The critical importance of specialty certification: the American Board of Obstetrics and Gynecology certification rationale.

The pass/fail results of 44 North American medical specialty certification examinations are compared and analyzed. A calculated annual failure rate was used to equate one- and two-part examinations. Failure rates on American boards generally varied between 8 and 61 percent. Foreign medical graduates (FMGs) had failure rates two to three times higher than those of North American graduates in almost all specialties. Failure rates for comparable North American and FMG candidates tended to be higher on Royal College of Physicians and Surgeons of Canada specialty certification examinations than on equivalent American specialty board examinations. The place of specialty certification in the continuum of American graduate medical education is delineated. Questions are raised concerning the standards required for specialty certification.

Thus, any of these specialties could take the lead in provid-ing perioperative care.However, the 2014 Institute of Medicine report on gradu-ate medical education in the United States noted that there is “a gap between new physicians’ knowledge and skills and the competencies required for current medical practice.”

The American Board of Medical Specialties and its member boards have been serving as a key foundation for professional self-regulation for the past century. During this time the standards for specialty board certification have evolved to meet the public's needs. Recent major changes have included time-limited certification status, the adoption of 6 core competencies, and the multifaceted recertification program termed Maintenance of Certification. During the past decade there has been a dramatic increase in the public's interest in improving the quality, safety, and efficiency of the US health care system. This article describes some of the milestones in the evolving public demand for physician accountability. The public's growing need for better health care delivery is, in turn, creating the need for the American Board of Medical Specialties and its member boards to evolve to meet the public's expectations of the profession of medicine to maintain its privileged status in specialty certification through self-regulation.

Little is known about the attrition of physicians trained in internal medicine (IM). The authors sought to examine career paths, disciplinary actions, and American Board of Medical Specialties (ABMS) certification status of IM residents. Three datasets were combined to study 66,881 residents in Accreditation Council for Graduate Medical Education-accredited IM residency programs nationwide from 1995 to 2004. Group differences (among an American Board of Internal Medicine [ABIM]-certified cohort; an ABMS-certified cohort (but not ABIM-certified); and a noncertified cohort) in IM residency performance ratings, specialty certification status, year of initial IM training, and medical board disciplinary actions were examined. Analyses included chi-square tests, analysis of variance, pairwise comparisons, and logistic regressions. Ninety-five percent of IM residents obtained ABIM certification; 1.6% received ABMS certification in another specialty; 3.4% received no ABMS specialty certification, of which 74.3% have a current medical license; and 66.6% self-reported IM as their primary specialty. During residency, the ABIM cohort performed better than those who never obtained ABIM certification. Disciplinary actions were lowest for the ABIM cohort (1.2%), 2.4% for the ABMS cohort, and highest and more severe for the noncertified cohort (6.0%). Only 5% of IM residents do not achieve IM certification. IM resident attrition minimally impacts physician supply, though those without certification appear to contribute disproportionately to poor physician performance indicators. Improved tracking of the U.S. physician workforce could aid policy makers in predicting manpower shifts in certain specialty areas, both during and after residency training.

Most nurses are confident in their belief that they provide excellent care; however, many find the idea of taking an examination to demonstrate their knowledge frightening. Earning a specialty certification is one of the most important accomplishments a nurse can achieve for oneself, one’s patients, and one’s employer, as it signifies knowledge and practice competency in the specialty (Oncology Nursing Certification Corporation [ONCC], 2008c). This column explains the benefits of certification and solutions to potential barriers to obtaining certification for oncology nurses who are contemplating certification. Certification is a voluntary personal and professional accomplishment that is recognized by patients, their families, peers, other health professionals, and employers. Specialty certification is not limited to health professions; it exists in other occupations such as business, accounting, and information technology. Obtaining a formal credential—Oncology Certified Nurse (OCN®), Certified Breast Care Nurse (CBCN), Certified Pediatric Oncology Nurse (CPON®), Advanced Oncology Clinical Nurse Specialist (AOCNS®), or Advanced Oncology Certified Nurse Practitioner (AOCNP®)—is not only an achievement, but a validation of the nurse’s clinical experience and knowledge. “Certification has been a personal challenge for me. It has helped validate my skills and knowledge in care of oncology patients. It was worth my time and energy to take the test”(Leak and Spruill, 2008). More than 2.9 million people in the United States are RNs (American Nurses Association, 2008). More than 500,000 nurses worldwide are certified in their specialty areas, including advanced practice nurses who have more than one specialty credential (American Board of Nursing Specialties, 2005). ONCC was established in 1984 to develop and administer a certification program in oncology nursing. It currently offers five certification examinations (ONCC, 2008c) (see Table 1). Currently, more than 27,000 nurses are certified, including 23,378 nurses with the OCN® credential, 1,731 CPON®, 1,225 AOCN®, 541 AOCNP®, and 220 AOCNS® (ONCC, 2008c). Table 1 Five Oncology Nursing Certification Examinations Offered by the Oncology Nursing Certification Corporation Since the 1990s, healthcare organizations have placed a higher value on specialty certification for nurses. Many employers now provide and pay for review courses for their employees. Some employers even reimburse their staff for the cost of successful completion of the credentialing examination. The increase in the number of healthcare organizations supporting nurses’ professional development via specialty certification may be partly because of the criteria for Magnet recognition from the American Nurses Credentialing Center (2008), which strongly encourages specialty certification to validate specialty nursing knowledge.

The American board of orthodontics and specialty certification: the first 50 years

Surgical skills simulation (SSS) tests the application of factual knowledge and shows how knowledge is applied, representing the second and third levels of Miller’s Pyramid of Learning. SSS permits high-stakes scenario testing in safe environments. Therefore, SSS incorporation into initial specialty certification began in 2002 in Australia and New Zealand. The United States began SSS incorporation into specialty certification in 2008. This paper will determine where the United States stands in the process of SSS incorporation into specialty certification. Google scholar Internet and PubMed searches phrased “medical board certification surgical skills simulation”, performed on September 1, 2016 yielded 16 relevant articles. Hand search on September 1, 2016 yielded 7 additional articles. In 2008, cardiac catheterization simulation was required for interventional cardiology maintenance of certification (MOC). In 2010 the American Board of Anesthesiology (ABA) required SSS as part of the MOC program. In 2014, the summative assessment, Colorectal Objective Assessment of Technical Skills became part of the American Board of Colon and Rectal Surgery certification. In 2017, SSS will be added to the ABA initial certification examination. The United States has been slow to incorporate SSS into initial certification and MOC. Assessment validation, capital and recurring costs, personnel, physical facility and time requirements are barriers limiting SSS expansion into specialty certification processes. As SSS allows rapid technical skill assessment, without posing a threat to patients, expansion of SSS into initial certification and MOC programs represents non-maleficence and beneficence, and should be encouraged.

The public seems to crave a simplistic index of 'quality', analogous to 'The Good Housekeeping Seal of Approval', for the complex endeavour of clinical medicine. The American Board of Medical Specialties (ABMS) and its member boards have purported to fill the vacuum in an effort that bears many of the earmarks of a public relations publicity campaign. The author examined the validity of the evidence touted in support of that effort. By applying Hill's causal epidemiologic criteria and logical and statistical inference, the author evaluated: (i) published data sources consisting of the most comprehensive collection of studies yet gathered that purports to provide evidence of the relevance of board certification to clinical outcomes, a collection presented by Sharp et al. apparently with the advice and consent of ABMS, that they posited as containing 'relevant findings', to what purpose they left unspecified; and (ii) the review article of Sharp et al. The data that Sharp et al. presented provided no credible link between specialty board certification and outcomes or 'quality' of clinical care. Sharp et al. ignored the evidence of absent evidence they found and proposed enthusiastic but unjustified conclusions in support of specialty board certification as an index of clinical 'expertise'. No evidence supports the touted clinical benefit of specialty board certification. Specialists in clinical medicine and surgery are unamenable to simplistic evaluation by examination, yet specialty board certification remains an ersatz standard of doctors' clinical quality in the absence of supporting evidence.

Only 62.6% of fellowship-trained and American Board of Internal Medicine (ABIM)-certified geriatricians maintain their specialty certification in geriatric medicine, the lowest rate among all internal medicine subspecialties and the only subspecialty in which physicians maintain their internal medicine certification at higher rates than their specialty certification. This study aims to better understand underlying issues related to the low rate of maintaining geriatric medicine certification in order to inform geriatric workforce development strategies. Eighteen-item online survey of internists who completed a geriatric medicine fellowship, earned initial ABIM certification in geriatric medicine between 1999 and 2009, and maintained certification in internal medicine (and/or another specialty but not geriatric medicine). Survey domains: demographics, issues related to maintaining geriatric medicine certification, professional identity, and current professional duties. 153/723 eligible completed surveys (21.5% response). Top reasons for not maintaining geriatric medicine certification were time (56%), cost of maintenance of certification (MOC) (45%), low Medicare reimbursement for geriatricians' work (32%), and no employer requirement to maintain geriatric medicine certification (31%). Though not maintaining geriatric medicine certification, 68% reported engaging in professional activities related to geriatric medicine. Reflecting on career decisions, 56% would again complete geriatric medicine fellowship, 21% would not, and 23% were unsure. 54% considered recertifying in geriatric medicine. 49% reported flexible MOC assessment options would increase likelihood of maintaining certification. The value proposition of geriatric medicine certification needs strengthening. Geriatric medicine leaders must develop strategies and tactics to reduce attrition of geriatricians by enhancing the value of geriatric medicine expertise to key stakeholders.

Introduction: Eligible residents during their fourth postgraduate year (PGY-4) of emergency medicine (EM) residency training who seek specialty board certification in emergency medicine may take the American Osteopathic Board of Emergency Medicine (AOBEM) Part 1 Board Certifying Examination (AOBEM Part 1). All residents enrolled in an osteopathic EM residency training program are required to take the EM Resident In-service Examination (RISE) annually. Our aim was to correlate resident performance on the RISE with performance on the AOBEM Part 1. The study group consisted of osteopathic EM residents in their PGY-4 year of training who took both examinations during that same year.Methods: We examined data from 2009 to 2012 from the National Board of Osteopathic Medical Examiners (NBOME). The NBOME grades and performs statistical analyses on both the RISE and the AOBEM Part 1. We used the RISE exam scores, as reported by percentile rank, and compared them to both the score on the AOBEM Part 1 and the dichotomous outcome of passing or failing. A receiver operating characteristic (ROC) curve was generated to depict the relationship.Results: We studied a total of 409 residents over the 4-year period. The RISE percentile score correlated strongly with the AOBEM Part 1 score for residents who took both exams in the same year (r=0.61, 95% confidence interval [CI] 0.54 to 0.66). Pass percentage on the AOBEM Part 1 increased by resident percent decile on the RISE from 0% in the bottom decile to 100% in the top decile. ROC analysis also showed that the best cutoff for determining pass or fail on the AOBEM Part 1 was a 65th percentile score on the RISE.Conclusion: We have shown there is a strong correlation between a resident's percentile score on the RISE during their PGY-4 year of residency training and first-time success on the AOBEM Part 1 taken during the same year. This information may be useful for osteopathic EM residents as an indicator as to how well prepared they are for the AOBEM Part 1 Board Certifying Examination.

Pediatric Recertification and Quality of Care: The Role of the American Board of Pediatrics in Improving Children’s Health Care

The Accreditation and Certification System After Next

Maintenance of Certification and Pediatrics Milestones–Based Assessment: An Opportunity for Quality Improvement Through Lifelong Assessment

Continuing Professional Development for doctors, certification, licensure and quality improvement. A model to follow?

Little is known about how psychologists choose their specialty practice area, and rehabilitation psychology is no exception. Specialization and specialty certification in professional psychology have been controversial topics impacting the field during the training sequence and across the span of professional careers (Drum & Blom, 2001; Robiner & Fossum, 2017). The American Board of Rehabilitation Psychology (ABRP) has been providing specialty certification since 1995 and rehabilitation psychology was recognized as a unique specialty in 2015 by the APA's Council for the Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP). There are limited established training programs and minimal information about the specialty in undergraduate course materials. The current survey is intended to provide information about how people are introduced to the field of rehabilitation psychology, specialty identification, and to identify opportunities for improvement. A survey of members of APA Division 22 and ABRP specialists was conducted to collect information about their exposure to and involvement in rehabilitation psychology. Results from 174 respondents suggest that personal relationships are the current key means of recruitment and confirms that rehabilitation psychology has limited presence in undergraduate training. Most professionals come to identify with rehabilitation psychology after training in clinical neuropsychology and health psychology. These preliminary results suggest that the current generalist training sequence does not provide sufficient exposure to, or preparation for the field of rehabilitation psychology. Recruitment opportunities should emphasize student leadership network activities and the identification of early and midcareer practitioners unaware of the rehabilitation specialty. (PsycInfo Database Record (c) 2022 APA, all rights reserved).