by Elizabeth Hofheinz, M.P.H., M.Ed., January 24, 2020
They are the gatekeepers of excellence when it comes to orthopedic surgery. The American Board of Orthopaedic Surgery (ABOS), established in 1934, has matured with the times and is now far past the days when newly minted orthopaedic surgeons had to haul old fashioned paper medical records to Chicago for an oral examination.
Nowadays, for the candidates who descend on Chicago each
year for the ABOS Part II Oral Examination, things are much more
streamlined…and getting more so, says Joshua Jacobs, M.D., immediate past chair
of the ABOS
Oral Examination Committee. 
“The oral portion of the exam has had a steady evolution,” notes Dr. Jacobs, “and we are proud of the fact that we test the candidates based on their own individual practices. To prepare for the oral examination, the candidates collect all their cases over a period of six months, typically beginning in their first year of practice. This six-month case list is submitted to the ABOS. Using a combination that involves human and computer efforts (an algorithm), we select the 12 most representative cases from that list…the candidates are then informed which cases are chosen. The candidates then upload specified clinical records and imaging studies on these 12 cases. The entire examination is based on these 12 cases and is administered by four panels of examiners with each panel having two examiners. Each of the 4 panels covers 3 of the 12 cases. In this fashion, all 12 cases will be used to assess the candidate’s data gathering skills, diagnosis and interpretive skills, treatment plan, technical skills, outcomes, applied knowledge, surgical indications, surgical complications and ethics and professionalism.”
Always striving for fairness and relevance, the ABOS does its best to match up the subspecialty interest of the candidates with the examiners. “Thus,” says Dr. Jacobs, “if the candidate primarily does spine surgery then a majority of his or her examiners will be spine surgeons.”
Asked where the candidates might stumble, he shares, “If they are going to falter it probably won’t be on the exam…it is in practice or in preparation for the exam. Issues that concern examiners include improper surgical indications, insufficient documentation, ordering inappropriate tests, incorrect interpretation of diagnostic tests and suboptimal surgical technique. Surgical technique can often be assessed on the postoperative imaging studies.”
Discussing the issue of using protected health information (PHI), Dr. Jacobs notes, “Medical records have to either have PHI redacted or the candidate must get consent from the patient to have PHI submitted with the medical record (this is optimal). Before the case collection period the candidate can put the appropriate language in a consent form (examples are given on the ABOS website) and have the patient give consent for the use of his or her unredacted medical record for the purpose of the ABOS exam. This is a great alternative to what is otherwise a time intensive process of uploading and redacting PHI. We encourage all candidates to begin uploading their 12 cases for the Part II exam as early as possible.”
And while the oral exam doesn’t directly assess research skills, the exam process sheds light on the candidate’s level of knowledge of contemporary trends in the management of musculoskeletal conditions. “Through the case presentation format, the oral exam provides the examiner with an opportunity to see how well the candidates understand the current state of the literature. The goal of exam is to ensure that any given candidate meets the threshold of competency and is qualified to practice orthopedic surgery. If the candidate is not knowledgeable regarding the current literature, then there is a chance that this will impact their surgical decision making or their indications for surgery.”
But the ABOS does much, much more than administer an oral examination. “Particularly exciting,” notes Dr. Jacobs, “is that the ABOS has now developed an alternative pathway to recertification, a web-based, longitudinal assessment (WLA) that has been created in cooperation with the American Academy of Orthopaedic Surgeons (AAOS) and numerous specialty societies. The WLA is based on the most impactful and relevant articles in the recent orthopaedic literature. These articles are selected by content experts who have been identified by the AAOS and other specialty societies. The ABOS WLA is conducted over multiple years and does not involve a high-stakes examination. The feedback from ABOS diplomates after the first year of administering the ABOS WLA has been overwhelmingly positive.”
“If you have any questions regarding the ABOS or its examinations, visit our website! Call us up!” says an enthusiastic Dr. Jacobs. “There is a wealth of carefully collected information on the website that will help get candidates on the right path for succeeding on the exams. Another option is to call the ABOS staff. We have a very responsive team that routinely gets high marks from individuals who have taken the exam.”
For additional information, please visit: https://www.abos.org