Peer review is a common process used in many professions as a means of self-regulation. It assesses performance in areas that are difficult to measure by objective standards. Peer review may be used by professions to assess and maintain quality, improve performance, determine adherence to standards, and maintain credibility to those outside the profession. Many professions have established peer review processes including law, accounting, and engineering. In academic professions, peer review is the well accepted method to assess scientific work.
The American Board of Orthopaedic Surgery (ABOS) uses a rigorous peer-review process as an important part of credentialing Candidates for ABOS Board Certification and ABOS Diplomates. Several other member boards of the American Board of Medical Specialties (ABMS) utilize similar processes. The ABOS Peer Review process assesses performance in practice, a key area of physician competence as defined by the ABMS. Performance in practice is central to a medical credentialing process; it is difficult to measure and benchmark through means other than peer review.
The ABOS Recertification Examination application asks for the names and email addresses of Diplomates of the ABOS and others who are familiar with the applicant’s work and are located in the same geographical practice area as the applicant. Peer review information from at least seven individuals, five of whom are ABOS Board Certified orthopaedic surgeons, is required. When applying for an ABOS examination, the email addresses of references should be double checked by the applicant – the email addresses on the application are utilized to send the peer review forms. This simple quality assurance step by the applicant can assist in a smooth credentialing process.
Peer reviewers will receive an email from the ABOS that includes a link to complete a 14-question survey covering the six areas of competency, which include patient care, surgical skills, and professionalism. Each question has a four-point scale, with scores ranging from unsatisfactory to excellent. There is also an “unable to evaluate” option for each question. The survey also queries the reviewer’s relationship to the applicant, how familiar the reviewer is to the applicant, and whether the applicant should be allowed to sit for an examination. There is a comment section as well.
When the ABOS does not receive enough valid peer review surveys completed for a Candidate or a Diplomate, the ABOS collects additional surveys by sending emails to Diplomates who practice nearby (identified by zip code). That allows for the collection of further peer review information from Diplomates familiar with a surgeon’s practice.
Ninety-eight percent of applicants meet the ABOS adequate peer review criteria and do not come to the attention of the Credentials Committee. For those applicants who do not reach an adequate level (either in quantity or quality), their entire application, including the negative peer review, is assessed by the Committee. When negative peer review information is received, ABOS staff will contact the reviewer to gain more information. Any additional information gained from that interaction will be included in the materials reviewed by the Credentials Committee. For those applicants that present serious concerns, the Committee has the option to take action. Possible actions available to the Committee include: 1) deferral, 2) denial, 3) required type of examination (written or oral), 4) practice site visit, or 5) process to gather more information.
Diplomates may wonder why a competitor should be given the opportunity to submit peer review information. ABOS Diplomates take the peer review evaluation process seriously and give a true indication of their knowledge of an individual and that individual's practice. When peer review is considered by the Credentials Committee, the source and potential conflicts of interest of the reviewer are also considered. Peer review is a professional responsibility and the dedication of ABOS Diplomates has been crucial to the success of the ABOS system.