	Yes
Clinically Active, Not Enough for a PIP	Active but “primarily in research, academic, or administrative roles insufficient to complete the PIP requirement”	No
Clinically Inactive	No clinical or consultative care in the past 24 months (e.g., medical leave, not practicing)	No

“If a diplomate is clinically active in at least one certification, they will need to complete the PIP requirement” [5].

Option 1: the Clinical Module (chart review)

The Clinical Module is a small, self-run audit of your own practice against a published standard [2][5].

The three steps, as written by ABPN

Step A, initial assessment of five patient charts. Collect data from “at least five of your own patient charts in a specific category (diagnosis, type of treatment, or treatment setting) obtained from your practice over the previous three-year period.” Compare those charts “with published best practices, practice guidelines, or peer-based standards of care,” using “a minimum of four quality measures” [2][5].

Step B, identify and implement improvement. “Based on results from chart reviews, develop and carry out a plan to improve effectiveness and/or efficiency of your medical practice.” If the initial review finds nothing to improve, “maintenance of performance in medical practice should be reassessed in Step C” [2][5].

Step C, reassessment of five patient charts. “Within 24 months of initial assessment, collect data from another five of your own patient charts (may use same or different patients).” Use “the same category and practice guidelines” as in Step A [2][5].

Where the module can come from

ABPN lists seven routes that count as a Clinical Module [2][5]:

A Clinical Module from the ABPN Approved CC Activities List (see below).
Your institution’s QI effort, if approved through the ABMS Portfolio Program. Completing an approved Portfolio QI project “receive[s] credit for one PIP Clinical Module,” and if it includes a patient or peer survey it can also count as a Feedback Module [5].
An approved registry, currently the APA’s PsychPRO Registry. The AAN Axon Registry closed June 1, 2024; ABPN accepted 2024 participation only for blocks ending in 2024 [2][5].
Participation in a Joint Commission-certified Primary or Comprehensive Stroke Center (neurology-oriented).
A Joint Commission-accredited, specialty-specific Ongoing Professional Practice Evaluation (OPPE). “Individual preapproval is no longer required” [2][5].
A QI effort under an international certification organization (e.g., RCPSC), submitted for preapproval.
Your own chart-review module, or your institution’s QI project, submitted for individual preapproval at no charge using the Individual PIP Pre-Approval Request Form [2][5].

ABPN also posts preapproved example modules (psychiatry: MDD, PTSD, SUD, delirium; plus an OPPE example), valid through December 31, 2026 [4].

Option 2: the Feedback Module (patient or peer surveys)

Same A-B-C structure and 24-month limit, but the data are structured surveys about your performance instead of charts [3][5].

Respondent counts

Step A must use one of these options, and Step C must use the same option [3][5][8]:

Feedback option	Respondents at Step A	Respondents at Step C
Patient feedback forms	5 patients	5 (same or different)
Peer feedback forms	5 peers	5
Resident evaluation forms	5 residents	5
360-degree evaluation forms	5 respondents	5
Supervisor evaluation form	1 supervisor	1

Who qualifies: “Peers may include other professional healthcare staff such as counselors, nurses, physicians, psychologists, and social workers.” Patients “may include those for which the diplomate supervises the care of another provider (e.g., resident)” [3][5].

Which survey instrument

You can use an ABPN feedback form (free, on the Approved CC Activities List), a Feedback Module product from that list, or your institution’s own patient survey or peer evaluation, provided it addresses the six general competencies: patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, professionalism, and systems-based practice. No preapproval is needed if the instrument covers all six [3][5]. The ABPN forms currently listed are the Patient, Peer, Resident Evaluation, Supervisor Evaluation, and 360 Degree Evaluation Feedback Forms [13].

Step B is the same idea as the Clinical Module: identify opportunities “as related to the general competencies and take steps to implement improvements as needed” [3][5].

ABPN-approved PIP products on the Approved CC Activities List

The list is a searchable database; PIP items are flagged “PIP C” (Clinical) or “PIP F” (Feedback) [12][13]. Filtering for Psychiatry plus “Applies to All Sub/Specialties” on 2026-08-21 returned these PIP-flagged entries [13]:

Provider	Activity	Type
ABPN	Patient, Peer, Resident, Supervisor, and 360 Degree Feedback Forms	PIP F (free)
ABPN	Individual PIP Preapproval Request Form	PIP C (free)
APA	Practice Assessment Tool for the Care of Patients with Borderline Personality Disorder	PIP C
APA	Practice Assessment Tool for the Care of Patients with Eating Disorders	PIP C
AAAP	PIP and SA activities on alcohol, cannabis, and opioid use disorders, and motivational interviewing	PIP C (also SA CME)
American Physician Institute	simplePIP and SA	PIP C and PIP F
CAHPS	CAHPS Patient Surveys	PIP F
Press Ganey	Clinician and Group, Medical Practice, Hospitalist, and Integrated surveys	PIP F

Subspecialty filters may surface additional items; check the live list [12]. ABPN “neither produces nor sells any CC products, other than its CC assessments” [9]; its entries are the free forms.

Worked example: a Clinical Module in an outpatient psychiatry practice

This example is illustrative. It is not an ABPN-preapproved module; it shows how a self-designed module maps onto ABPN’s rules. If you run your own module rather than one from the Approved list, ABPN’s text says to submit it for individual preapproval (free) [2][5], and the PIP Audit Form asks for exactly the elements below [8].

Topic (category): adult outpatients on a second-generation antipsychotic. ABPN requires “a specific category (diagnosis, type of treatment, or treatment setting)”; this is a treatment category [2].

Standard of comparison: the APA practice guideline for schizophrenia and the ADA/APA consensus recommendations on metabolic monitoring. ABPN requires comparison against “published best practices, practice guidelines, or peer-based standards of care” [2]. The audit form asks you to list the guideline(s) by name [8].

Quality measures (minimum four required [2]):

Baseline weight/BMI documented before or at antipsychotic start.
Fasting glucose or HbA1c documented within the guideline interval.
Fasting lipid panel documented within the guideline interval.
Blood pressure documented at follow-up.
(Optional fifth) Documentation that metabolic results were discussed with the patient or acted on.

Step A (month 0): Pull 5 charts of your own patients in this category from the past 3 years [2]. Score each chart yes/no on each measure. Record the dates of review; the audit form asks for “Date(s) of the Initial chart reviews” [8]. Suppose 3 of 5 have a lipid panel on file.

Step B (months 1-12): Write a short improvement plan: add a metabolic-monitoring order set or EHR reminder, schedule labs at the prescribing visit, add a checklist line to your note template. The audit form asks you to “Describe your plan for focused improvement” [8]. Implement it.

Step C (month 6-24, no later than 24 months after Step A): Pull another 5 charts (same or different patients) in the same category, scored against the same measures and guideline [2]. Record the dates. Suppose 5 of 5 now have a lipid panel.

Attest: in the Physician Portal, attest to one completed PIP activity for the block [5][15]. Keep the scoring sheets (without patient identifiers), the written plan, the guideline citation, and the review dates in your CC file; submit them only if audited [7][8].

A PHQ-9 measurement-based-care module works the same way (category: adult outpatients with MDD; measures: PHQ-9 at intake, at each medication change, documented response to non-remission, suicide-item follow-up; standard: APA MDD guideline).

How to attest in the ABPN Physician Portal

What ABPN formerly called “Physician Folios” is now the ABPN Physician Portal (www.abpn.org/physicianportal), where you “view and attest to your CC requirements” [15]. The CC Booklet tells diplomates to “complete and attest to the following CC activities for each 3-year block/cycle in the Physician Portal account ‘Activity Attestation’ section,” including “One Performance in Practice (PIP) activity” [5]. Diplomates attest annually and “do not need to submit documentation to the Board unless they are audited” [9]. If you are claiming reciprocal PIP credit from another ABMS board (below), attest to it in the Continuing Certification Activity Requirements section [5].

Alternatives ABPN accepts in lieu of a self-run module

Beyond the Clinical Module routes listed above (Portfolio Program, PsychPRO, OPPE, stroke center, international QI), two more options exist [5][9]:

Reciprocal credit from another ABMS board. A PIP completed for another ABMS Member Board during your current ABPN block counts; attest to it in the Portal and keep proof of good standing in case of audit [5].
Fellowship waiver. Graduates of an ACGME-accredited subspecialty fellowship who pass the subspecialty exam have one full block of CME, SA, and PIP waived; the waiver appears automatically in the Portal [5][9].

The ABPN FAQ summarizes it this way: diplomates get PIP credit “for approved institutional QI and feedback activities, approved registry participation, as well as participation in the ABMS Portfolio Program” [9].

Record-keeping and audits

ABPN randomly audits “approximately five percent” of diplomates in the CC Program each year; lapsed diplomates are audited on re-entry [7][10].
You have 90 days from the notification email to submit documentation for the current 3-year cycle; “No extensions are provided” [7].
For the PIP, you submit the PIP Audit Form plus supporting documentation. The form asks for: module type; topic (diagnosis, treatment, or setting); the guidelines used; the quality measures (minimum 4); dates of initial and follow-up reviews; and a description of your Step B plan. For Feedback Modules it asks for the option used, dates of initial and follow-up evaluations, a copy of the form, and the plan [8].
“Do Not submit any identifying patient information” or raw feedback data [7][8].
A failed audit changes your status to “Certified, Not Meeting Requirements.” You then have the remaining time in your next block to cure it; if not cured “by the end of the next block (6 years),” you are reported as “Not Certified” [5][7].

ABPN does not state a retention period beyond the audited cycle; a practical rule is to keep PIP materials until the audit window for that block has passed (audits are announced at the start of the year after a block ends [9]).

Recent changes to note

The June 2025 CC Booklet describes the three steps as completed “within a three-year CC block,” while the module pages and the Step C bullets keep the 24-month rule [2][3][5]. Plan for both.
The AAN Axon Registry closed June 1, 2024; only 2024 participation for blocks ending in 2024 was honored [2][5].
Individual preapproval is no longer required for Joint Commission OPPE [2][5].
The posted preapproved example modules are valid through December 31, 2026 [4].

Common questions

Is the PIP the same as “MOC Part 4”? Yes. ABPN’s handout refers to it as the “Part IV requirement,” and its FAQ lists Performance in Practice as one of the four CC components [6][9].

Can I do two Feedback Modules, or one of each? You only need one. “Diplomates are only required to complete ONE Clinical Module OR Feedback Module activity to complete the PIP activity” [5].

Do I have to wait a minimum time between Step A and Step C? ABPN sets only a maximum (24 months) [2][3]. It asks you to “allow ample time” for all three steps [1]. Step B has to be a real, implemented plan, so a same-week reassessment is not defensible on audit.

My charts showed no gaps. Do I still need Step B and C? Yes. If no improvement area is found, “maintenance of performance in medical practice should be reassessed in Step C” [2][3].

I supervise residents but do not see patients myself. Supervising residents counts as clinically active, and patients can include those whose care you supervise [3][5]. The Resident and Supervisor Evaluation options also fit academic settings [3].

References

Improvement in Medical Practice (PIP). ABPN. https://abpn.org/maintain-certification/moc-activity-requirements/improvement-in-medical-practice-pip/ Accessed 2026-08-21.
Clinical Chart Review Module. ABPN. https://abpn.org/maintain-certification/moc-activity-requirements/improvement-in-medical-practice-pip/clinical-chart-review-module/ Accessed 2026-08-21.
Patient or Peer Feedback Module. ABPN. https://abpn.org/maintain-certification/moc-activity-requirements/improvement-in-medical-practice-pip/patient-or-peer-feedback-module/ Accessed 2026-08-21.
Clinical Chart Review Module Examples. ABPN. https://www.abpn.org/maintain-certification/moc-activity-requirements/improvement-in-medical-practice-pip/clinical-chart-review-module/clinical-chart-review-module-examples/ Accessed 2026-08-21.
Continuing Certification (CC) Program Booklet, June 2025. ABPN. https://abpn.org/wp-content/uploads/CC-Booklet.pdf Accessed 2026-08-21.
Performance in Practice (PIP) Handout, Fall 2025. ABPN. https://abpn.org/wp-content/uploads/ABPN-PIP-Handout.pdf Accessed 2026-08-21.
ABPN Continuing Certification (CC) Audit Guidelines. ABPN. https://abpn.org/wp-content/uploads/ABPN-CC-Audit-Guidelines.pdf Accessed 2026-08-21.
Performance in Practice (PIP) Audit Form. ABPN. https://abpn.org/wp-content/uploads/PIP-Audit-Form.pdf Accessed 2026-08-21.
CC Program FAQs (combined). ABPN. https://abpn.org/wp-content/uploads/CC-Program-FAQ_Combined.pdf Accessed 2026-08-21.
ABPN Diplomate Audits. ABPN. https://abpn.org/maintain-certification/abpn-diplomate-audits/ Accessed 2026-08-21.
Clinical Activity Status. ABPN. https://www.abpn.org/maintain-certification/cc-program/clinical-activity-status/ Accessed 2026-08-21.
ABPN Approved CC Activities List (landing page). ABPN. https://www.abpn.org/maintain-certification/abpn-approved-products-list/ Accessed 2026-08-21.
Approved CC Activities List database (Psychiatry and All Sub/Specialties filter). ABPN. https://application.abpn.org/moc_products/includeMOCProductsPage.asp Accessed 2026-08-21.
FAQ: Do diplomates have a range of approved options available that meet PIP requirements? ABPN. https://abpn.org/faq/diplomates-range-approved-options-available-meet-improvement-medical-practice-pip-requirements/ Accessed 2026-08-21.
ABPN Physician Portal Account. ABPN. https://abpn.org/maintain-certification/physician-portal/ Accessed 2026-08-21.
Self Assessment for MOC, Accreditation Statement. (provider site) Accessed 2026-08-21.