Every year, the American Board of Orthopaedic Surgery (ABOS) produces a new Part I Written Certification Examination. The Examination is graded on a standard, and the results for first time test takers graduated from US and Canadian programs and for all examinees taking the test are published. The process by which the examination is written and scored is on the ABOS website, entitled “How the ABOS Part I Examination is Developed.” It can be accessed via this link. While in most years the passing rate falls within an expected range, there are some years when it does not. When the results of the examination fall outside the expected range as it did this year, a thorough review of the Written Examination process is performed prior to release of the results. The review found that the 2026 examination was developed and scored using the same established processes as previous examinations, was not significantly more difficult than previous examinations, and met established psychometric standards for difficulty and reliability. This report details the results of that review.
The process of exam construction is a collaboration with volunteers (all of whom are ABOS Diplomates and are practicing orthopaedic surgeons), ABOS staff, and contractors.
The Part I Blueprint Committee meeting for the 2026 examination was held in February 2025. The committee consisted of 16 ABOS Board Certified orthopaedic surgeons. Since the blueprint is used for the Part I Examination and the AAOS Orthopaedic In-Training Examination, committee membership was split between the AAOS and ABOS.
Questions for the examination were chosen from the ABOS Question Bank to meet the requirements of the blueprint. Each year, new questions are written by ABOS Diplomates on the ABOS Question Writing Task Force (QWTF) and are added to the question bank. Old questions are reviewed by the QWTF to ascertain that all questions in the bank are clearly written, still supported in the published peer-review literature, and are still relevant to current practice. The QWTF is comprised of approximately 40 ABOS board certified orthopaedic surgeons chosen for their expertise in their specialty.
The 2026 Part I Examination was first assembled in the fall of 2025 in collaboration with examination experts at the American Board of Medical Specialties (ABMS). While most of the questions had never appeared on the ABOS Part I Examination, approximately 30% were high-quality questions that are used to equate the examinations from year to year.
The ABOS Field Test Task Force met on November 14, 2025. Twenty-seven ABOS Board Certified orthopaedic surgeons, chosen for their expertise and their knowledge of what a graduating orthopaedic surgery resident should know, met to review each question recommended to appear on the examination. Unacceptable questions were removed and replaced with questions from the bank.
The final review of the entire examination was conducted by the ABOS Board of Directors in February 2026. Each question was reviewed for clarity, pertinence, and appropriateness for the examination. Unacceptable questions were removed and replaced with questions from the question bank.
In total, approximately 60 ABOS Board Certified orthopaedic surgeons—all practicing orthopaedic surgeons–reviewed the examination before it was administered. The review showed that the examination was prepared in a similar fashion to previous years.
The 2026 ABOS Part I Examination was administered on July 14, 2026. A Key Validation exercise was held to review questions that were statistical outliers. Six questions from this year’s examination were removed from scoring. This compares favorably with the three questions that were removed from the 2025 examination. The examination results were statistically reviewed by a group of experienced psychometricians. The examination was scored based on the standard that was accepted from the 2025 Part I Examination using the Angoff method and the Hofstee compromise method.
Based on the standard, the examination did have a lower pass rate than in the many years. The overall failure rate was 17.4 % and the failure rate for first time takers from US and Canadian residency programs was 12.7%. The psychometricians compared the 2026 examination to the 2025 examination and to the pooled benchmark. The difficulty of the examination was noted to be slightly, but not significantly, easier than the 2025 examination (0.06 in 2026 compared to 0.08 in 2025, pooled benchmark of -0.04). The mean percentage of correct answers needed to pass the examination was 69.6% in 2026 compared to 68.6% in 2025. The Rasch reliability was 0.84 in 2026, compared to 0.81 in 2025, with a pooled benchmark of 0.82. Values over 0.8 on the Rasch reliability index are considered to represent an examination that is reliable. The main difference noted by the psychometricians was the Mean Person Measure, a value which judges how well the group as a whole performed on the examination. In 2026, the Mean Person Measure was 1.54, compared to 1.84 in 2025 with a pooled benchmark of 1.80. While the examination results produced a bell shape curve when comparing the number of candidates to examination score, more candidates did not meet the passing standard in 2026 than in previous years.
The AAOS Orthopaedic In-Training Examination is roughly linked to the ABOS Part I Examination through questions that are placed on both examinations. Through this linkage, residents are told if their OITE score meets or exceeds the ABOS minimum passing standard threshold. The percentage of PGY-5 residents who met or exceeded the standard threshold by year are as follows: 2022 – 83.4%, 2023 – 92.8%, 2024 – 83.6%, 2025 – 74.6%. OITE performance cannot predict how an individual candidate will perform on the Part I Examination. However, the 2025 OITE results indicate that a smaller percentage of PGY-5 residents were meeting or exceeding the threshold associated with the ABOS Part I passing standard before the 2026 Part I Examination was administered. This provides additional context that is consistent with the findings of the Part I examination review.
The results of this review showed that the 2026 Part I Written Examination was produced and scored in the same manner as previous examinations. This year’s ABOS Part I Examination was found to have clearly met the psychometric criteria for difficulty, reliability, and mean percentage to obtain a passing score. The primary difference identified in the analysis was candidate performance.
