we have a long-term perspective on family medicine residency education and the changing environment of graduate medical education over the past several decades. The changes instituted by the ABFM represent significant aid to program directors as they work to ensure that their graduates are prepared to safely and effectively enter independent practice. Board certification is an important metric of clinical knowledge. Other important training domains include application of clinical knowledge, communication and interpersonal skills, professionalism, intellectual curiosity and learning to improve the process and quality of care, and understanding systems of care and the role of the team and practice within the broader medical neighborhood. While these domains are all important, most are challenging to measure, and board certification as a measure of medical knowledge has been correlated with quality of care, overall ratings of a resident's clinical competence, and career satisfaction.2-5 For all these reasons, improvement in board scores is good for residency programs, their graduates, and the public.