Address correspondence to Jeffrey S. Berns, MD, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, 1 Founders Pavilion, Philadelphia, PA 19104. E-mail: bernsj@ uphs.upenn.edu 2015 by the National Kidney Foundation, Inc. 0272-6386 http://dx.doi.org/10.1053/j.ajkd.2015.05.002 Recently, unhappiness has been expressed about certain elements of the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program. Concerns have also been raised about the decline in pass rates among first-time test takers for the ABIM Nephrology Certification Examination, from 86% to 87% in 2011-2013, to 80% in 2014. A commentary by Yuan and colleagues in this issue of AJKD downplays the roles of the ability of nephrology trainees to master the requisite content and the quality of training some fellows receive as important reasons for this decline in pass rates. Instead, they contend that initiatives of the Accreditation Council for Graduate Medical Education (ACGME), such as the Next Accreditation System and the Milestones project, or loss of validity and relevance of the ABIM certification exam in nephrology may be largely to blame. As Chairs of the ABIM Nephrology Specialty Board and Nephrology Board Exam Committee, respectively, we are responding to their comments about the ABIM Nephrology Certification Examination. It is important to respectfully address some erroneous or unsubstantiated comments made by Yuan and colleagues. We will specifically address their suggestions that the pass rate decline is due to a lack of external validity of the exams, flaws in exam development and implementation, deficiencies of the nephrology exam committee members, or the relevance of the exam to clinical practice. Our goal is to provide useful information that helps foster a healthy discussion that benefits the nephrology community at large. The recent decline in initial certification exam pass rate comes at a time when the nephrology community faces a myriad of problems and pressures, including an increase in the number of nephrology fellowship training programs and positions at the same time that the number of applicants for these positions has declined. We understand the frustration of nephrologists, including Dr Yuan and colleagues, and recognize that not passing the certifying exam has personal, professional, and financial consequences. We will not comment on the suggestion of links between ACGME activities and ABIM nephrology exam results other than to state that there are none that we are aware of that have been documented. The content and format of ABIM initial certification and MOC exams may be different in future years than they are today as changes in medicine, assessment, and technology evolve. However, they remain, even as currently constructed and administered, broadly