With the launch of MOC, the ABD relied on its educational partners to respond to MOC elements by creating educational materials and activities to help diplomates satisfy time-specific requirements, which included a self-assessment (SA) component. To meet the SA component, each diplomate accumulates at least 100 points of SA credit every 3 years during each 10-year MOC cycle (at least 300 SA points per 10 years). Self-assessment credit was traditionally awarded for activities that quizzed diplomates using board style test questions that showed respondents their answers compared with peers. By 2014, partners in all corners of dermatology education were creating qualifying activities. Many of these activities were offered at significant expense to diplomate participants. Most educational organizations that offered the qualifying SA activities justified the costs to the diplomates in terms of the technology needed to meet the ABD’s requirements for self-assessment: specifically, to show audience performance on each question, to track individual scores, and to provide educational materials such as handouts to each learner after the activity. To many diplomates, this appeared like a conflicted money grab rather than the necessary cost of providing the education. Expense, limited relevant activities, and time away from patient care to meet MOC components were the most frequent complaints heard by the ABD during the first 10 years of MOC.