August 2001 Bulletin

AAOS, ABOS probe recertification issues

Explore alternatives to future maintenence of certification approaches

By Randy N. Rosier, MD

A combined task force of the AAOS and the American Board of Orthopaedic Surgery met on Feb. 14, 2001 to discuss the process of recertification and future approaches to maintenance of certification. The goals of the meeting were to:

  1. review the current procedures for ABOS recertfication, alternative pathways, and testing analysis and validation processes;
  2. review American Board of Medical Specialties (ABMS) initiatives on maintenance of certification approaches;
  3. review AAOS/Board of Councilors concerns regarding recertification; and
  4. explore possible alternatives in moving forward toward future maintenance of certification approaches.

The task force reviewed the current multiple pathways for the recertification process, which include a practice-based oral examination; a general orthopaedic written or computerized examination; and computerized subspecialty practice profiled examinations in sports medicine, spinal surgery and adult reconstruction. In addition, diplomats who hold a Certificate of Added Qualifications (CAQ) in hand surgery may recertify by successful completion of this examination.

The history of recertification and the recent ABMS endorsement of the evolving concept of maintenance of certification were discussed. The current competence movement of the ABMS and its member Boards was discussed, including the description of the competent physician and the six competencies defined in 1999 (medical knowledge, practice-based learning and improvement, interpersonal and communications skills, professionalism, systems-based practice and patient care).

In addition the ABMS components for assessment (professional standing, lifelong learning, cognitive skills and practice performance) were reviewed. The ABMS-Maintenance of Competence committees are working on recommendations regarding evaluation of the four components and in particular, developing principles for assessment of practice performance.

Concerns about the current recertification procedures, including cost issues, relevance to practice evaluation, lack of direct linkage to CME programs and time away from practice were presented and considered. A consultant from the National Board of Medical Examiners explained the process of test development, standard setting and statistical validation. The need to have legally defensible standards and testing evaluation was also discussed. Alternative approaches such as CME course-related testing were extensively debated, as was the potential role of the ABOS in question development for CME-related testing.

Other proposals discussed included the concept of recertification credits, where CME and standardized testing might be included as components toward recertification; decreasing the weight of the standardized examinations in the process; a CME review course linked to a standardized examination; and provision by the ABOS of question content for CME-related post-testing. The need for defensible statistical validity of any examination format was considered in evaluating these proposals.

The action plan developed by the task force involves the following activities: A survey of the AAOS membership regarding sentiments about recertification/maintenance of certification will be prepared and sent out to determine the scope of the perception of difficulties with the current system. Information will be solicited from two additional testing organizations to determine the feasibility of the CME-related testing approach, along with a better understanding of the cost of developing a CME-based system. Information on the task force meeting will be disseminated through the AAOS e-mail news service, and the task force will arrange a follow-up meeting in the fall of this year.

Randy N. Rosier, MD, is chair of the AAOS/ ABOS Work Group on Maintenance of Competence/Recertification.

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