ABOS Presidents report
Advancing the mission
By Gordon M. Aamoth, MD
President, American Board of Orthopaedic Surgery
The mission of the American Board of Orthopaedic Surgery (ABOS) is to assure the American public that certified orthopaedic surgeons are truly qualified competent doctors.
Achieving that mission is a demanding process and, as I reported in the January 2002 issue of The ABOS Diplomate, during my tenure as ABOS President I plan several initiatives to advance that mission. Those initiatives include reevaluation of the ABOS certification process, reassessing and reengineering of the maintenance of certification concept, revisiting the certification/recertification process of nonsurgical and/or retired orthopaedic surgeons, looking at eligibility for certification of foreign trained orthopaedic surgeons, and developing a practice performance and outcomes measurement process.
As we move forward in 2002, it may be instructive to consider our history and reflect on the opportunities that await us.
History of ABOS
The ABOS was founded in 1934 by individuals from the American Orthopaedic Association (AOA), the American Academy of Orthopaedic Surgeons (AAOS), and the American Medical Association (AMA). It is a private, voluntary, nonprofit, autonomous organization that exists to serve the public and the medical profession by establishing educational standards for residents and by evaluating initial and continuing qualifications and competence of orthopaedic surgeons.
The Board is composed of 20 orthopaedic surgeonstwelve active directors, six senior directors and two directors-elect plus an executive director. These directors each serve a 10-year term and work an average of 24 days a year without compensation or honorarium. In addition, more than 300 orthopaedic surgeons volunteer to serve on the Question Writing Task Force, the Field Test Task Force, the Question Writing Task Force for Recertification and as oral examiners for the Part II Oral Certification Examination and the Oral Recertification Examination.
The Part I Written Certification Examination is taken following satisfactory completion of an orthopaedic residency education program accredited by the Accreditation Council for Graduate Medical Education (ACGME) in addition to a passing superior review by the program chair. The Part II Oral Certification Examination follows after a candidate has successfully passed the Part I exam.
Requirements to sit for the Part II exam include: the active and continuous practice of operative orthopaedic surgery for at least 22 months of which 12 consecutive months must be in the same location, a full and unrestricted state medical license, unrestricted hospital privileges, demonstration of competence and adherence to acceptable ethical and professional standards. In addition, the ABOS Credentials Committee evaluates the results of a stringent peer review.
The Part II examination is practice based. Candidates submit a case list to the Board of their own cases collected over a six-month period of which 10 are selected for the examination. Candidates are examined by three different panels of two examiners each (six examiners total) of which at least three share the same practice profile as the candidate. Whereas Part I tests medical knowledge, Part II tests application of that knowledge in the ethical care of patients.
On July 13, 2001, the Part I Written Examination was administered to 789 candidates of which 77% passed and 23% failed. Of the first time US/Canadian-educated examinees, 87% passed and 13% failed. The Part II Oral Examination was administered on July 10-12, 2001 to 725 candidates of which 86% passed and 14% failed.
The current process of re-certification is voluntary. Requirements include a full and unrestricted state medical license, 120 hours of Category I CME credits during the three years prior to application, a stringent peer review based on letters of recommendation and other relevant information, an evaluation of credentials by the ABOS Credentials Committee, and finally passing one of the seven secure and proctored examination pathways.
The choice of seven examination pathways include: a practice based oral examination, a general clinical written examination conducted during the annual meeting of the AAOS, a CAQ in hand exam for those wishing to re-certify their CAQ, a computer administered general clinical examination, or a computer administered practice profile examination in adult reconstruction, sports medicine or spine surgery.
Computer administered examinations are available during the months of March and April at 250 Pro-Metric Testing Centers throughout the country. During 2001, 571 re-certification candidates were examined; 98% successfully passed. Of the certifying classes of 1986 and 1987 (the initiation of time-limited general certificates), 98% have been re-certified.
The American Board of Medical Specialties (ABMS), the umbrella organization for the 24 specialty member Boards, of which the ABOS is one, is committed to the development of a Maintenance of Certification© (MOC) program which is consistent among all member Boards. This commitment came in response to several factors including medical error investigation, geographical variation of quality/quantity of care, HMO variations in quality of care, patient advocacy groups, the U.S. Government, insurance companies, and large business coalitions who purchase health care.
In 1998 the ABMS initiated a Task Force on Competence who defined the competent physician as ". . . one who possesses the medical knowledge, judgment, professionalism and clinical communication skills to provide high quality patient care. Patient care encom- passes the promotionof health, prevention of disease and diagnosis, treatment and management of medical conditions with compassion and respect for patients and their families. Maintenance of competence should be demonstrated throughout the physicians career of lifelong learning and ongoing assessment of practice . . ."
The ABMS has identified six general components of competence: (1) patient care, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism and, (6) systems-based practice. In addition four elements for assessing these competencies have also been identified: (1) evidence of professional standing, (2) evidence of commitment to lifelong learning and involvement in periodic self-assessment, (3) evidence of cognitive expertise, and (4) evidence of evaluation of performance and practice.
However, in order for the Maintenance of Certification© (MOC) initiative to be successful, the American Board of Orthopaedic Surgery must have the cooperation of the American Academy of Orthopaedic Surgeons. To this end, a task force consisting of leaders of both organizations has been convened to investigate how to achieve a successful MOC program. The Task Force is surveying the AAOS membership to ascertain existing knowledge about this initiative and solicit opinions about novel ways to ensure continued competence among the members of the AAOS.
This joint task force has been charged with developing the curriculum for the MOC initiative. As the AAOS is the premier orthopaedic organization currently offering CME courses, it will develop CME and other educational material to complement the content and curriculum requirements of the MOC initiative. It is anticipated that the current AAOS self-assessment tools will become a specific requirement of the MOC.
The MOC initiative provides a unique opportunity for the ABOS and the AAOS to work together in the development and implementation of continuing assessment of competence of ABOS Diplomates and AAOS Fellows.