American Board of Orthopaedic Surgery sets standards for our residency education
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Most orthopedic surgeons know of the American Board of Orthopaedic Surgery. But how well do they really know the organization?
The American Board of Orthopaedic Surgery (ABOS) was founded in 1934 at the Palmer House in Chicago as a private, voluntary, nonprofit organization that exists to serve the best interests of the public and the medical profession. While most probably know the ABOS is responsible for the initial and continuing qualifications and competence of practicing orthopedic surgeons, they may not know that the ABOS is also responsible for establishing education standards for orthopedic residents.
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The ABOS Board of Directors is made up of 20 practicing orthopedic surgeons, all of whom are ABOS Board Certified and participating in ABOS Maintenance of Certification (MOC). These directors serve 10-year terms as volunteers and are nominated by the American Academy of Orthopaedic Surgeons, the American Orthopaedic Association (AOA), and the AMA. In addition, the ABOS Board of Directors has a public member who serves a 3-year renewable term. The ABOS Board of Directors is supported by a small full-time staff in North Carolina.
In addition, more than 300 orthopedic surgeons serve as ABOS volunteers in each calendar year. The ABOS would not be able to fulfill its mission without the support of these dedicated volunteers. The ABOS is always looking for new volunteers. The first step to becoming an ABOS volunteer is to complete a volunteer application, which can be found on one’s ABOS dashboard.
Assessment tools
Previously, setting standards for orthopedic surgery residency education consisted of determining how long rotations should be and how much training should take place. Several years ago, the ABOS introduced the ABOS Knowledge, Skills, and Behavior (ABOS KSB) Program to provide assessment tools to measure the competency of residents as they progress through their education. Knowledge is measured through the AAOS’ Orthopaedic In-Training Examination (OITE). The ABOS and AAOS have worked together to create a standardized blueprint for each examination and also created a set of questions that to appear on both examinations. This allows the OITE and ABOS Part I Examinations to be roughly linked. Similar to the PSAT/SAT relationship, residents can go to their ABOS dashboard and evaluate their OITE performance and get an indication of how likely they are to pass the ABOS Part I Examination. All residents have access to this program and to an ABOS dashboard.
For surgical skills, residents whose program is participating in ABOS KSB can request an assessment of their surgical skills from the attending physician. Attending physicians will receive a text or email, asking them to complete a brief survey. Residents can view their performance online and program directors/program coordinators can see the surgical skills for their residents. Program directors can see both individually and program-wide the surgical skills for which residents are not yet competent and provide additional training in those areas.
Finally, residents’ professional behavior is measured after each rotation and yearly through a 360-evaluation. Many of the Diplomates who come before the ABOS Credentials Committee have professional behavior issues, so the ABOS hopes potential issues can be identified and addressed during residency.
Goals
The eventual goal is for residency directors to use the ABOS KSB Program assessment tools to arrive at a decision to certify residents to sit for the ABOS Part I Examination and do independent practice.
After completing residency, I took the ABOS Part I Examination in the basement of the Hyatt Regency in Chicago. Now, those examinations are conducted throughout the United States at Prometric Testing Centers. The examination measures not only orthopedic knowledge, but also strives to evaluate the application of that knowledge. The ABOS puts a lot of time into the development of the ABOS Part I Examination and goes to great lengths to make sure that appropriate questions are placed on the examination. There is a 12-step process from the time the questions are written to the time that examination results are posted, with practicing orthopedic surgeons working with professional editors to make sure that each question is valid. This involves the work of volunteers and staff, but the work pays off with a high-quality, reliable, valid examination.
Two years after passing the ABOS Part I Examination, orthopedic surgeons are eligible to take the ABOS Part II Oral Examination. That examination looks at an orthopedic surgeon’s own cases to make sure he or she is practicing safe medicine. Candidates submit 6 months of worth of surgical cases and the ABOS selects 12 cases that the candidate presents at the time of the examination. Many veteran orthopedic surgeons remember bringing suitcases of X-rays and records to Chicago. However, the examination has been digital for some time now and the required documents and images are uploaded ahead of time and are available on the candidate and examiner screens.
After passing the ABOS Part II Oral Examination, the orthopedic surgeon is ABOS board certified. They are a Diplomate for 10 years and become part of the ABOS MOC Program. There are about 30,000 ABOS Diplomates. Each year there are about 900 new ABOS Diplomates.
Requirements
While some have negative thoughts about the ABOS MOC Program, most of these requirements have been around for decades. Many of the requirements are already being met by ABOS Diplomates. The ABOS MOC Program consists of the following four parts:
- Professional Standing: Diplomates must have a valid medical license and hold hospital or surgicenter privileges;
- CME: Diplomates must submit CME and self-assessment examination credits;
- Knowledge Assessment: Diplomates have several options for the Knowledge Assessment requirement: 1) an ABOS Computer-Based Examination; 2) an ABOS Oral Examination (need to pass once every 10-year MOC cycle); or 3) the ABOS Web-Based Longitudinal Assessment Pathway (need 5 quality years); and
- Practice Improvement: Diplomates must submit a case list and have peer review conducted once in every 10-year ABOS MOC cycle.
The ABOS MOC Program has undergone many changes in the last 5 years to keep it relevant and not overly burdensome to ABOS Diplomates, while still ensuring the ABOS fulfills its mission of protecting the public.
Finally, the ABOS offers subspecialty certification in orthopedic sports medicine and surgery of the hand. These certifications are for ABOS Diplomates who have completed a fellowship in one of those areas, demonstrate expertise and meet the case list requirements. The ABOS Diplomate then takes an examination to receive this Subspecialty Certification designation.
Staff at the ABOS are available by phone and email to answer questions. Each orthopedic surgeon has a dedicated ABOS certification specialist, based on the first letter of the surgeon’s last name, to help that surgeon. If you have suggestions for topics for future updates, please contact me at dmartin@abos.org.
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