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The environmental scan revealed a broad array of recertification requirements for health professionals across countries, professions, and organizations

• Certifying organizations in the United States and other countries varied in their recertification requirements.
• Recertification exams were most common in, but not exclusive to, the United States.
• Alternatives to high-stakes exams were being considered or implemented by the U.S. PA certifying organization and several U.S. physician certifying organizations; these primarily included longitudinal assessments with smaller, regularly spaced batches of questions.
• Most APN organizations had not required exams for recertification.

The literature review found limited evidence on how recertification requirements for U.S. PAs, U.S. APNs, and U.S. osteopathic physicians affect patients and health professionals

• There was no empirical evidence concerning the effects of PA recertification (including high-stakes exams) on patient care.
• The review found more evidence regarding U.S. allopathic physician recertification; some (but not all) studies found associations between recertification and indicators of better care.
• The evidence regarding the impact of recertification requirements in other countries was more limited in size and scope than for U.S. allopathic physicians.

Interviews with health professional certifying organization representatives provided context about how organizations conceptualize their recertification and assessment requirements

• Emphasis on formative and summative goals of recertification requirements varied.
• Common themes emerged regarding attention to the relevance of requirements to health professionals' practice, as well as a perceived tension between a responsibility to assure the public of the health professionals' competence and a desire to account for the burdens on and preferences of health professionals.