Case Lists (MOC Part IV)
Case lists are a key component of the American Board of Orthopaedic Surgery (ABOS) certification and recertification process. They are a metric for ABOS to assess a diplomate’s practice and also provide diplomates an opportunity to self-evaluate their performance in practice with a goal to improve patient care. Case lists are critical to an Oral Examination since the diplomate’s case list is used to select cases for the actual examination. Case selectors review the entire list, practice profiles based on the list, and complications and use this information in selecting 12 cases for the examination.
The American Board of Medical Specialties (ABMS), which sets standards for 24 boards, requires a process for diplomates to personally review their performance in practice. The ABOS fulfills this requirement with case lists. Case List collection begins on January 1st of the calendar year one year prior to the examination. Recertification Candidates, for any ABOS MOC/Recertification Assessment Pathway, will begin collecting with the first surgical case of the calendar year and collect all consecutive surgical cases in that year up to the point where the Recertification Candidate reaches 75 cases. The Candidate stops collecting cases either after collecting 75 cases or has collected all cases in that calendar year. A minimum of 35 cases is required in order for the Recertification Candidate to sit for the Recertification Examination of their choice. Diplomates who do not perform 75 surgical cases in a calendar year will need to enter all cases for that calendar year.
Case lists allow diplomates to review their practice including adhering to accepted standards, patient outcomes, and rate and type of complications. When entering cases into the ABOS exclusive Scribe system—and especially when printing a summary report—diplomates see a snapshot of the types of surgery performed and complications that occurred. In our busy practices, it can be difficult to take the time to reflect on and pull together these important issues and critically look at what we are doing.
Diplomates receive a feedback report based on their submitted case list for the Recertification Examination. (Note: Feedback reports are not released until all Recertification Examinations are administered in a calendar year.) The report shows how many cases were performed over the time period, the three most common International Classification of Disease (ICD) and Current Procedural Terminology (CPT) codes used, the complication rate, as well as other data. These data are benchmarked against other diplomates taking the Recertification Examination and particularly against others in the same subspecialty. Diplomates should review the information and use it to again evaluate their practice and choose the appropriate practice improvement activities.
The Board also uses the case lists as part of its credentialing process. All diplomates are credentialed prior to being approved for their recertification or the Part II Examination. The credentials committee assesses outliers in case list profiles, such as a large number of arthroscopies in elderly patients or arthroplasties in young patients or excessively high complication rates. Based on this case list review, in conjunction with other information such as peer review, the committee may accept, defer, or deny a diplomate’s application to take a Recertification Examination. They may also require an Oral Recertifying Examination to evaluate performance in practice. About 98 percent of recertification applicants do not come before the Credentials Committee. For Part II, 96 percent of applicants do not come before the Credentials Committee.