PCI process and outcomes assessments can be used for internal quality-improvement efforts and public reporting. Public reporting of institutional risk-adjusted outcomes is becoming more common. Although operator-level outcomes can be assessed and risk adjusted, the results are much less reliable due to lack of statistical power resulting from lower volumes. Any public reporting must use statistical methods that meet the high criteria established by the AHA Work The cognitive knowledge and technical skill required to perform PCI continue to grow. Details on the training required for interventional cardiology are found in the most recent ACCF Core Cardiology Training Statement.868 7.3. Certification and Maintenance of Certification: Recommendation Class IIa 1. It is reasonable for all physicians who perform PCI to participate in the American Board of Internal Medicine interventional cardiology board certifica- tion and maintenance of certification program. (Level of Evidence: C) The American Board of Internal Medicine established inter- ventional cardiology board certification in 1999 as an added qualification to the cardiovascular disease board certifica- tion. Since 1990 all certificates from the American Board of Internal Medicine are time limited for a 10-year period and require all diplomats to participate in maintenance of certifi- cation to maintain their board-certified status. Maintenance of certification in interventional cardiology requires physicians to document a minimum of 150 interventional cases over the 2 years before expiration of the current certification, complete self-assessment modules of their medical knowledge, partic- ipate in practice-based quality-improvement activities, and pass a secure, knowledge-based examination.869 871 For those who cannot meet the case volume requirement, an alternative option is to submit a log of 25 consecutive cases including patient characteristics and procedural outcomes. 