One of the American Board of Orthopaedic Surgery’s (ABOS) guiding principles is the belief that “there is no place for bias or discrimination within the field of orthopaedic surgery or within our organization.” The ABOS recognizes that bias, implicit or otherwise, does exist and while the Board may not be able to solve the larger societal issues, we can and are looking at our organization and processes to identify and remedy any biases or inequities.
Last year the ABOS created a Diversity, Equity, and Inclusion (DEI) Task Force, chaired by Dr. Charles Nelson, which was charged with investigating those issues at all levels of our organization, reviewing our current certification processes for the presence of implicit bias, and implementing programs to encourage diversity, equity, and inclusion on the ABOS Board and among our staff and more than 700 volunteers.
It is well known that the number of women and underrepresented minorities in orthopaedic surgery is lower than in other surgical specialties. The ABOS recognizes the importance of diversity and inclusive representation in the areas of ethnicity, gender, subspecialty, geographic location, and practice type, a belief that is reflected in the current composition of our Board of Directors, which includes three African American males, three women, and one Asian American male among our 21 directors. With respect to our cadre of ABOS Volunteers, we understand there is still work to be done, particularly regarding race and gender, and the ABOS remains committed to achieving similar diversity among our volunteers to ensure demographics that are, at the very least, reflective of our profession.
The ABOS has been collecting race/ethnicity, sex, and age data for three years, and under the direction of the ABOS DEI Task Force, soon to become a formal Standing Committee, we are beginning to look at oral examination performance relative to demographic information. In 2022 we created a series of educational videos on implicit bias and mandated oral examiner education/training. For this project, the ABOS partnered with Goodstock Consulting, a nationally recognized DEI organization, to create a series of training videos designed exclusively for our Oral Examiners to help them understand the potential negative impact that unconscious bias may have in delivering a fair Examination, and to further ensure that scoring is solely based on the Examinee’s practice. On post-examination survey, over three-fourths of Oral Examiners strongly endorsed the video series as being helpful. A similar number suggested we use the same or a modified version of the videos next year. Among many positive comments we received, it was suggested that all orthopaedic surgeons should watch the videos. The ABOS DEI Task Force is also in the early stages of identifying potentially biased questions on our Part I and Computer-Based Recertification Examinations.
The ABOS is committed to a Certification process that is free of unintended bias, and to diversifying our volunteer work force. If you are eligible and would like to participate in any of our volunteer activities, please consider becoming a volunteer by completing the brief form on your ABOS Dashboard. We welcome ALL diplomates to be a part of our process of self-regulation to ensure the safe, ethical, and effective practice of orthopaedic surgery.
Gregory A. Mencio, MD
President, American Board of Orthopaedic Surgery
Executive Medical Director’s Report
The American Board of Orthopaedic Surgery (ABOS) is always looking for ways to improve the Board Certification and Maintenance of Certification (MOC) processes so that they remain relevant to orthopaedic surgeons, while staying true to the mission of the ABOS and protecting our patients.
The ABOS regularly surveys Diplomates, Candidates, and Residents for input concerning processes and procedures, and participation across those stakeholder groups is greatly appreciated. Many of the original features of the ABOS Web-Based Longitudinal Assessment (ABOS WLA) Pathway were based on survey responses from ABOS Diplomates. Recent modifications to the Pathway have also originated in feedback from participants. Improvements made to the ABOS Oral Examinations often come from survey responses as well. The Board and Staff genuinely appreciate and make every attempt to respond to the feedback received from the many ABOS stakeholders.
Thank you to the nearly 10,000 Diplomates who responded to the recent ABOS MOC survey. RTI International, who conducted this survey as well as several previous ABOS surveys, reports that our survey completion rates are much higher than many other medical specialties. They can see that orthopaedic surgeons are engaged in physician self-regulation and want to make the process better. The Board recently received the survey report from RTI. Results from the survey will be discussed in a future issue of this e-newsletter after the Board reviews the findings and makes plans to respond.
We also had a high response rate from both Examiners and Examinees on the recent ABOS Oral Examinations survey. While the ABOS Oral Examinations are widely respected in the field—every year we have other organizations observe the ABOS Oral Examination process—we know there is always room for incremental improvement. Changes continue to be made in all aspects of the examination based on survey responses and input. If you participated in the ABOS Part II Oral Examination even just 5 years ago, you may not recognize it now.
In the last few years, the ABOS has also started surveying orthopaedic surgery residents. As setting standards for residency education has been part of the ABOS’ mission since its founding, input from orthopaedic residents who are “in the trenches” is critical as we evaluate our programs. The most recent survey of residents was regarding the linking of the American Academy of Orthopaedic Surgeons’ Orthopaedic In-Training Examination (AAOS OITE) with the ABOS Part I Examination. That linking project is described in this issue of the ABOS Diplomate e-newsletter. Information gained from residents completing the survey is helping the ABOS in efforts to communicate the value of the linking initiative.
We read every open-ended comment on our surveys and take them seriously. Thank you for taking the time to let us know your thoughts. With your thoughtful input, we will continue to improve.
You can always reach out to me directly at firstname.lastname@example.org with any suggestions you have.
David F. Martin, MD
Executive Medical Director, American Board of Orthopaedic Surgery
ABOS WLA is a Success
More than 14,400 Diplomates participated in the 2022 American Board of Orthopaedic Surgery Web-Based Longitudinal Assessment (ABOS WLA) Pathway. This is the fourth year that the ABOS has offered the Pathway, and the number of participants continues to increase each year. More than 99% of participants earned a Quality Year.
More than 8,200 ABOS WLA participants completed a recent survey about the ABOS WLA:
- 95% had an overall positive experience in completing questions
- 92% agreed that the 2022 Knowledge Sources were high quality
- 83% agreed that the ABOS WLA would help them provide better care to patients
- 77% agreed that the ABOS WLA Knowledge Sources helped them identify and fill knowledge gaps
The Board is pleased that Diplomates are getting tangible benefits from participating in the ABOS WLA Pathway and excited that the program has the potential to improve patient care.
Knowledge Sources for the 2023 ABOS WLA will be posted in January.
Completing the ABOS WLA Pathway fulfills the Knowledge Assessment portion of the ABOS Maintenance of Certification (MOC) Program. All Diplomates, no matter what Knowledge Assessment Pathway they choose, still must meet the other parts of MOC.
For more information about the ABOS WLA, go to www.abos.org/moc/abos-web-based-longitudinal-assessment-abos-wla/.
Linking of the ABOS Part I Examination and the AAOS OITE
The American Board of Orthopaedic Surgery (ABOS) and the American Academy of Orthopaedic Surgeons (AAOS) have collaborated on the development of a collection of examination items (questions) that are included on both the ABOS Part I Certifying Examination and the AAOS Orthopaedic In‐Training Examination (OITE).
The purpose of including a set of common items on both examinations is to roughly link the examinations and identify the score on the AAOS OITE that approximately corresponds to the minimum passing performance level on the ABOS Part I Certifying Examination. This approximation is based on a relatively small sample of shared items and is not a guarantee of or predictive of future performance on the ABOS Part I Examination. This linking process is now being done on a yearly basis with a new set of examination items being developed and utilized in the process each year. The two examinations now also share a common Blueprint, developed with input from both organizations and available on the ABOS website.
Many factors, including changing levels of knowledge and testing conditions, impact actual performance on the AAOS OITE and the ABOS Part I Examinations. The ABOS Part I Examination is a summative assessment with a goal of allowing an orthopaedic surgeon to demonstrate mastery of the body of knowledge deemed necessary for ABOS Board Certification. The AAOS OITE is a formative assessment aimed at assisting orthopaedic residents in their acquisition of that body of knowledge. Residents can view information about the linking process as well as their scores on their ABOS Resident Dashboard. This information is provided to give residents a rough benchmark to help guide their education and examination preparations. The number correct score on the AAOS OITE that roughly corresponds to a passing score on the ABOS Part I Examination is reported on a yearly basis and can vary year over year, based on the difficulty of the examinations.
For additional information, listen to a recent episode of the ABOS Podcast about the linking initiative, featuring ABOS Executive Medical Director Dr. David Martin and AAOS 2nd Vice President Dr. Paul Tornetta. Both have been instrumental in this initiative. You can find the episode on most podcast apps and through anchor.fm/abos.
ABOS Selects Four Outstanding Residents for Advisory Panel
The American Board of Orthopaedic Surgery (ABOS) has selected four outstanding orthopaedic surgery residents to participate as the second cohort of the ABOS Resident Advisory Panel. Many talented orthopaedic residents from across the country applied for two-year terms on the Panel.
The new members of the ABOS Resident Advisory Panel are:
- Steven Greene, MD, University of Mississippi Medical Center
- Michelle Lawson, MD, Oregon Health & Science University
- Joseph Sliepka, MD, University of Washington
- Claire Isabelle Verret, MD, Zucker School of Medicine at Hofstra/Northwell
This cohort will join the first group of Advisory Panel members that were selected last year:
- Matthew Booth, MD, Washington University
- Erik Fritz, MD, University of Minnesota
- Alex Gu, MD, George Washington School of Medicine and Health Sciences
- Madeline Lyons, MD, Loyola University Medical Center
The ABOS Resident Advisory Panel assists the ABOS by providing information that will be used to support orthopaedic residents across the country. They work with the ABOS Graduate Medical Education (GME) Committee and the ABOS Communications Committee. The goal is for the ABOS Resident Advisory Panel to identify and work on a project each year that will benefit orthopaedic residents across the country.
All applicants submitted an application, curriculum vitae (CV), personal statement, and a letter of recommendation from their residency program director. These were reviewed by members of the ABOS Board of Directors who serve on the ABOS GME Committee. The ABOS looks forward to an outstanding and productive year working with these accomplished residents.