Certification and Judgment　― Redefining Excellence in Percutaneous Coronary Intervention Practice ―

agement, and periodic renewal based on procedural ment.Distinct from other Western systems, the BMCVIT program emphasizes hands-on technical proficiency and mentorship than written assessment alone, fostering both technical precision and clinical judgment. 8,9This philosophy aligns with Japan's clinical environment, where intravascular imaging is in >90% of PCI procedures, reflecting a long-standing commitment to imagingguided optimization. 2,10,11Previous registry analyses from abroad have reported inconsistent associations between board certification and T he quality of percutaneous coronary intervention (PCI) outcomes is linked not only to technological innovation but also operator experience and procedural volume, particularly for complex or acute cases. 1-3However, volume alone does not reflect the multifaceted proficiency required for a safe intervention. 4,5Hence, many countries have introduced certification systems to ensure operator proficiency and competency. 6,7In Japan, the Board-Certified Members of the Cardiovascular Intervention and Therapeutics (BMCVIT) program, established by the CVIT in 2009, is one of the most structured and practice-integrated certification systems worldwide.The curriculum provides comprehensive, case-based training covering imaging-guided PCI, complication man-