The American Board of Orthopaedic Surgery (ABOS) Maintenance of Certification (MOC) and Recertification programs reflect our commitment to both the public trust and to ABOS Diplomates. As a result, the ABOS priorities are to minimize the expense and burden placed on Diplomates, without compromising the rigor of evaluation necessary for public trust. Those priorities have led to several planned and implemented changes.
The ABOS welcomes and openly solicits feedback from surgeons through several venues. For example, the joint AAOS/ABOS Task Force on MOC has members from both organizations who participate in quarterly conference calls. In addition, the ABOS conducts separate debriefing sessions with examinees and examiners after each certifying and recertifying oral exam. Finally, the ABOS strives to keep open lines of communication between Diplomates and the ABOS office, executive medical director, and members of the ABOS board of directors. Several of the changes outlined in this article were initiated through these communication channels.
Computer-based recertification exams
Beginning in 2018, several changes designed to increase the variety of recertification examinations to reflect changing practice patterns will be implemented. Three new practice-profiled recertification examinations—pediatric orthopaedics, orthopaedic trauma, and foot and ankle surgery will be available next year. They will be added to the existing computer-based examinations in general orthopaedics, spine, adult reconstruction, hand surgery, and sports medicine. The new recertification examinations are being supported and informed by volunteer subject-matter experts identified by the AAOS and the appropriate specialty societies who are helping to build examination blueprints that will eventually map to practice-profiled recertification examinations.
Also taking effect in 2018, the ability to sit for a hand surgery or sports medicine recertification examination will no longer be limited to those who hold subspecialty certification. Instead, any Diplomate who wishes to take either examination for recertification will have that option.
The 80 general orthopaedic questions have been removed from all subspecialty and practice-profiled examinations. With the addition of the three new practice-profiled recertification examinations, most orthopaedic surgeons will be able to recertify via a computer-based examination administered at a local testing center and based on a body of knowledge that closely matches their practices.
Diplomates are first eligible to take a recertification examination during their eighth year of the 10-year cycle. With timely application, the Diplomate has three chances to pass the recertification examination in any 10-year cycle. The examinations have approximately a 95 percent pass rate each year.
The ABOS is proud that fees (application and examination) have been stable for more than 8 years. No increases are under consideration for the near future. In 2016, the ABOS eliminated the $100 MOC fee due after the first 120 Continuing Medical Education (CME)/20 Self-Assessment Exam (SAE) credits were submitted.
Although computer-based examinations can accurately evaluate a surgeon's fund of knowledge, the oral examinations given in Chicago each year provide a much better "snapshot" of the surgeon's actual practice. The ABOS Oral Recertification Examination continues to be the best option for those Diplomates with tightly specialized practices that do not match any of the computer-based general or practice-profiled examinations.
The Oral Recertification Examination is based solely on a Diplomate's practice. After submitting a case list, Diplomates taking the oral examination will be notified which 12 of their cases have been chosen for the examination. The Oral Recertification Examination is very similar to the Part II Oral Examination. Because the process has been digitized, there is no need to bring voluminous documentation to the examination; everything is uploaded electronically prior to the examination.
ABOS Oral Recertification Examinations are administered by approximately 200 experienced orthopaedic surgeons who donate 4 days of time away from their practice each year. That commitment to preserving safety and quality in our profession is commendable.
The ABOS is currently testing a new recertification examination option. This Virtual Practice Evaluation (VPE) will assess a Diplomate's cases and practice much like the oral examination but without the need for the examinee to be present. The VPE would be performed by the same group of examiners who administer the oral examinations, with essentially an identical application and case list but, again, without the need for the Diplomate to actually travel to Chicago. Testing and appraisal of the VPE is underway to ensure the validity of this assessment tool and identify who might benefit from it.
Several other process changes are also underway. The ABOS is working to provide improved blueprints of the content for all computer-based examinations. This is in response to candidate requests for additional content details so that they can prioritize and optimize their examination study and preparation. Visit www.abos.org to view the detailed blueprints currently available; others will be added soon. Modifications are underway to simplify the application, case list entry, and document uploading processes.
ABOS's current certification and recertification programs and processes have evolved and been refined with input from our profession's leaders over the past 82 years. Nonetheless, the ABOS is always looking for improvements. Open communication will make those improvements possible and we welcome input from Diplomates.
Communication is a key component for decreasing perceived burden. The redesigned ABOS website is a good source of information and includes extensive video instructions on each step of the MOC process. Plus, Diplomates have an individual ABOS staff point of contact for email or telephone questions.
The public perceives board certification as an indication of competence, quality, and safety at the highest level. That perception is a tremendous value for the board-certified orthopaedic surgeon. The ABOS remains committed to preserving that value for patients, orthopaedic surgeons, and our profession.
Future issues of AAOS Now will present greater detail on important MOC issues. The ABOS looks forward to working with the AAOS to add value and decrease burden in all ABOS processes.
James Roberson, MD, is president of the American Board of Orthopaedic Surgery; David F. Martin, MD, is the ABOS executive medical director.
Summary of current and upcoming changes
- Three new practice-profiled recertification examinations—pediatric orthopaedics, orthopaedic trauma, and foot and ankle surgery—are being developed.
- Hand surgery and sports medicine recertification examinations are being made available to all interested Diplomates.
- General orthopaedic questions have been removed from subspecialty and practice-profiled examinations.
- A new recertification pathway—the Virtual Practice Evaluation (VPE)—is being tested. The VPE will assess a Diplomate's cases and practice much like the oral examination but without the need for the examinee to be present.
- The ABOS is working to provide improved blueprints of the content for all computer-based examinations. This is in response to candidate requests for additional content details so that they can prioritize and optimize their examination study and preparation.
- Modifications are underway to simplify the application, case list entry, and document uploading processes.