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Medical board certification guarantees that practicing physicians maintain a standard of evidence-based knowledge essential for quality care. Certification exams must ensure physicians understand and implement current guidelines and standards. Longitudinal assessment (LA) has emerged as a popular alternative to traditional summative examinations for both initial certification and maintenance of board credentials. While LA offers notable advantages—including scheduling flexibility, immediate feedback, detailed answer explanations, and resources for continued learning. Significant gaps in understanding how physicians engage with LA and whether it achieves its intended goals of promoting meaningful ongoing development and learning. These insights are critical for optimizing future assessment programs and ensuring they effectively support physician learning.