The American Board of Orthopaedic Surgery (ABOS) Board Recertification program began in 1986. Subsequently, when Maintenance of Certification (MOC) was introduced by the American Board of Medical Specialties (ABMS) in the late 1990s, the ABOS worked with the American Academy of Orthopaedic Surgeons (AAOS) to develop an effective MOC program beneficial to orthopaedic surgeons and their patients. Our website has a section that includes links to several publications confirming that board certified physicians who participate in MOC take care of patients more efficiently, more effectively, and with fewer malpractice claims.
Recently implemented extensive changes in MOC were developed with the goal of minimizing expense and burden for Diplomates without compromising value. The ABOS continues to work closely with the AAOS, subspecialty societies, and individual orthopaedic surgeons to refine and improve the MOC process.
ABOS MOC has been simplified – the program currently involves only the following elements:
- Medical Licensure and Hospital Privileges
- CME/SAE Credits
- ABOS Peer Review (once every 10 years)
- ABOS Case List submission (once every 10 years)
- Knowledge Assessment/Examination (once every 10 years)
Recent MOC changes include:
- Adding three new Practice-Profiled Recertification Examinations (Foot/Ankle, Pediatrics, and Trauma) to the existing Adult Reconstructive, Spine, and General Orthopaedics Recertification Examinations, Hand, and Sports Medicine.
- Removing the 80 general orthopaedic questions from all ABOS Practice-Profiled Examinations.
- Allowing all Diplomates the opportunity to take an Orthopaedic Sports Medicine or Surgery of the Hand Practice-Profiled Recertification Examination.
- Providing detailed Blueprints for all ABOS Examinations to guide education and study. These are available on the ABOS web site.
- Eliminating the MOC CME fee.
- Standardizing the deadline and timeframe for Application and Case List submission across all examination options.
- Streamlining the Application and Peer Review processes.
- Standardizing the Case List to limit case entry to a maximum of 75 cases for all Diplomates.
We often hear understandable concern about “high stakes” examinations. However, the ABOS Computer Recertification Examinations have between a 95 to 98 percent pass rates each year, and if the application is started in year seven of the 10-year cycle, the Diplomate has three opportunities to pass the examination. The eight different Practice-Profiled Examinations provide most orthopaedic surgeons an option of a computer examination mirroring their own subspecialty practice which is given at a local testing center with flexible scheduling. We believe the increased number of options for Practice Profile Exams should afford an effective means of dramatically decreasing the overall cost of MOC by providing an option completely relevant to the individual’s practice. Currently, the largest MOC associated expense is travel and missed practice opportunity to attend a Board Review Course. Often the diplomate elects to do so in order to review concepts outside the usual scope of practice of that surgeon. The Practice Profile Exams are now entirely based on each subspecialty practice and contain no general questions.
Those who prefer an even more individualized evaluation of their own specific practice may elect to take an ABOS Oral Recertification Examination. Currently the Oral Examination does require travel to Chicago. The ABOS will be piloting in July of this year a Virtual Practice Evaluation (VPE), with the benefits of an oral examination of the individual practice without the need to travel to Chicago.
Containing cost is an ABOS priority. ABOS Application and Examination fees have been stable for eight years and the MOC fee has been eliminated. The total fees seen by a Diplomate are approximately $2200 or $220 per year over the 10-year cycle. The ABOS Board of Directors consists of 20 Orthopaedic Surgeons and one Public Member who serve as volunteers without compensation. This significant 10 year service commitment involves 30 to 40 days per year of travel without compensation. The ABOS operating budget is revenue neutral each year.
While the ABOS has made several major changes, we are intent on continuing to refine the process and welcome feedback from Diplomates. We remain dedicated to our mission and open to constructive collaboration. As always, if you have additional questions or concerns, do not hesitate to contact the ABOS Office.
James Roberson, MD
President, American Board of Orthopaedic Surgery
Executive Medical Director's Report
In his article this month, Dr. Roberson does a great job of discussing the American Board of Orthopaedic Surgery (ABOS) Maintenance of Certification (MOC) program, addressing common misconceptions, and explaining the recent improvements to the program. I would like to highlight two additional changes that have been instituted based on thoughtful and constructive feedback from ABOS Diplomates.
The first change involves the ABOS Case List requirements. After each session of the Oral Examinations (both Recertification and Part II), we hold a debriefing session. These sessions are moderated by the ABOS President and include the Chair of the ABOS Oral Examination Committee, other select Board members, and key ABOS staff who listen to feedback from examinees. We hold similar sessions for the Oral Examiners. From these sessions, we have received helpful input on ways to improve the collection of ABOS Case Lists all our Diplomates submit, not just those taking an Oral Examination. This has resulted in the elimination of redundant and outdated questions and a streamlined Case List entry process into ABOS’s Scribe system.
The entry of complications has been problematic and a source of confusion. There is now a new complication classification system on the ABOS Scribe site that should allow Diplomates to easily determine what complications should—and shouldn’t—be included (and how those complications should be classified). While the ABOS Case List entry process still involves some work, we believe it is now less burdensome while allowing for successful case selection (for Oral Examinees), self-reflection, and assists the ABOS in determining “outlier” candidates.
The second change is with the MOC Application itself. For the last several years, we have sent brief surveys to those who have applied for ABOS Part II and ABOS Recertification Examinations. Changes have been made based on that valuable feedback. Diplomates found some parts of the application confusing and were unsure of what items they needed to have before starting the process. The instructions and many parts of the application have been reworded and clarified. A recent survey of Diplomates indicated that these changes have been helpful – please do not hesitate to contact me with constructive criticism to help us continue to make improvements.
Adjustments have been made to the technology for the 2018 ABOS Part II Oral Examination application that opened six weeks ago. These changes now make it easier to enter hospital and surgeon information. For ABOS Peer Review, Diplomates can utilize a pulldown menu to find the appropriate surgeon and do not have to search for the Diplomate’s email address. The system is much more user friendly. These changes will be available for the next ABOS Recertification Examination Application process which will start on November 1.
We believe in listening to our Diplomates; our processes have been shaped by collaborative interaction with specialty societies, subspecialty societies, and their members. As you will see in this issue, more than 2,000 Diplomates recently completed the ABOS Annual Communications Survey. As those results accumulate, we will actively respond and keep you informed.
As always, feel free to contact us. I am personally happy to answer any questions or concerns that you may have and I am receptive to your input.
David F. Martin, MD
Executive Medical Director, American Board of Orthopaedic Surgery
Transferring CME and SAE Credits from AAOS
In March 2017, immediately preceding the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting, the ABOS began its process of automatically transferring CME/SAE from the AAOS’s Learning Portfolio. These CME/SAE are those that have been entered into or stored on AAOS’s Learning Portfolio website, including those CME/SAE obtained from organizations other than the AAOS.
With the first automatic transfer, the ABOS received nearly 100,000 records for more than 10,000 Diplomates. This process has continued and now occurs four times per day. Previously, a button was pressed by the Diplomate to enact the transfer of CME/SAE. Now, assuming that valid CME/SAE have been entered and a corresponding certificate has been uploaded, those credits will automatically be transferred to the Diplomate’s ABOS Dashboard.
ABOS staff reviews each CME/SAE activity that is submitted (whether through this automatic transfer or when directly submitted by the Diplomate through their ABOS Dashboard) to ensure that the subject matter of the CME/SAE exercise is relevant to the field of orthopaedic surgery. A list of approved CME/SAE subject areas can be found at www.abos.org/moc/cmesae/continuing-medical-education.aspx.
As was expected by the ABOS, there were numerous CME/SAE transferred from the AAOS that had already been directly entered into ABOS’s Dashboard by the Diplomate. The ABOS’s CME/SAE processing system automatically sends an email to the Diplomate when the ABOS reviews CME/SAE and either has a question pertaining to the CME/SAE or when the CME/SAE is not approved. Since a CME/SAE activity cannot be counted twice, Diplomates will receive a message from their Certification Specialist explaining why any credits were not accepted and in many cases for the next year the explanation will be that the CME/SAE is a duplicate. If you receive an email about a duplication and you have a concern, then please email your ABOS Certification Specialist. Otherwise no action on your part is necessary.
If you notice that credits have not transferred, the first step is to confirm with the AAOS that your credit for the activity has been recorded. The next step is to check with the ABOS to make sure that your AAOS membership number is correct in ABOS files.
This automatic CME/SAE transfer from the AAOS Learning Portfolio to the ABOS Dashboard will help streamline this process for our Diplomates. The ABOS is currently working with other societies so that Diplomates' CME/SAE credits recorded by those organizations will also be transferred ABOS Dashboards automatically.
Communications Survey Results
Thank you to the more than 2,000 Diplomates who have recently completed the annual ABOS Communications Survey. Staff have carefully reviewed each submitted response and the results will help us ensure that we communicate the appropriate information in the preferred communication channels.
Overall, the results were very similar to the results of the 2016 ABOS Communications Survey. Not surprising was that most Diplomates are interested in their ABOS MOC status/progress (especially upcoming deadlines/reminders) and about changes to the ABOS MOC Program in general. ABOS Diplomates are busy, and we will make sure that all communications are useful and effective. In addition, there will be single method of communications that ABOS uses.
Most ABOS Diplomates desire regular communication from the ABOS, with 83% choosing either monthly or quarterly. With all ABOS communications, we want to deliver information that is important and timely.
In the last year, we have redesigned the ABOS website and the ABOS Diplomate Dashboard. If you have not visited either, please take a quick look. We regularly add information to the website. A large majority of ABOS Diplomates value the ABOS website and Dashboard as effective communication vehicles.
The most popular method of reaching our Diplomates identified in the 2017 ABOS Communications Survey is an email that contain one topic. The ABOS regularly send personalized email reminders -- those usually contain important deadlines. These are sent only to those individuals who are affected. So while some ABOS Diplomates may be emailed a reminder to complete their ABOS Recertification Application, their partner who just completed the ABOS Recertification process will not.
The Diplomate e-newsletter was also a popular communication choice. Only 23% of ABOS Diplomates identified text messages as effective, while 9% identified social media as useful, numbers nearly identical to last year. Many Diplomates included negative comments about the ABOS using social media. At this time, the ABOS does not plan on using social media or text messages.
Possibly the most interesting response was that a vocal minority of Diplomates still believes that using the U.S. Mail is appropriate. As part of the ABOS on-going communications improvement process, we will look into the use of U.S. Mail in certain situations.
Overall, most Diplomates think that current ABOS communication methods are of a high quality. The ABOS Website earned the highest overall ranking. As mentioned before, the ABOS Website was redesigned in 2016—both the look and content. More than half of ABOS Diplomates have not viewed an ABOS instructional video, but this is to be expected since the instructional videos are intended for those who are finalizing their ABOS MOC requirements. The ABOS Video Program appears to be helpful for those Diplomates who have taken advantage of it.
The ABOS remains committed to being responsive to constructive commentary and criticism. We are interested in your comments and welcome your valuable feedback. The ABOS regularly sends surveys, and we are thankful to those Diplomates who respond.
Aaron S. White
Chief Operating Officer, American Board of Orthopaedic Surgery