The American Board of Orthopaedic Surgery implemented a recertification program in 1986. This process has expanded to include a number of examination pathways that take into account subspecialty practices. Over the past two decades, general competencies of physicians have been defined and programs for evaluation and maintenance of these competencies developed. In an effort to have a more continuous process rather than episodic examinations only, and stimulate lifelong learning and practice improvement, recertification is now undergoing transformation to a Maintenance of Certification program. Maintenance of Certification as a process will emphasize ongoing self-assessment and lifelong learning, with required components occurring more frequently during the 10 year recertification cycle. Patient satisfaction and communication surveys will be incorporated to provide feedback to physicians to improve practice performance. Case list reviews, with a focus on patient safety measures, will also be a new addition to the process.