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 six-month 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. Diplomates who choose a computer-based Recertification Examination prepare a three-month case list as their performance in practice requirement.
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. As I discussed in the last issue of The Diplomate, 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.
The Board recognizes that the data should not be interpreted as a definitive assessment of appropriate procedures, practice profiles, or expected complication rates. The data do not capture information on patient co-morbidities, case complexity, or other specific factors that might affect complication or re-operation rates. We also recognize that the data is self-reported, which affects the comparative benchmarks.
The Board believes that case lists are important. I personally will apply for the 2018 General Recertification Examination, and I am currently preparing my three-month case list. I have found it interesting to look back at the cases to observe my recent past practice. It appropriately refreshed my mind on a few complications that I might have preferred to have forgotten. Hopefully, revisiting them in this self-reflection activity will, in at least a small way, help my future patients.
Larry Marsh, MD
Interim Executive Director Report
At the end of July, more than 860 new and veteran orthopaedic surgeons gathered in Chicago to take an American Board of Orthopaedic Surgery (ABOS) Oral Examination. I would like to publicly congratulate the 700 new Board Certified orthopaedic surgeons. Ninety-six percent of candidates who took the Part II Examination in July passed. Another 137 Board Certified orthopaedic surgeons took the Oral Recertification Examination as part of their Maintenance of Certification (MOC) process and 87 percent of these examinees passed.
The biggest change to this year’s examination had to do with the Protected Health Information (PHI) for the patients in the 12 cases that each examinee presented. Previously, that information had to be redacted. This year, ABOS allowed that information to be visible if the surgeon received written permission from the patient to utilize their health information during the examination. The surgeon is asked to attest that they received such permission from the patient. In addition, we asked examinees to upload far fewer records than in previous years. Both of these changes came because of feedback from previous examinees. Based on the debriefing sessions we had with this year’s examinees, both of those changes seemed to be popular.
The ABOS staff has created a number of videos that document useful methods to prepare for the oral examination. Examinees who watched the videos during the case-uploading process and before the examination responded during the examinee debriefing that the videos were extremely helpful. These videos, as well as others we are in the process of developing, can be found on the ABOS’s newly designed website.
Our oral examiners are outstanding and deserve much praise for giving up time from their busy practices and their families to volunteer at the examination. Many of these examiners have been coming from areas around the country for years. In addition, I would like to extend a special thank you to our staff who make the examination run smoothly. ABOS has a well-designed technology system to conduct the oral examination. Our IT staff has consulted with other Boards who are interested in hosting similar examination administrations. We are constantly looking for ways to make the examination process run more smoothly and we welcome your feedback and constructive criticism.
I have attended every Oral Examination since 2001, first as an examiner, then as a Board member, and now as a staff member. The examination is a lot of work and many individuals function behind the scenes to be sure that the Examination runs smoothly. The ABOS feels that the Oral Examination is an extremely effective mechanism to evaluate orthopaedic surgeons and their practices.
Please do not hesitate to contact me with your feedback and suggestions. Thank you!
David F. Martin, MD
Interim Executive Director
New SAE Option for Pediatric Orthopaedic Surgeons
Orthopaedic surgeons who treat children have a new option to earn 10 of the 40 self-assessment examination (SAE) credits needed in order to apply for an American Board of Orthopaedic Surgery (ABOS) Recertification Examination.
Created by the Pediatric Orthopaedic Society of North America (POSNA), the Supracondylar Humerus Fracture Practice Improvement Module (PIM) allows an orthopaedic surgeon to reflect on the care of patients with supracondylar humerus fracture, compare the treatment with that of other Board Certified orthopaedic surgeons, and develop an action plan to improve the care of patients.
To participate in this PIM, a diplomate selects 10 consecutive patients that the diplomate treated for supracondylar humerus fracture. The diplomate will be asked to audit patient records and enter the data requested in the web‐based ABOS data reporting system (Scribe). The diplomate will then be given feedback that compares the diplomate’s treatment with the treatment rendered by the other orthopaedic surgeons participating in this PIM.
PIMs allow orthopaedic surgeons to review aspects of their practices, compare themselves with their peers, educate themselves about best practices, develop and implement a plan to improve, and reassess at a later date. There is also a carpal tunnel syndrome PIM sponsored by the American Society for Surgery of the Hand (ASSH).
PIMs are another example of how ABOS diplomates can earn SAE credits, in addition to the traditional scored and recorded examinations, as well as registries, a Multi-Specialty Portfolio Program, and the Resurgens Scorecard. As a reminder, to meet ABOS’s MOC requirements a diplomate must earn 20 approved SAE credits by the end of the third year of their 10-year MOC cycle, in order to be listed on the ABOS website as “Participating in MOC: Yes” and 40 by the time of application for recertification. (You also need 120 CME/240 Category 1 CME credits during the same time period.)
For more information or to register, please email me at firstname.lastname@example.org.
Brenda H. Kulp, RN, BSN, MA
MOC and Professional Education Specialist
In order to maintain your designation on ABOS’s website as “Participating in MOC: Yes,” a minimum of 120 orthopaedic-related ACCME Accredited Category 1 CME credits, of which at least 20 credits are from Self-Assessment Examinations (SAE), must be submitted by the end of the third year of your 10-year cycle. Prior to registering for a Recertification Examination, you need 240 CMEs and 40 SAEs.
You can learn about what types of CMEs and SAEs are accepted by reviewing this page. To view how many CME/SAE credits you have submitted, go to abos.org and click “Login.” While logged in to your ABOS dashboard, make sure that you have transferred any credits earned from the American Academy of Orthopaedic Surgery (AAOS). When submitting credits, certificates must be uploaded at the time of submission. Please check that all previously submitted credits include a certificate. To learn how to upload credits and transfer from AAOS, view this video.
Credits will only be approved if they are Category 1, orthopaedic related, and a certificate is uploaded. CME/SAE earned from the AAOS and transferred from AAOS do not need a certificate due to the approval process of the AAOS. Please note that the ABOS is working with the AAOS and a few subspecialty societies to increase the options and capabilities relating to transferring CME/SAE credits and certificates.
All credits are reviewed by ABOS staff. If an activity does not meet ABOS’ requirements, you will receive an email explaining why. You will then need to fix the issue, whether it’s uploading a missing certificate, removing the entry if it is not orthopaedic-related, or modifying the information, if the information was entered incorrectly.
If you called the ABOS office anytime in the last year, Sonya Parker was probably the person with whom you initially spoke, as she was ABOS’ Office Assistant. Sonya quickly gained the knowledge and experience to be promoted to a Certification Specialist in August. She now works in numerous ways with diplomates and Part II candidates whose last names begin with the letters P through Z, including processing their applications and guiding them through the Maintenance of Certification (MOC) process.
Sonya has had a very diverse professional career. She started off as a tool and die machinist, where she honed her analytical skills to making industrial machine parts. After starting a family, Sonya entered the medical field, first in medical billing/coding and then user support for a national medical practice management software company. Prior to coming to ABOS in 2015, she spent more than 20 years as an office manager for an internal medicine practice.
Outside of the office, Sonya likes to read, swim, and hike. She also still works with tools and also enjoys creating glass art.
Sonya is very knowledgeable about Certification and Maintenance of Certification and is a valuable part of our team.
Chief Operating Officer