In the spring, more than 9,500 Diplomates of the American Board of Orthopaedic Surgery (ABOS) took part in the inaugural Web-Based Longitudinal Assessment Program (ABOS WLA). It was a successful launch, and the ABOS looks forward to its growth. However, many ABOS Diplomates want to take only one assessment every decade and are happy with the numerous options offered with an ABOS Computer-Based Recertification Examination (CBRE). The ABOS has made several improvements to the Examinations over the past four years.

The ABOS now offers CBREs that are practice-profiled in the following subspecialties:

• general orthopaedics
• adult reconstruction
• foot and ankle
• orthopaedic sports medicine
• orthopaedic trauma
• pediatrics
• shoulder and elbow
• surgery of the hand
• spine

The ABOS added the shoulder and elbow practice-profiled CBRE to its offerings this year and added trauma, pediatrics, and foot and ankle two years ago. Previously, orthopaedic sports medicine and surgery of the hand recertification options were available only to those who held an ABOS Subspecialty Certificate. Now, any ABOS Diplomate can take these Examinations to recertify their orthopaedic boards; however, Diplomates can only earn Subspecialty Certification by meeting the specific requirements. Most Diplomates can now find a CBRE in their subspecialty.

Each CBRE consists of 150 multiple-choice questions pertinent to practicing orthopaedic surgeons focused only in that subspecialty. Previously, in addition to the subspecialty questions, all subspecialty exams also had 75 general orthopaedic questions. Feedback from Diplomates was that Examinations should truly be practice-specific and include only questions pertaining to the applicable subspecialty. The group of general orthopaedic questions is no longer a part of any Examination.

You can see a breakdown of the topics covered on each Examination by visiting www.abos.org and reviewing the Examination Blueprints, which are found in the MOC (Maintenance of Certification) section under Examination Options. When an orthopaedist is preparing for a CBRE, the ABOS highly recommends that he or she review the Examination Blueprint and focus on reviewing the areas emphasized there.

The Examination Blueprints are developed by practicing orthopaedic surgeons who were nominated to participate by AAOS and the appropriate subspecialty societies. For each subspecialty blueprint, the group met at the National Board of Medical Examiners offices in Philadelphia to consider what an orthopaedic surgeon in that subspecialty needs to know to practice competently and safely. Blueprints are developed based on numerous factors, including data from the ABOS Case List Database, which contains relevant information on the types of surgeries orthopaedic surgeons are actually performing. The Examination Blueprints are reviewed regularly to keep up with changing practice patterns and new developments in the profession.

Another change the ABOS has made is to move all CBREs to August and September, starting this year. Previously, most were given in the spring. The ABOS WLA is now given in the spring, whereas the ABOS Oral Recertification Examination—another option—is given each July.

The ABOS continues to make the recertification Application process easier. Diplomates are encouraged to complete the Application in year seven of the MOC cycle, but it also can be completed in years eight or nine. An Application and Case List are required regardless of the recertification pathway. The Application has more pre-printed information and is quicker to complete than in the past. The Case List, which is part of the Application process, also has been streamlined, resulting in less time required for completion. Also, Diplomates now have to enter only 75 consecutive surgical cases, starting with the first surgical case of the Application year, regardless of the pathway. The next Application deadline is Dec. 2 for those Diplomates whose certifications expire in 2020, 2021, or 2022. The ABOS highly recommends that Diplomates apply in the first year eligible to maximize assessment opportunities.

The ABOS highly recommends that orthopaedists take time before the exam to review the Examination tutorial, which demonstrates how the interface works and gives additional break time during the Examination itself. Once a recertification Examination has been taken, the ABOS strives to release the score as quickly as possible. There is a process in place to ensure that all Examinations are valid and reliable, producing scores that are scalable each year. The ABOS does that by working with psychometricians who summarize the statistical performance of each question. Then, a Key Validation Committee reviews the data. Poorly performing questions are removed before scoring. Psychometricians also analyze the degree of difficulty for each question and the Examination overall.

Next, the ABOS Written Examination Committee uses that information to set the cut score—the pass/fail point. The ABOS does not set an overall pass rate (percentage of people who pass/fail)—just the cut score, which is designed to produce the same likelihood of passing or failing no matter when the Examination is taken. The ABOS website shows the pass rate for each practice-profiled CBRE.

Many of the changes the ABOS has made are based on Diplomate input and feedback. The ABOS encourages orthopaedists to provide feedback whether using formal methods like surveys, contacting the office at 919-929-7103, or emailing a Certification Specialist. Their contact information can be found on www.abos.org; click “Contact.” The ABOS staff is always eager to help Diplomates understand their options.

The ABOS thanks all of the volunteer orthopaedic surgeons who help with developing the blueprints and writing and reviewing the Examination questions. Although many volunteers have been with the organization for years, the ABOS is always looking to increase its pool of volunteer subject-matter experts. To volunteer, go to www.abos.org and log in to your ABOS Dashboard. There is a button that takes you the volunteer form and provides information about each opportunity. Filling out that form will put your name on the ABOS Volunteer List.

Michael S. Bednar, MD, is chair of the ABOS Written Examination Committee.