Credentialing is an important aspect of the Board Certification and Recertification process. Each Candidate who applies for an American Board of Orthopaedic Surgery (ABOS) Certification Examination and each Diplomate who applies for a Recertification Examination goes through the ABOS credentialing process; but to many the process may be a mystery. The ABOS wishes for each Candidate and Diplomate to understand the components required in our process and this article will explain who the ABOS Credentials Committee is and why its role is so important to the validity of Board Certification.
Thirteen of the 21 ABOS Directors serve on the Credentials Committee. Twelve members are practicing orthopaedic surgeons (who are also Diplomates) and one is the public member of the Board. Only a small percentage of applications to take the examination are reviewed by the Credentials Committee, with several factors prompting such a review. These factors include, but are not limited to, the loss of a state medical license or hospital privileges; when an analysis of the applicant’s case list identifies concerning statistical outliers; and/or significant negative peer review. The Credentials Committee extensively reviews and discusses each application, with supporting documentation which is brought forth to the Committee.
Peer review is perhaps the most important, yet most commonly misunderstood, part of the credentialing process. When applying for the Part II Examination or a Recertification examination, the applicant provides the names and email addresses of partners, orthopaedic surgeons in the area who are not partners, and other health care professionals familiar with the applicant's work, such as the Chief of Anesthesiology and Nursing. It is from these individuals that the ABOS solicits feedback. Therefore, as an orthopaedic surgeon, you will on occasion receive an email request for feedback on colleagues. The overwhelming majority of peer review received by the ABOS is positive; and is thus a testament to the high quality of patient care delivered by Board Certified Orthopaedic Surgeons. In the rare case that a Diplomate receives significantly negative peer review, the ABOS Executive Staff will followup with additional communication, at which point all factors will be carefully considered by the Credentials Committee. The ABOS strongly believes that it is a Diplomate’s duty to the profession to provide valid peer review when requested.
The Credentials Committee meets four times a year. Prior to the meeting, each committee member is provided background information on all applications being reviewed, and two Directors are assigned to do a more in-depth review of each application. Options available to the Committee for those applying to take one of the examinations include: allowing the applicant to sit for the examination for which he or she applied; denial of the application for Part II candidates; requiring the Diplomate to take an Oral Examination; deferral for a year with a request for additional information; a site visit to the actual practice of the Diplomate or Candidate; or revocation of the Diplomate’s Certificate. Site visits are done by experienced, volunteer orthopaedic surgeons who take the time to spend one to two days reviewing the requested information and interviewing the requested individuals at the practice location of the Diplomate or Candidate. This willingness to participate in a site visit by these volunteers exemplifies the commitment by our Diplomates to ensure that Board Certification is an indication of quality and safety.
Adverse actions taken by the Credentials Committee are appealable. Appeals are heard by a smaller group of Directors, who do not serve on the Credentials Committee, with the appealing surgeon invited to be present.
In addition to credentialing for the examination process, some Diplomates come before the Credentials Committee outside of the examination application process. The ABOS Rules and Procedures state that one must maintain a full and unrestricted license to be Board Certified and loss of medical license, among other factors, prompts a review by the Credentials Committee. In this setting, options for the Committee may include revoking a Diplomate’s certificate and/or requesting additional information.
Only about 2% of applicants for examinations come before the Credentials Committee, and for many of those the decision is made to allow them to sit for the examination for which they are applying. Even fewer come mid-cycle. The process is carefully constructed and is an essential tool for the validity of ABOS’s Certification and Recertification.
James Roberson, MD
President, American Board of Orthopaedic Surgery
Executive Medical Director’s Report
|Albert Einstein College of Medicine/Montefiore Medical Center
||A Program for Teaching Orthopaedic Tool-Skills
|Baylor College of Medicine Department of Orthopaedic Surgery
||Efficacy of an Arthroscopic Virtual Based Simulator in Orthopaedic Training
|Dartmouth-Hitchcock Medical Center
||Utilizing Intra-Procedural Interactive Video Capture with Google Glass for Immediate Post-Procedural Resident Coaching
|Rush University Medical Center
||The Effect of Simulator Training in Clinical Performance: A Prospective Randomized Clinical Trial
|University of California, Davis Medical Center
||Learning Through Repitition
|University of Iowa Carver College of Medicine
||Augmented Reality Simulator Training Leads to Improved Wire Navigation Performance in First-Year Orthopaedic Residents
|University of Michigan Department of Orthopaedic Surgery
||Evaluating Internal Fixation Skills Using Surgical Simulation
|University of Minnesota Department of Orthopaedic Surgery
||Does Training on a Simulator Improve Performance in Knee Arthroscopy in Interns?
|Wake Forest Baptist Health Department of Orthopaedic Surgery
||An Easier Way to Classify Acetabulum Fractures
|West Virginia University School of Medicine
||Use of the F.A.S.T. (Fundamentals of Arthroscopic Surgery Training) Program to Improve Arthroscopic Skills
The American Board of Orthopaedic Surgery (ABOS) serves the best interests of the public and medical profession by establishing educational standards for orthopaedic residents and by evaluating the initial and continuing qualifications and competence of orthopaedic surgeons. Regarding the educational component, in 2014 ABOS solicited research grant proposals from orthopaedic surgery residency programs that promoted innovations in surgical education of residents.
Ten researchers from across the country were awarded grants of $25,000 each to fund their projects. All ten of these researchers have finished or are finalizing their research projects. At the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in San Diego from March 14-18, the ABOS will highlight the research findings in a section of our information booth, through videos and posters. The box to the right of this article contains a list of the projects and their sponsoring institutions.
While a portion of the ABOS exhibit booth at the AAOS Meeting will pertain to the research projects, the remainder of the booth will once again be staffed by ABOS Certification Specialists who can answer questions that you may have concerning Board Certification, Maintenance of Certification, or any of ABOS’s processes. We have had a booth at the AAOS meeting for many years and Diplomates have found it very helpful. I will be at the booth throughout the meeting, as will many members of the Board of Directors. Stop by and ask a question or just say “hello.” We will be in the Ballroom 6 Lobby of the San Diego Convention Center.
The ABOS is currently planning and working on additional initiatives to better standardize and improve the learning of knowledge, skills, and behaviors of orthopaedic surgery residents. I look forward to sharing with you in a future issue of The Diplomate information on these new initiatives once they have been finalized.
Last, but certainly not least, the ABOS will be giving two presentations at the AAOS Annual Meeting. The first is "Board Certification and Maintenance of Certification: How to Navigate the Requirements and Examinations," which will take place on Wednesday, March 15 at 4:30 pm in Room 31A of the Convention Center. We will be hosting the "Forum for Young Orthopaedic Surgeons" on Thursday, March 16, at 10:30 am in Room 2 of the Convention Center. This annual event is geared toward those who will be taking the Part I or Part II Examinations in the next few years.
David F. Martin, MD
Executive Medical Director, American Board of Orthopaedic Surgery