Published 3/24/2021
Michael S. Bednar, MD, FAAOS; David F. Martin, MD, FAAOS

COVID-19 Does Not Slow Down the ABOS

The COVID-19 pandemic has affected nearly everyone and everything over the past year, including the American Board of Orthopaedic Surgery (ABOS). The ABOS thought it was critical to continue with Board Certification operations but made adjustments as needed. Although patient and physician safety were top priorities, keeping its programs running and allowing ABOS Diplomates to stay up to date with their Board Certification were also critical. Finding ways for ABOS Diplomates to maintain their Board Certification will continue to be a priority in 2021.

The good news is that all ABOS programs were able to continue in 2020 with changes and adaptations. In the spring of 2020, the popular ABOS Web-Based Longitudinal Assessment (ABOS WLA) program was administered for the second time. More than 12,600 Diplomates participated—about 3,000 more than in 2019. As with the first administration in 2019, many Diplomates stated that they enjoyed participating in an assessment that did not require them to leave their homes. In addition, due to impacts related to the COVID-19 pandemic, the ABOS opened the 2020 ABOS WLA program to many Diplomates who were not previously eligible. Hundreds took advantage of that opportunity. In response to the pandemic, Knowledge Sources related to COVID-19 and its effects on the field of orthopaedic surgery were made available through that program. More than 99 percent of participants earned a Quality Year in the 2020 ABOS WLA program.

The 2021 ABOS WLA is currently underway, and the ABOS invites all eligible Diplomates to participate. The ABOS WLA is a great way to review Knowledge Sources that may be of interest to AAOS Fellows. The Knowledge Sources have been chosen by expert panels of orthopaedic specialists who were nominated by AAOS and various subspecialty societies. The six-week assessment window allows busy orthopaedic surgeons to take the assessment at a time and place that are convenient to them. The Knowledge Sources are available for review now, and the six-week administration window opens on April 6.

In July 2020, 844 Candidates took the ABOS Part I Examination. Traditionally, the ABOS Part I Examination is offered on only one day each year. In order to accommodate all eligible Candidates at testing centers that were functioning at decreased capacity due to social distancing regulations and decreased staffing, the ABOS extended the testing window to two weeks. The ABOS was able to accommodate all interested Candidates for the Examination, and the pass rate was similar to that of past years. For this year, the ABOS anticipates returning to the previous single-day schedule on July 14. Arrangements will be made to accommodate other dates if that becomes necessary.

The 2020 ABOS Computer-Based Recertification Examinations and Subspecialty Certification Examinations also took place as scheduled in August 2020, September 2020, and October 2020. For those Diplomates who did not feel comfortable taking an assessment in a testing center, the ABOS worked with them to roll over their applications to 2021 without penalty.

The biggest change in 2020 was with the ABOS Part II Oral Examinations and the ABOS Oral Recertification Examinations. Those in-person examinations were scheduled to take place in Chicago in July 2020. As the Examination date approached, it became clear that the ABOS could not hold them in person; the ABOS Board of Directors also knew that it was not fair to the nearly 1,000 Candidates and Diplomates who had prepared for the Examinations to wait until 2021.

The ABOS responded by creating the 2020 ABOS Case Based Examination, a three-stage assessment program. This examination format allowed the ABOS to perform an in-depth multistage evaluation of each Examinee’s practice remotely, eliminating the potential health risks associated with in-person gatherings. Over the past few years, the ABOS has piloted a Virtual Practice Evaluation, which was used as the backbone for the Case Based Examination.

As is done with the traditional in-person Oral Examinations, Examinees submitted a list of all surgical cases over a specified period. The ABOS then selected 12 of those cases for presentation at the Examination. In the spring of 2020, the Examinees uploaded pertinent documents and images for each of those 12 Selected Cases into the ABOS’ online Scribe Portal.

In the first stage, Examiners remotely reviewed the documents and images related to the selected cases without the Examinee present. The 12 selected cases from all Examinees were evaluated and scored in that first stage. Examiners were provided a scoring rubric to allow them to evaluate each case in a standard fashion. There were Examinees with practices that were not amenable to complete evaluation using the methods of this Stage 1, and those Examinees were moved to Stage 2 of the ABOS Case Based Examination.

The second stage was performed on those Examinees for whom Examiners required additional information that could not be obtained during the first stage. This second stage consisted of a remote online Case Based Oral Examination, with each Examinee undergoing two one-hour examination sessions. In each of these two sessions, the Examinee interacted through Zoom with two Examiners. In total, four Examiners assessed each Examinee participating in Stage 2, again utilizing a standard scoring rubric.

All Examinees were then moved to Stage 3 of the process. This third stage of evaluation was conducted by the ABOS Board of Directors. The materials provided by all Examinees and Examiners in the first two stages were available for review, evaluation, and decision making.

Examinees who were successful in the 2020 ABOS Case Based Examination became either ABOS Board Certified or recertified their ABOS Board Certification. If, however, through this process, the ABOS Board of Directors was unable to conclude that an Examinee met the standards for ABOS Board Certification, then the Examinee was invited to participate in the 2021 ABOS Oral Examination with no additional Examination fees and no loss of Board Eligibility/Certification.

At the time that this issue went to press, the ABOS is planning to hold the 2021 Oral Examinations during the third week of July in Chicago. Certainly, that could change based on the implications of the COVID-19 pandemic. Orthopaedic surgeons registered for the 2021 ABOS Part II Examination and ABOS Oral Recertification Examination will be emailed details once they are finalized by the ABOS.

Making all of these operations run smoothly required hard work, dedication, and cooperation. The ABOS is indebted to more than 400 volunteer orthopaedic surgeons who took time away from patients and family to assist in these processes. Special thanks are also due to all ABOS Candidates and Diplomates for being flexible throughout the past year.

Although there will still be challenges as we move forward this year, the ABOS will continue to work to ensure that ABOS Board Certification and Continuing Certification remain relevant and valuable.

Michael S. Bednar, MD, FAAOS, is president of the ABOS.

David F. Martin, MD, FAAOS, is the executive medical director of the ABOS.