89in-depth review of the SAM is performed every 5 years by members of the original development team, as well as by new additions to the group, with a goal of replacing at least one-third of the questions.Finally, the commenting feature accessible to Diplomates after completing the SAM questions has also proven to be a helpful tool for keeping SAMs up to date. As with the hedges, staff members review this feedback on a regular basis. In addition to providing input regarding ambiguous or controversial content, these comments can also alert our staff to content that has become outdated because of new recommendations or studies.After a physician has revised or replaced a question, the changes go to the Content Development department. The new or revised content is then edited and incorporated into the department's database. From there, the new content is exported to the IT department, where it is moved into another database. The editors then review the questions once more in the format used on the Web., Cnce approved, the changes are deployed to our website.While complex and labor-intensive, these strategies have served to keep the SAMs current and assure our Diplomates that the content remains dynamically responsive to the changing field of family medicine!