AAOS Now

Published 10/1/2009
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John G. Seiler III, MD; James R. Kasser, MD; David F. Martin, MD; Shepard R. Hurwitz, MD

Volunteers: The backbone of certification

The exceptional commitment of board-certified orthopaedic surgeons to their profession can be seen whenever the oral examinations of the American Board of Orthopaedic Surgery (ABOS) are given. The United States has approximately 25,000 board-certified orthopaedic surgeons, and more than 14,000 of them are currently participating in the recertification process.

Administering the part II oral examination requires 150 volunteer orthopaedic surgeon examiners from all orthopaedic subspecialties. Examiners come from all across the United States. This past summer, over three 12-hour days, these volunteers questioned 695 candidates who were completing their initial certification process. They also administered 127 examinations to diplomates who used the oral pathway as a mechanism for recertification. Going forward, both candidates and diplomates will participate in the Maintenance of Certification (MOC) process as required by the American Board of Medical Specialties and planned and administered by the ABOS.

Altogether, the volunteer examiners donated more than 4,000 cumulative work hours (excluding travel) to improve the quality of our specialty. In spite of the very tough economic times and the uncertainty created by the latest round of proposed healthcare reforms, experienced diplomates again answered the call and gave their time and energy to this process—one that is unique to orthopaedic surgery and helps ensure the quality of care for patients in the United States.

The importance of self-regulation
One key component of a profession is its ability to self-regulate. The ability of orthopaedic surgeons to perform this essential function is central to our contract with society, and board certification is one tangible example of this function. For their part, the oral examination candidates understand the importance of the process and participate voluntarily. In so doing, they agree to review their own practice patterns and present 10 cases to the volunteer examiners to demonstrate their performance in practice.

Using this very open format, candidates have an opportunity to demonstrate that they meet the test for practice performance. Their voluntary participation signifies their understanding of the fact that they must meet the standards of the profession to obtain board certification. Likewise, the ABOS demonstrates the importance of this issue by including professionalism as a specific component in the scoring rubric. The overarching goal of the oral examination exercise is simple: to ensure that our orthopaedic colleagues are practicing in a manner that meets the standard.

Do you have what it takes?
What does it take to be an oral examiner? To qualify, you must have obtained initial board certification and then have participated successfully in the recertification process in orthopaedic surgery. You must also obtain two letters of support from board-certified orthopaedic colleagues. These qualifications are carefully reviewed by the ABOS. In subspecialties with Certificates of Subspecialty Certification, the ABOS prefers examiners who have successfully completed that process.

All examiners must themselves have participated in the recertification process to ensure that they meet the standards for orthopaedic practice. As MOC becomes fully deployed, we anticipate that oral examiners will also need to be participants in the MOC process. Finally, examiners must be willing to serve our profession by volunteering for the entire week of examination administration.

A volunteer who is designated as an oral examiner is added to the pool of examiners for the examination. Each year, the ABOS executive director, along with the chair and members of the ABOS Oral Examination Committee, assigns the examiners for the summer oral examination process.

Each summer, the ABOS also begins the internal process of training new examiners. New examiners must agree to abide by the ABOS conflict of interest policy and participate in a standard orientation process. New examiners spend the first day of the examination familiarizing themselves with the scoring rubric and examination process by observing examinations given by experienced examiners during the oral recertification examination. After reviewing the examination methods and undergoing a standard orientation session, new examiners are ready to begin administering oral examinations.

In 2009, 32 new examiners successfully participated in the part II exams and were added to the ABOS examiner pool. After the examinations are completed, the Oral Examination Committee conducts a post hoc analysis of the examiners and the examination. As a way to continuously improve the examination, the Board provides detailed feedback to the examiners about their performance in the examination.

You get more than you give
As is true for most volunteer activities, examiners get more than they give. They know that this process is important to the public good, and they are committed to maintaining the standing of the orthopaedic profession (See sidebar). The certification process meets the needs of the orthopaedic profession and could not be achieved without the tremendous support of the volunteer examiner workforce, which is virtually unmatched across all fields of medicine.

On behalf of the ABOS, we would like to honor and thank the 150 volunteer examiners that gave generously of their time and expertise again this summer. Their significant contributions continue to make a difference—not only for our profession, but for our patients as well. Volunteerism is alive and well in orthopaedic surgery.

John G. Seiler III, MD, is the ABOS president; James R. Kasser, MD, chairs the ABOS Oral Examination Committee; David F. Martin, MD, is the ABOS treasurer; and Shepard R. Hurwitz, MD, is the executive director of the ABOS. For more information, visit the ABOS Web site, www.abos.org

Examiners weigh in
As noted, volunteers are at the core of the ABOS oral examination process. AAOS Now contacted two volunteers to find out what brings them back each year.

Kenneth A. Jurist, MD
Bloomfield Hills, Mich.

I have been an examiner for about 5 years now and consider it a privilege and an honor. Although the week is rigorous, it is invigorating at the same time. Exploring a candidate’s depth of knowledge and trying to differentiate nervousness from inadequacy is challenging. I get to explore the thought processes of newly trained surgeons from all parts of the country. More often than not I am reassured that we are turning out excellent surgeons from our training programs. On occasion, however, I will find the opposite and feel fortunate to be able to identify those whose knowledge and skills are not on par with the vast majority.

Taking a week out of practice or away from vacation may seem like a chore, but I look forward to it every year. The importance of being examined by actual practicing surgeons, who have successfully completed the very same pathway as the examinees, is enormous. The list of possible alternatives is not nearly as attractive.

Mary I. O’Connor, MD
Jacksonville, Fla.

I enjoy being a Board examiner. It is one of the most important activities that I do in terms of patient safety. As a profession we need to be responsible for identifying individuals who are not competent as orthopaedic surgeons. I believe the process of the oral boards does this in an effective and equitable manner. I also enjoy going over the cases with the examinees and am impressed by how many caring, bright young surgeons our institutions have trained.