April 2002 Bulletin

Maintenance of competence: Building a process that works

It is a genuine privilege to have the opportunity to serve in this leadership role for the next year. It has been a pleasure to work closely and well with Richard Gelberman, MD, over the past year and I will continue to support the full implementation of the initiatives set in place during his presidential year. The entire AAOS continues to benefit from the extraordinary volunteer efforts of its Fellows for any number of activities and from the very talented staff that keeps the day-to-day work of the Academy and Association on track.

Over the next year, there are a number of areas I plan to address in an amplified manner from what we have done in the past. These include leadership development programs, diversification of orthopaedics on all levels, advocacy priorities and progress, implementation of work for our new Council on Academic Affairs, and further work in the arena of evidence-based medicine.

But I would like to comment this month on something that directly affects the majority of our Fellows, namely the issue of maintenance of competence. In this same issue of the Bulletin, there is a detailed overview of the activities of the American Board of Orthopaedic Surgery (ABOS) by its president, Gordon Aamoth, MD. On page 21, Dr. Aamoth has succinctly outlined the six components of competency and the four methods of assessing competency, as defined by the American Board of Medical Specialists (ABMS), of which the ABOS is a member. As a member, the ABOS is obligated to abide by the dictates of the ABMS.

Over half of the Board-certified orthopaedic surgeons in the United States now have time-limited Board certification. While I do not have a time-limited Board certificate, I have voluntarily passed the re-certification examination in the past.

I am aware of the concerns of some of our Fellows that the current re-certification process is costly in time and money and may not always be effective in identifying those individuals functioning outside the acceptable norms of orthopaedic practice. Yet, I strongly believe that the AAOS, as an organization, needs to continue to accept and support the concept of maintenance of competence as an appropriate method to keep all of us up-to-date in our orthopaedic practice and skills.

Never before has the public been more is demanding of information about our practices and us. There are public websites in many states that post information on our practice profiles and us. One example you may wish to visit is nydoctorprofile.com , which lists the medical education, translation service availability, and medico-legal history for each physician licensed in New York.

Medical errors and patient safety issues have further increased public scrutiny of maintenance of competence among all physicians and surgeons in the United States. We need to be able to ensure our patients that we have upgraded our orthopaedic skills and knowledge as we have progressed through our years of practice. Since 1991, the AAOS has had a position statement in place, which supports the concept of lifelong learning as important for all orthopaedists. With medical liability insurance rates rising rapidly in many states this past year, it is even more crucial that we as a profession are able to assure the public that we are doing all we can to improve patient safety and the overall level of orthopaedic practice.

In the ABMS guidelines, there are four parts to assessing competence: professional standing, lifelong learning, practice performance and cognitive knowledge. .

It is the cognitive knowledge evaluation component that likely can be improved to make this more of a learning experience and less of a feared examination. We have evaluated some of the efforts of pediatricians and internists in dealing with maintenance of competence and I think that cooperative efforts between ABOS and AAOS can make this work for orthopaedics as well.

Establishing and publishing a curriculum on which the ABOS maintenance of competency evaluation will be based will allow us to focus our CME activity choices. Future Academy publications and self-assessment examinations will concentrate on that knowledge which is considered by the ABOS to be most important in maintaining our competence. This process has the potential to provide more effective and efficient on-going learning and take away some of the uncertainty of the current examination process.

We also have worked this past year with the ABOS to explore ways to improve the overall process of maintenance of competency and we have made some headway. One important step occurred in February, when the ABOS and the AAOS formed a new Maintenance of Competence Task Force. The AAOS representation on the task force will be chaired by Roby Thompson, MD, a past president of AAOS. We also plan to survey a number of AAOS Fellows this spring in order to elicit opinions of our membership on this issue. Throughout, it will be our goal to work with the ABOS to make the maintenance of competence process one that will help us provide the best care for our patients, assure the public that we are committed to this process, and facilitate the process for our Fellows.

In the year ahead, I look forward to hearing about concerns you have and about issues you think need more AAOS attention. Helping to facilitate the integration of all components of our orthopaedic world to solve problems together is a major goal for me.

Vernon T. Tolo, MD

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