Learning Objectives

  • Demonstrate an increase in the learner’s knowledge of clinical medicine.
  • Demonstrate an improvement in the learner’s ability to make decisions that provide safe and effective medical care.
  • Recognize areas of personal strength and areas for growth in clinical knowledge.

Intended Audience

Physicians and residents who are seeking to maintain and augment their knowledge in clinical medicine and/or preparing for their initial board certification or recertification.


The Massachusetts Medical Society (MMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) and must ensure independence, balance, and scientific rigor in its accredited continuing education activities.

All individuals in control of the content for an MMS accredited continuing education activity must disclose all financial relationships with ineligible companies.

AMA Credit Designation Statement

The Massachusetts Medical Society designates this enduring material for a maximum of 347 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

AAPA Credit Designation Statement

AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 347 hours of Category 1 credit for completing this program.


ABIM CME MOCSuccessful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 347 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Read the ABIM Policy here.

Royal College of Physicians and Surgeons of Canada

Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

Method of Participation

You must answer questions correctly to receive CME credit and MOC points.
Six questions answered correctly are designated for 1 AMA PRA Category 1 Credit™.
Six questions answered correctly equal 1 MOC point.

Accreditation Term:

CME credit and MOC points are available for 3 years. Term begins January 27, 2020.

Original Release Date: January 27, 2014
Review dates: 2015, 2016, 2017, 2019
Termination Date: January 27, 2023

The Massachusetts Medical Society (MMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) and must ensure independence, balance, and scientific rigor in its accredited continuing education activities.

All individuals in control of the content for an MMS accredited continuing education activity must disclose all financial relationships with ineligible companies.

Individual Disclosures

During their tenure with NEJM Knowledge+, the following planners, authors, and reviewers have disclosed the following relevant financial relationships with an ACCME defined ineligible company.

Vaneeta Bamba, MD
–    Member of the Growth Advisory Board for Genetic Short Stature for Novo Nordisk

Thomas M. Best, MD, PhD
–    Consultant for Abbot and ZetrOZ

Ethan G. Brown, MD
–    Grant/contract research with Gateway Institute for Brain Research
–    Consultant for Rune Labs

William Busse, MD
–    Advisory board for Merck
–    Consultant for Amgen, Novartis, GlaxoSmithKline, MedImmune, and Genentech
–    Data monitoring boards for Genentech and Boston Scientific
–    Study oversight committee for IC

Andrew T. Chan, MD
–    Consultant for Bayer Healthcare, Pfizer, Pozen, and Millenium Pharmaceuticals
–    Speakers bureau for Millienium Pharmaceuticals

Vincent W. Chiang, MD
–    Financial interest in and advisory board member for AugMI Labs

Ezra M. Cohen, MD
–    Consultant for Cornerstone Research Group

Jean M. Connors, MD
–    Honoraria from Pfizer
–    Consultant for Proteostasis Therapeutics
–    Scientific advisory board for Portola Pharmaceuticals

Kelly M. Cordoro, MD
–    Consultant for Anacor Pharmaceuticals
–    Scientific steering committee for Celgene

Peter D. Friedmann, MD, MPH
–    Legal expert consultant for Endo Pharmaceuticals
–    In-kind research support from Alkermes
–    Scientific advisory committee for Indivior

Rajesh T. Ghandi, MD
–    Scientific advisory board for Gilead and Merck
–    Grant support from Tibotec (Janssen Therapeutics), Abbott, ViiV Healthcare, Gilead, Merck, and Theratechnologies
–    Consultant for Theratechnologies

James E. Gern, MD
–   Consultant for Janssen Pharmaceutical Companies of Johnson & Johnson, GlaxoSmithKline, Boehringer Ingelheim, MedImmune AstraZeneca, and Merck
–   Grant support from GlaxoSmithKline and Merck

Emily M. Godfrey, MD, MPH
–   Speakers’ bureaus for Merck Pharmaceuticals and Bayer Women’s Health
–   Consultant for Teva Women’s Health

Jason Robert Gotlib, MD
–   Clinical trial research funding from Novartis, Promedior, Incyte, CTI Biopharma, Gilead, Seattle Genetics, and Pharmacyclics
–   Study steering committee member, advisory board member, and receipt of honoraria from Novartis
–   Advisory board member and receipt of honoraria from Incyte

Jonathan S. Hausmann, MD
–    Consultant and advisory board member for Novartis
–    Consultant for Pfizer and Biogen

Brian C. Healy, MD
–    Grant support from Analysis Group, Celgene, Novartis, Merck Serono, Verily Life Sciences, Tiziana Life Sciences, and Genzyme

Ole-Petter Riksfjord Hamnvik, MB BCh BAO, MMSc
–    Consultant for Fusion Pharmaceuticals

Elizabeth Harrison, MD
–   Financial interest in Pfizer, Merck, and Express Scripts

Simon M. Helfgott, MD
–    Consultant for AbbVie and Genentech

Mihir M. Kamdar, MD
–    Scientific advisory board member and stockholder for Amorsa Therapeutics
–    Expert advisory panel for Collegium Pharmaceuticals
–    Consultant for Fern Health, Medtronic, and Vivtex
–    Received fees from Medtronic and Fern Health

Amel Karaa, MD
–    Consulting fees from Akros Pharma, Concert, Alexion, Lumleian, and MitoBridge
–    Grant support, reimbursement for travel, and consulting payments from Stealth BioTherapeutics and Shire
–    Grant support, consulting fees, reimbursement for travel, and honoraria from Sanofi Genzyme
–    Grant support and reimbursement for travel from Reata Pharmaceuticals and Protalix Biotherapeutics

Ruslan Korets, MD
–    Consultant for Boston Scientific

Jenna C. Lester, MD
–    Consultant for Rodan + Fields

Eli Miloslavsky, MD
–    Fellowship in 2012—2013 from Genentech

Paul A. Monach, MD
–    Grant support from Genentech

Christopher J. Moran, MD
–    Grant support from Allergan

Alan C. Moss, MD
–    Consultant for Janssen Pharmaceutical Companies of Johnson & Johnson, Theravance Biopharma, Seres Therapeutics, Boehringer Ingelheim, Pfizer, Gilead, and Mallinckrodt Pharmaceuticals
–    Grant research/support from Pfizer and Boehringer Ingelheim

Leigh C. Reardon, MD
–    Consultant and speakers bureau for Actelion
–    Speaker for Janssen Pharmaceutical Companies of Johnson & Johnson
–    Participant in advisory board meeting for CareDx

Richa Chibbar, MD
–    Consultant for Ferring Pharmaceuticals and AbbVie

Shari S. Rogal, MD, MPH
–    Grant support from Gilead

Misha Rosenbach, MD
–    Consultant for Celgene

Paul E. Sax, MD
–    Consultant for Bristol-Myers Squibb, GlaxoSmithKline, Merck, Janssen Pharmaceutical Companies of Johnson & Johnson, and Gilead
–    Grant support from Bristol-Myers Squibb, GlaxoSmithKline, Merck, and Gilead

Marvin I. Schwartz, MD
–    Consultant for Boehringer Ingleheim, InterMune, and Merck

Bradford Shingleton, MD
–    Consultant for Transcend Medical
–    Grant Research/support from Alcon

John I. Takayama, MD, MPH
–    Financial interest in Omnicell

Derrick J. Todd, MD, PhD
–    Consultant for Kiniksa Pharmaceuticals, Genentech, Optum, and Regeneron

Avram Z. Traum, MD
–    Consultant for Alexion Pharmaceuticals

Ruth Ann Vleugels, MD, MPH, MBA
–    PI for a randomized controlled clinical trial funded by Pfizer

Andrew A. Wagner, MD
–    Consultant for BK Ultrasound

Raymond Y. Wang, MD
–    Advisory board member or consultant for Biomarin Pharmaceutical, Neurogene, RegenxBio, Takeda, Orphazyme, and Inventiva Pharma
–    Equity ownership in Biomarin Pharmaceutical, RegenxBio, and Sarepta Therapeutics
–    Speaking engagement for Biomarin Pharmaceutical
–    Webinar participant for Ultragenyx Pharmaceutical
–    Drug Monitoring Committee member for Denali Therapeutics

Sharmeel K. Wasan, MD
–   Grant support from Pfizer

Melissa B. Weimer, DO, MCR
–    Advisory role with Alkermes

James L. Zehnder, MD
–    Grant research/support from Novartis

All relevant financial relationships have been mitigated prior to the beginning of this activity in accordance with ACCME and MMS policies. All other individuals in control of the content have reported no relevant financial relationships with ineligible companies for this activity. The complete list of contributors can be found here.

Disclosure of Commercial Support

No commercial support was received for this activity.

Medium or Combination of Media Used

This is an adaptive self-assessment tool designed to adjust to the learner’s strengths and areas for growth, and can be accessed from a desktop, laptop, tablet, or smartphone. Learners choose the subspecialty area and are presented with a sequence of questions. After each question is answered, the user is provided with the key learning point, detailed feedback that discusses the correct answer as well as each of the wrong answers, and citations to relevant articles.

Estimated Time to Complete the Educational Activity

One hour for every 6 questions answered correctly.


Each clinical vignette includes citations and references.

Hardware/Software Requirements


  • Google Chrome 30+, Safari 5.0+, Internet Explorer 11.0+, Mozilla Firefox 10.0+, Microsoft Edge
    Recommended: Google Chrome 39+, Safari 7+, Internet Explorer 11, or Firefox 32+
  • Windows 7 (32-bit and 64-bit), Windows 8+. Windows 7+ is recommended.
  • Minimum 1 GB of RAM but 2 GB or greater is recommended
  • 2.33 GHz or faster x86-compatible processor, or Intel® Atom™ 1.6 GHz or faster processor for netbooks
  • Display resolution: 1024 × 768 or better

Mac OS

  • Google Chrome 14+, Safari 5.0+, Mozilla Firefox 12.0+
    Recommended: Google Chrome 39+, Safari 7+, or Firefox 32+
  • Mac OS X v10.6+
  • Minimum 1 GB of RAM but 2 GB or greater is recommended
  • Intel Core™ Duo 1.33GHz or faster processor
  • Display resolution: 1024 × 768 or better


NEJM Knowledge+ apps are available for iOS and Android smartphones and tablets; Android phones may access NEJM Knowledge+ through our mobile-optimized browser version.

  • iOS devices running OS 7+(includes iPhone and iPad devices). iOS version 8+ is recommended.
  • Android version 4+ (includes smartphones and tablets). Android version 5+ is recommended. Note: Android phones will also support the browser version of each product (Chrome recommended).

Contact Information

For all questions and comments, please contact NEJM Knowledge+ by email at knowledgeplussupport@nejm.org or call toll-free (within the USA and Canada) or +1-781-434-7998.

Policy on Privacy and Confidentiality

Read our Privacy Policy.


Copyright information can be found in the NEJM Group Terms of Use.

ABIM Policy

Participant data is governed by ABIM’s Confidentiality Policy and submitted to the ABIM using the ACCME PARS system. Identifiable patient data shall not be provided to ACCME or ABIM by any organization or participant.

Public Information About Providers of MOC Activities

The following information, provided to ACCME by the provider, is considered public information, and therefore may be released by ABIM and/or ACCME.

  • Activity title
  • Activity type
  • Accredited provider name
  • Accredited provider contact information (including phone number and website address)
  • Joint provider name (if applicable)
  • Activity date (start date, in the case of a multi-day live activity or enduring material activity)
  • Specialty(ies) activity addresses
  • Maximum allowable MOC points and patient safety credit awarded

The following information will be made available in physicians’ MOC history reports located in the secure physician login area of ABIM’s website:

  • Activity title
  • MOC point value, including patient safety credit, if applicable
  • Activity completion date