Changes to the American Board of Internal Medicine's Maintenance of Certification Program: Preserving Core Assessment Values As Maintenance of Certification (MoC) for practicing physicians has evolved into more continuous programs, controversy has arisen over how physicians should self-regulate their profession and serve the public trust in doing so. As a result, the American Board of Internal Medicine (ABIM) has focused on making substantial changes to its MoC program by inviting physician members of the internal medicine community to play critical roles in shaping the program's processes through innovation. Much of the recent focus has been on changing the high-stakes assessment to one that is more relevant and authentic to practice, less burdensome and anxiety provoking for physicians, and more continuous over the course of their career. However, at the same time, ABIM has been careful to preserve the core values of integrity and fairness that are central to testing programs especially when making consequential decisions about test-takers in order to ensure that public expectations are met. This paper lays out the case for a continuous certification program with consequences and the story of how substantial changes were made using an evidence-based approach involving the physician community.