To practice medicine in the United States, doctors must be licensed by the states in which they work. However, licensure does not indicate whether a doctor is qualified to practice in a specific medical specialty. Board certification is the process by which a physician (MD) in the United States demonstrates a mastery of the basic knowledge and skills that define an area of medical specialization. Before a doctor can become Board Certified, each must complete: four years of premedical education in a college or university; a course of study leading to an MD degree from a qualified medical school and three to five years of full-time experience in an accredited residency training program. In the field of psychiatry, the American Board of Psychiatry and Neurology identifies qualified specialists through rigorous credential and training requirements and successful completion of Board examinations for psychiatry. This is just the first step in the career-long learning and assessment process required by the rigorous American Board of Medical Specialties Maintenance of Certification program. To maintain Board certification, a doctor must actively keep pace with the latest advances in his or her specialty and demonstrate best practices for patient safety, communications and ethics.