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ABOS: 90 Years of History

By Frederick M. Azar, MD

    • Industry Insights

The American Board of Orthopaedic Surgery (ABOS) has been celebrating its 90th anniversary throughout 2024. ABOS is proud to be the certifying Board for orthopaedic surgeons.

For much of the Board’s history, orthopaedic surgeons were all certified as general orthopaedic surgeons. There were no subspeciality certifications. However, over the last several decades, hardly any orthopaedic surgeon would consider themselves a general orthopaedic surgeon. Today, about 94% of orthopaedic surgeons enter a fellowship program after residency. As a team physician, a sports medicine fellowship was key for my role.

Orthopaedic sports medicine has a special place at the ABOS. It is one of two areas in which orthopaedic surgeons can earn ABOS Subspecialty Certification (surgery of the hand is the other, with 36 ABOS Diplomates holding both Subspecialty Certifications).

For the 2,700 of us who hold ABOS Subspecialty Certification in Orthopaedic Sports Medicine, it is a way to distinguish ourselves in the unique field of Orthopaedic Sports Medicine and show patients, whether professional athletes or weekend warriors, that we are highly trained professionals. I was privilidged to have been a part of the first group of orthopaedic sports medicine surgeons to earn Subspecialty Certification in 2007.

I hope you saw the article from Christopher Kaeding, MD, AOSSM President, in the fall issue of Sports Medicine Update, where he shares the exciting news that the ABOS Subspecialty Certification Examination is now available immediately after fellowship. Individuals can take the Examination when the knowledge they have learned in fellowship is fresh, and earn Subspecialty Certification as soon as they become ABOS Board Certified.

The ABOS feels that we can and should adapt to changes—while still maintaining the effective process that has long supported high-quality training and expertise.

For example, since the founding of Subspecialty Certification in Orthopaedic Sports Medicine, the ABOS has required Candidates to submit a surgical Case List for per review. While the methods of collecting a Case List and administering peer review have changed over 90 years, the overall goals have remained aligned with the Board’s mission to protect the public. Generations of ABOS Directors have maintained this process as an effective way to determine an orthopaedic surgeon is practicing safe medicine.

Since early in its history, the Board has required both a written and an oral examination to become ABOS Board Certified. The ABOS Board of Directors believes that these two examinations complement each other, so Candidates can demonstrate they have both the knowledge and skills necessary to be a competent orthopaedic surgeon. In fact, the Palmer House Hilton—where the ABOS Part II Oral Examination is administered—is the place where the ABOS was founded in 1934!

Technology has also greatly changed how ABOS Board Certification examinations are administered. For the Part II Oral Examination, I brought x-rays and patient notes in a suitcase to Chicago. Part I Examinations are now administered at testing centers around the world. Today, Part II Oral Examination Candidates are not allowed to bring anything with them to the Examination—all the images and notes they have uploaded ahead of time will appear on the computer monitor.

Possibly the biggest change to ABOS Board Certification was awarding 10-year time-limited certificates starting in 1986. Prior to that, all ABOS Diplomates received lifetime certification. After many years of debate, the Board realized that it was important for a Diplomate to recertify. The knowledge base in orthopaedic surgery advances quickly. While Continuing Medical Education is important, the Board realized it is not enough. As peer review and Case Lists are important for ABOS Board Certification, the Board also believes they are important for Maintenance of Certification (MOC).

I am proud that I was part of the Board when the ABOS created the ABOS Web-Based Longitudinal Assessment Pathway (ABOS WLA). The program was launched in 2019, and an overwhelming majority of Diplomates have told us on surveys that they have changed their practice based on the articles they have read as part of the ABOS WLA Pathway. As a sports medicine surgeon, I appreciate the opportunity to choose articles in my field and easily find many others that interest me. Even if you are not participating in the ABOS WLA Pathway, I highly recommend the articles. In 2024, subject matter experts chose articles for the orthopaedic sports medicine section from six different journals, including AOSSM’s The American Journal of Sports Medicine.

One final aspect of the ABOS is residency education, part of the mission statement. Since the Board issued its first requirements in residency education more than 80 years ago, the biggest change is the current rollout of the ABOS Knowledge, Skills, and Behavior Program (ABOS KSB). All orthopaedic surgery residency programs will have access to the program by January 2025 and all residents will be required to participate starting July 1, 2025.

The Knowledge portion consists of residents taking the AAOS Orthopaedic In-Training Examination (OITE), which now shares a blueprint with the ABOS Part I Examination. The two examinations are roughly linked so residents can better prepare for the ABOS Part I Examination.

For Skills, residents request faculty rate their surgical skills across such areas as pre-procedure plan, technical performance, and visuospatial skills. The program gives real-time, formative feedback to both the resident and to the program.

After each rotation, residents also ask faculty to complete a Professional Behavior assessment, looking at areas such as ethics and communication. ABOS Diplomates who come before the ABOS Credentials Committee almost always appear because of Professional Behavior issues. Let’s get those addressed in residency. The Board believes early intervention from the programs can help residents improve early in their careers.

Overall, the Board has had a relatively stable notion of what makes a competent orthopaedic surgeon, modifying the ways that surgeons are evaluated. And over the last 90 years, we have found ways to improve those evaluation tools so they benefit patients while making the programs smoother and more beneficial for orthopaedic surgeons.

To learn more about the ABOS history, go to https://www.abos.org/about/history/.

Frederick M. Azar, MD, is Chair of the ABOS 90th Anniversary Task Force, a member of the American Orthopaedic Society for Sports Medicine, and an orthopaedic sports medicine surgeon in Memphis, TN.

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