Thank you to the more than 9,000 American Board of Orthopaedic Surgery (ABOS) Diplomates who completed last year’s survey concerning the ABOS Knowledge Assessment Pathway. A majority of Diplomates indicated that phasing out the ABOS Practice-Profiled Examinations will have little to no impact on their recertification plans. However, approximately 20% of ABOS Diplomates let us know that they would prefer to continue to take a Computer-Based Recertification Examination to satisfy the Knowledge Assessment portion of their ABOS Maintenance of Certification (MOC) Program. The ABOS will honor its commitment to these individuals by continuing to offer ten different Computer-Based Recertification Examinations. Fewer Diplomates taking the Computer-Based Recertification Examinations makes it more difficult to set valid passing standards. To ensure that the ABOS can arrive at sound standards, the administration schedule of these examinations will be adjusted to increase the number of participants for each examination.
All examination options will be offered in 2021 and 2022. Starting in 2023, the General Orthopaedic Surgery Computer Examination will continue to be offered every year while all the Practice-Profiled Examinations will be offered every other year. The ABOS will release a schedule this summer that will outline which examinations will be offered in each year moving forward. Diplomates will be allowed to take the examinations earlier in their recertification cycle to allow for multiple opportunities to take the examination.
The ABOS WLA Pathway remains a very popular option. Last year, more than 12,600 Diplomates participated and were able to choose Knowledge Sources that were applicable to their practices. In addition, Diplomates with very specific practice areas may choose to take an ABOS Oral Recertification Examination.
The ABOS Recertification Application and Case List submission platforms are available now for those who have ABOS Board Certification expiration years of 2022, 2023, and 2024. All Diplomates, no matter which Knowledge Assessment Pathway they choose, must complete an Application and Case List, in addition to meeting the Continuing Medical Education (CME) and Self-Assessment Examination (SAE) requirements of the ABOS MOC Program.
If you have any questions about your requirements, I highly recommend contacting your Certification Specialist.
Executive Medical Director’s Report
If you are considering participating in the 2021 American Board of Orthopaedic Surgery Web-Based Longitudinal Assessment (ABOS WLA) Pathway, I hope you have had a chance to look at the 203 Knowledge Sources that are available for you to review, study, and select for the assessment portion of the pathway. There are 101 new Knowledge Sources—10 new Knowledge Sources in each of 10 orthopaedic subspecialty areas and the new required Knowledge Source—plus 102 Knowledge Sources that have carried over from 2020 and 2019.
In addition, participants have one required Knowledge Source each year. This year, the Board has chosen an article that spotlights diversity, equity, and inclusion in orthopaedics. It is a timely article and I suggest that all orthopaedic surgeons read it, even those who are not participating in the ABOS WLA. Every year, the Board spends much time considering the topic for the ABOS WLA required Knowledge Source. If you are participating in the ABOS WLA for the first time, you are allowed—but not required—to choose a previously required Knowledge Source.
If you make the decision to participate in this pathway, you will select 15 of the Knowledge Sources prior to beginning the Assessment portion of the pathway. The ABOS recommends using the Google Chrome browser when reviewing the Knowledge Sources. The 2021 ABOS WLA Assessment Window—the period when you are required to answer 30 questions based on your 15 chosen Knowledge Sources—will be open from April 6 through May 25.
For the first two years of the ABOS WLA administration, there have been two different ways to successfully complete the pathway. We heard from Diplomates that having two methods for successful completion caused significant confusion. To make the ABOS WLA Pathway easier to understand and ensure meaningful engagement, all Diplomates, no matter their certification expiration year, must earn 5 Quality Years (correctly answering at least 24 questions each year) by the 8th year of their ABOS Maintenance of Certification (MOC) cycle to successfully complete the ABOS WLA Pathway. The “Accumulating Success” option, in which 120 questions must be answered correctly, has been eliminated. More than 99% of Diplomates who participated in the 2020 ABOS WLA earned a Quality Year.
Diplomates who hold Certificates that expire in 2025 or sooner must have earned a Quality Year in 2020 to participate in the ABOS WLA Pathway and must earn a Quality Year this year to continue. Those Diplomates with Certificates that expire in 2026 or 2027 and who have not yet started the ABOS WLA Pathway must begin this year, or they will need to wait until their next 10-year cycle to participate. Those whose Certificates expire in 2028-2030 and who are interested in the ABOS WLA Pathway are highly recommended to begin this year to provide the best chance of success. Diplomates who have Certificates that expire in 2031 can start next year, and those who have Certificates expiring in 2032 can start in 2023.
For more information on the ABOS WLA Pathway, go to www.abos.org/moc/abos-web-based-longitudinal-assessment-abos-wla/.
The ABOS still offers the Computer-Based Recertification and Oral Recertification Examinations as pathways to satisfy the Knowledge Assessment portion of the ABOS Maintenance of Certification (MOC) Program. Diplomates may choose those pathways and are not required to participate in the ABOS WLA Pathway.
The ABOS WLA would not be possible without the help of many volunteers. We have practicing orthopaedic surgeons in each subspecialty select the Knowledge Sources and write the questions. Most of these dedicated volunteers have done this since the inception of the ABOS WLA Pathway three years ago. This year, we have had additional volunteer orthopaedic surgeons participate in the ABOS WLA early to assist in the question-editing process. We remain indebted to the journals and their publishers for once again providing Diplomates open access to the Knowledge Sources. Thank you to all these individuals for contributing to the success of the ABOS WLA Pathway!
Oral Examination Changes
With a primary concern of ensuring the safety of Examinees, Examiners, and Staff, the American Board of Orthopaedic Surgery (ABOS) has made the difficult decision to postpone in-person ABOS Part II and Oral Recertification Examinations until October 2021. The ABOS remains committed to give each Examinee the opportunity to attain or maintain ABOS Board Certification through an effective evaluation of their practice. To accomplish that mission, the 2021 ABOS Oral Examinations will consist of two Stages.
Stage 1 will take place in July without the Examinees present. The ABOS conducted this type of Remote Case Based Practice Examination in 2020 with good success and has tested this concept for the past several years.
While this remote case evaluation is effective, there will be Examinees who have practices that are not amenable to evaluation with this method as well as Examinees for whom the ABOS determines that additional evaluation may be needed to better understand their practices. Those Candidates will take part in Stage 2 of the process, which will be an in-person Oral Examination during the week of October 17-21, 2021, in Chicago. The ABOS is working on alternative virtual plans that would take place during the same week in October if in-person examinations are not possible.
All Examinees have been contacted with additional information and will continue to receive targeted communications about the process. ABOS Diplomates who are interested in being considered for participation as an Oral Examiner should complete the Volunteer Form found on their ABOS Diplomate Dashboard.
Why Peer Review?
The American Board of Orthopaedic Surgery (ABOS) uses a rigorous peer review process as an important part of credentialing for ABOS Board Certification and Maintenance of Certification (MOC). The ABOS Peer Review process assesses performance in practice, a key area of physician competence.
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. Many professions, including law, accounting, and engineering, have established peer review processes. In academic professions, peer review is a well-accepted method to assess scientific work.
As part of the ABOS Certification and Recertification Application Process, applicants are asked for the names and email addresses of Diplomates of the ABOS, and others, who are familiar with the applicant’s work and who are in the same geographical practice area as the applicant.
Those providing peer review receive an email from the ABOS that includes a link to complete a brief survey covering areas of competency, which include patient care, surgical skills, communication, and professionalism. The survey also queries the reviewer’s relationship to the applicant, how familiar the reviewer is to the applicant, and the reviewer’s opinion as to whether the applicant should be allowed to continue in the ABOS Board Certification process. There is a comment section as well.
The ABOS collects additional surveys by sending emails to Diplomates who practice nearby (identified by zip code). That allows for the collection of further peer review information from Diplomates familiar with a surgeon’s practice. Recipients of the surveys can opt out if they do not have adequate knowledge to provide reasonable peer review.
Approximately 95% of applicants receive adequate peer review and do not come to the attention of the ABOS Credentials Committee. For those applicants who receive negative peer review evaluations, their entire application, including the negative peer review, is assessed by the Committee. In most cases, when negative peer review information is received, ABOS staff contacts the reviewer to gain more information prior to taking any action. Any additional information gained from those interactions is included in the materials reviewed by the ABOS Credentials Committee. For those applicants who present serious concerns, the Committee has the option to act. Possible actions available to the Committee include: 1) deferral, 2) denial, 3) required type of examination (written or oral), 4) practice site visit, or 5) process to gather more information.
Diplomates may wonder why a competitor should be given the opportunity to submit peer review information. ABOS Diplomates take the peer review evaluation process seriously and generally 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 of the review and potential conflicts of interest of the reviewer are also considered. Peer review is a professional responsibility, and the dedication of ABOS Diplomates to this process has been crucial to the success of the ABOS system.
ABOS is Reaching Out to Residents
The American Board of Orthopaedic Surgery (ABOS) mission includes maintaining the highest educational standards for training orthopaedic residents, in order to protect the public. However, orthopaedic residents often first hear from the ABOS at the end of residency when applying to sit for the ABOS Part I Examination. The ABOS Board of Directors has determined that the ABOS will engage with residents upon matriculation in residency, so that they understand the ABOS Board Certification process starting at the beginning of residency.
The ABOS’s mission is to protect the public. Most of our processes associated with setting standards for resident education have been done traditionally through measuring the time residents spend in the various rotations, and ultimately judging their performance on the ABOS Part I and Part II Examinations. The ABOS Knowledge, Skills, and Behavior (KSB) program has been developed to give residents the opportunity to take greater responsibility for their own educational progress toward ABOS Board Certification. The KSB program contains assessment tools that will allow residents and their program directors to follow their acquisition of orthopaedic knowledge, skills, and behavior. The program will help residents become better orthopaedic surgeons, and that will ultimately benefit patients.
The ABOS has been piloting the ABOS KSB program for several years in Orthopaedic Residency Programs across the country. Additional Residency Programs have decided to participate and are being added to the program. Many residents and attendings state that the surgical skills program is easy to use, the time commitment is not significant, and the feedback that residents receive is valuable. The surgical skills assessment tools are a web-based, real-time, workplace-based assessment that appeals to the digital mentality of this generation of residents. The behavior assessments are conducted less frequently and only take a few minutes to complete. The evaluations have been an excellent resource for program directors and have helped guide residents on behavioral norms that will be valuable as they enter their practice. The ABOS Podcast recently featured a Residency Program Director and Resident talking about KSB. To listen to that, click here.
ABOS Diplomates have a password protected Dashboard that provides the ability to follow progress through the ABOS Maintenance of Certification (MOC) program. The ABOS is developing a Resident Dashboard to allow them also to follow their status in the ABOS KSB program, starting at the beginning of residency. The ABOS Resident Dashboard allows a resident to quickly see everything from their Orthopaedic In-Training Examination (OITE) score (Knowledge) to how successfully they are progressing with surgical skills and with behavior evaluations.
Communication with the residents directly is important to the ABOS. The ABOS has also recently added new webpages to the ABOS website specifically aimed at residents. The inaugural Orthopaedic Resident e-newsletter launched in January.
Finally, the ABOS has recently established a Resident Advisory Panel to receive input directly from residents. This year, more than 80 residents have applied for the three available spots on the Panel. ABOS Directors on the ABOS Graduate Medical Education (GME) Committee are currently reviewing applicants’ CVs, personal statements, and recommendations. Direct feedback from residents will help the ABOS in decisions regarding residents. Their voice is important, and we look forward to working with residents to improve our programs.
ABOS-ABMS Visiting Scholars Program
For the seventh consecutive year, the American Board of Orthopaedic Surgery (ABOS) and the American Board of Medical Specialties (ABMS) have partnered to support the ABOS-ABMS Visiting Scholars Program. This Program fosters research that informs physician assessment and certification, supports the development of next generation leaders, and helps build awareness about the value of Board Certification to external audiences.
The one-year, part-time program provides the ABOS-ABMS Visiting Scholar with opportunities to:
- Gain exposure to the fields of quality improvement, health care policy, physician assessment, and continuing professional development
- Engage with national health care leaders and the ABMS Member Boards
- Conduct research of value to their programs, organizations, and the certification community
- Present and disseminate their research
- Expand their professional networks
To learn about the projects of the previous ABOS-ABMS Scholars, click on this link. The ABOS has sponsored six highly accomplished Visiting Scholars. Please share this program with your junior colleagues and residents. It is a wonderful opportunity.
Remaining at their home institutions and organizations, the Visiting Scholars participate in program webinars and pursue research projects in collaboration with identified mentors. Visiting Scholars also participate in three meetings during the course of the year with ABMS and Member Board leaders, and the leadership of ABMS Associate Members, among others. Once the year is over, scholars can continue their relationship with the ABOS and ABMS Board Communities through an alumni network. Visiting Scholars receive a stipend to support their research and program participation.
The Visiting Scholars Program is open to early career physicians, junior faculty, fellows, residents, and individuals holding a Master or Doctorate degree in public health, health services research, and public health policy and administration, or other related disciplines.
The ABMS will host a webinar for potential applicants on April 14th. To register, click here. The ABOS-ABMS Visiting Scholars Program Application must be received by 5 pm CT on June 7, 2021. Click on this link to read more about the program and the application process.