If your board certification expires in 2010, you’re among the first group of Diplomates to go through the American Board of Orthopaedic Surgery’s (ABOS) Maintenance of Certification (MOC) process for board recertification. The goal of this new program is to encourage ongoing professional improvement among orthopaedic surgeons.

Although 2010 is still three years away, it’s not too early to plan out exactly how you intend to meet the program requirements. For an overview of the requirements, the deadlines, and other key aspects of MOC, read on. (Note: This information is specific to the class of 2010; future articles in AAOS Now will cover requirements for other classes. The ABOS has the best and most authoritative information on MOC.)

MOC requirements

MOC requirements are divided into the following four categories:

• evidence of professional standing
• evidence of life-long learning
• evidence of cognitive expertise
• evidence of performance in practice

A description of the requirements of each component follows. Table 1 shows the deadline dates for meeting each of these requirements.

Evidence of professional standing
Under this component, if you are in practice when you apply for the MOC examination, you must have a full and unrestricted license to practice medicine in the United States or Canada or be engaged in full-time practice in the U.S. federal government for which licensure is not required. If you have voluntarily allowed your license to lapse and are no longer in the active practice of orthopaedic surgery, contact the ABOS for instructions regarding the MOC process.

Each hospital/surgical center where you have admitting and surgical privileges must submit an original, signed, and notarized letter documenting those privileges to the ABOS office.

The final part of this MOC component is the peer review that the ABOS conducts upon receipt of the completed electronic application. Individuals within your practice community will be sent applicant evaluation forms, which are based on the six general competencies as defined by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties: medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. The ABOS Credentials Committee reviews all completed and returned forms.

Evidence of life-long learning
This component requires completion of 120 category 1 continuing medical education (CME) credits, including 20 credits for completing one or two scored and recorded self-assessment examinations (SAEs). “Scored and recorded” examinations require that your answers be sent—electronically or in hard copy—to the organization that published the exam. Self-scored exams that offer CME credit are helpful in fulfilling the 120-credit requirement but do not count toward the self-assessment requirement.

Several sources—including the AAOS and orthopaedic specialty societies, state medical societies, some medical specialty societies, medical schools, hospitals, journals, and other groups—offer category 1 CME. All sources of category 1 CME must be accredited by the Accreditation Council for Continuing Medical Education to provide category 1 CME as designated by the American Medical Association. The CME provider will supply written verification of your participation, either automatically or on request.

The Academy has an online, password-protected CME transcript service (www.aaos.org/transcript) for documenting your participation in and completion of AAOS CME programs. You may also upload CME credit information awarded by other CME providers to your personalized transcript. The site enables you to print or download your transcript for submission to the ABOS. Note that it is your responsibility—not the CME provider’s—to submit the documentation to the ABOS. The ABOS Web site (www.abos.org) has detailed instructions on submitting this information.

You must also have a minimum of 20 category 1 CME credits from scored and recorded SAEs that you complete during a three-year cycle. The SAEs are scored and returned confidentially to you by the organization that provides the examinations. Your SAE results should help direct your personal study plan for quality improvement. You must simply provide documentation that you have attained the required number of scored and recorded SAE credits to the ABOS. Each SAE examination you use should carry a minimum of 10 category 1 CME credits; you may use one or two exams to fulfill this requirement.

SAEs from the AAOS, the American Society for Surgery of the Hand, the American Orthopaedic Society for Sports Medicine, and other ABOS-approved self-assessment instruments are acceptable. The SAEs must be topical to orthopaedics and/or your orthopaedic specialty.

Evidence of cognitive expertise
This component requires completion of a secure computer examination or an oral examination.

A secure computer examination is administered at an accredited testing site; proof of identity is required. Exam questions focus on core orthopaedic knowledge, including ethics and patient communication.

If you choose to take an oral exam, you must submit a six-month case list. The ABOS selects 12 cases, and you may choose 10 of the 12 for the examination. Three 35-minute sessions are conducted and independently graded by two different examiners. The practice-based oral examination is only available if you are engaged in the surgical care of patients. Passing the practice-based oral examination also meets the requirements for the fourth MOC component, evidence of performance in practice.

For more details, contact the ABOS.

Evidence of performance in practice
Before applying for the computer-administered recertification examination, you must submit all your surgical cases for a consecutive three-month period, or a maximum of 75 consecutive surgical cases. This case list is not required if you take the oral examination. You can submit the case list online using the ABOS “MOC case list” template.

Evaluating performance in practice puts the focus on quality improvement. The case list provides a way for you to identify your own “best practices” and to establish a baseline for improvement during the next MOC cycle. “Best practices” will differ for individual practices and are likely to include personal compliance with practices such as “sign-your-site,” perioperative antibiotics, and deep venous thrombosis prophylaxis. As more “best practice” metrics are developed, you will be able to demonstrate that you are practicing safe, effective care.

Your case list and other information is available to the ABOS Credentials Committee, which can accept, defer, or deny application for sitting for the examination, or require a particular pathway for evaluation.

Applying for and taking the examination
Visit the ABOS Web site to apply for the recertification examination. Refer to the table for the application due dates.

When the ABOS receives your MOC application, it will begin a formal credentialing process. When you have successfully completed the credentialing process and have completed the life-long learning requirement, you will be admitted to take an examination.

MOC’s continuing development
According to G. Paul DeRosa, MD, ABOS executive director, the classes of 2011 and 2012 will have the same MOC rules as the class of 2010. If your certification expires in 2011 or 2012, visit the “Diplomates” section of the ABOS Web site for your MOC requirements and due dates.

The MOC program is not yet in final form for classes beyond 2012, however. Changes to the requirements, as well as additional requirements, can be expected in this dynamic program.

Direct all questions about MOC to the ABOS. The ABOS Web site (www.abos.org) has information about the MOC program and the latest notices from ABOS. You may also call the ABOS at (919) 929-7103 with questions about MOC.