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.
Similar to several other member boards of the American Board of Medical Specialties (ABMS), the American Board of Orthopaedic Surgery (ABOS) uses a rigorous peer-review process as an important part of credentialing applicants and diplomates. For the ABOS, peer review assesses performance in practice, a key area of physician competence as defined by the ABMS. Most would agree that performance in practice should be central to a medical credentialing process but 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 physicians/surgeons, five of which are Board Certified orthopaedic surgeons, is required. When applying for an ABOS examination, the email addresses of references should be double checked by the applicant. This simple quality assurance step by the applicant can assist in a smooth credentialing process.
Peer reviewers will receive an email that includes a link to complete a 14-question review 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 questionnaire also asks 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 box to explain why not, if applicable and also an area for comments.
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 the adequate level, their entire application, including the negative peer review, is assessed by the committee. When the ABOS receives negative peer review, 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 decides upon the best option. Options available to the Committee include requiring the individual to take an oral examination, deferral to allow the ABOS more time to gather information, or a site visit to the actual practice of the diplomate or candidate.
We are sometimes asked why a competitor should be a peer reviewer. Won’t they automatically give a poor evaluation? Most diplomates take the 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.
Most of you have been--or will be--ABOS peer reviewers for a professional colleague. Peer review has been part of the ABOS credentialing and performance in practice evaluation processes for many years. If you receive a request to complete a peer review evaluation, please complete it honestly, fairly, and in a timely manner. Answer as many questions as you can, but please indicate those areas that you cannot accurately evaluate. Your efforts will contribute to a meaningful Board Certification process.
Peer review is part of our professional obligation to the practice of orthopaedic surgery. Thank you for your participation. Please let me know if you have any questions or comments.
Larry Marsh, MD
Interim Executive Director Report:
In the last issue of The Diplomate, I discussed three new practice-profiled recertification examinations and changes to several other recertification examinations. These changes were made in response to feedback that the American Board of Orthopaedic Surgery (ABOS) has received form Diplomates. We have received overwhelmingly positive responses to these changes from our diplomates. More than 75 diplomates have now changed the type of recertification examination that they will take or the year in which they will sit for their recertification examination in order to take advantage of these modifications. Remember, if you have registered for a 2017 examination and would like to change the type or year, you need to let the ABOS know in writing by August 31, 2016. Please contact the ABOS office if you have any questions.
For this issue, I would like to discuss the Continuing Medical Education (CME) requirements of Maintenance of Certification (MOC). Prior to applying for a recertification examination, you need to submit 240 orthopaedic-related ACCME Accredited Category 1 CME credits, of which at least 40 credits are from Self-Assessment Examinations (SAE). SAE credits come from scored and recorded examinations developed by an orthopaedic sponsor and approved by ABOS. Credit is earned by taking the examinations and submitting it to the sponsor for scoring and feedback. (Self-scored examinations involve answering questions and reviewing the answers and references and do not meet the SAE requirements for MOC.) SAE credits may also be obtained by participating in ABOS-approved practice improvement activities and receiving credit.
To maintain a listing on the ABOS and American Board of Medical Specialties (ABMS) websites as Participating in MOC: Yes, you will need to complete and have approved 120 CME credits (of which 20 need to be SAE credits) by the end of the third year of your 10 year cycle. Please keep in mind that the CME and SAE credits need to be approved by the ABOS prior to their counting toward the MOC requirements.
What are orthopaedic-related CME activities? There are numerous CME opportunities available to surgeons. But to be accepted for MOC, activities need to be directly related to the prevention, diagnosis, and treatment of diseases and injuries of the musculoskeletal system. The title on the certificate must indicate that it is an orthopaedic-related activity. This list provides examples of what the ABOS considers orthopaedic-related CME activities. For instance, there are many excellent educational activities related to changes in healthcare legislation, billing/coding, and electronic medical records, but as those are not specifically related to orthopaedics, they cannot be accepted for credit towards the ABOS MOC CME requirements.
In addition, the American Medical Association (AMA) offers credit for passing recertification and subspecialty certification examinations. Those credits cannot be used to satisfy MOC requirements. Diplomates may be able to use these CME for other requirements such as state licensure renewal requirements.
If you have any questions about whether a specific activity is acceptable, please contact your examination coordinator. Soon, you will receive feedback on your password-protected portal if you have uploaded CME credit for an activity that cannot be accepted by the ABOS for MOC credit because it is not orthopaedic-related.
To be utilized for SAE credit an activity needs to be approved by the ABOS. Therefore, all of those are orthopaedic-related. To learn more about SAEs, this article from a few months ago gives a good overview of your options.
The ABOS is committed to lifelong learning for our diplomates – we are anxious to award credit for the Continuing Medical Education activities in which our Board Certified Orthopaedic Surgeons are participating. If there is an activity that you feel should be credited, please contact us. Thank you for your dedication to this cornerstone of continuous certification!
David F. Martin, MD
Interim Executive Director
Kim Grover, Certification Specialist
Kim Grover is one of our newest staff members. She began her employment with the ABOS in 2013 and quickly gained the knowledge and experience to be promoted to a Certification Specialist in 2015. Soon after Kim became a Certification Specialist, the ABOS staff was restructured, so that Part II candidates and diplomates work with one Certification Specialist for all their needs. Kim serves diplomates and Part II candidates whose last names begins with the letters F through O. As a Certification Specialist, Kim works with candidates and diplomates in numerous ways, including processing their applications and guiding them through the Maintenance of Certification (MOC) process.
Kim brings a unique customer service skill set to ABOS. Before coming to the ABOS Kim was a customer service manager for one of the Southeast’s largest supermarket chains. Kim truly takes pride in providing excellent service to ABOS diplomates and candidates.
Kim is originally from Minnesota but has been in North Carolina for 22 years. Kim still has family and friends in Minnesota and travels back as often as she can. She enjoys volunteering and you can find her several days a month at the Durham Rescue Mission. She loves reading and watching all types of sports (and has become a big fan of the University of North Carolina teams). Kim also likes experimenting with cooking and baking.
Kim is an important part of our team, and as a manager I appreciate her hard work, dedication, and professionalism.
Chief Operating Officer