MOCA® Part 4: Improvement in Medical Practice

Diplomates must complete multiple activities over their 10-year MOCA cycle to demonstrate that they are participating in evaluations of their clinical practice and are engaging in practice improvement activities.

The traditional MOCA Part 4 requirements are completion of Case Evaluation and Simulation Course during the 10-year MOCA cycle. One activity must be completed between Years 1 to 5, and the second between Years 6 to 10. An Attestation is due in Year 9. More information is below.

Case Evaluation

Also known as a practice improvement project or quality improvement project. A four-step process where diplomates assess their practice and implement changes that improve patient outcomes.

A project may be completed in anesthesiology or an anesthesiology subspecialty, and may be completed by an individual, practice group or hospital. If completed by a group, each diplomate must submit his/her own documentation. 

In lieu of a self-directed Case Evaluation diplomates may complete one of the following:

  • Reciprocity with other ABMS Boards: One Part 4 activity through any other ABMS Board as long as the date completed falls within the required timeframe as the Case Evaluation. Documentation of completion of the activity must be submitted with diplomates' requests for Part 4 credit. All diplomates enrolled in MOCA must complete a Simulation Education Course and an Attestation as defined by their specific program requirements.
  • Quality Improvement Project through the Multi-Specialty Portfolio Program: This requires your healthcare organization to apply and gain approval for group quality improvement activities. For more information click here.


A contextual learning opportunity to assess and improve their practice in areas such as crisis management in a simulation setting at an ASA-endorsed center.


The ABA obtains attestations and evidence of a diplomate’s clinical activity and ongoing program of practice assessment and performance improvement.