Certificate Of Added Qualification Research Articles

Sports Medicine Professionals (Care of the Young Athlete)

Patient Education| 2021 Sports Medicine Professionals (Care of the Young Athlete) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Sports Medicine Professionals (Care of the Young Athlete). Pediatric Patient Education 2021; 10.1542/peo_document569 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Care of the Young Athlete Topics: athlete, sports medicine, physical therapists Athletes may deal with many different types of medical personnel after an injury. Athletes also may be referred by their primary care doctors to a sports medicine doctor or other sports medicine specialists for further evaluation and treatment. The following is information from the American Academy of Pediatrics about the most common sports medicine specialists. Primary care sports medicine doctors are pediatricians, family medicine doctors, and other doctors with special training in sports medicine. Training includes 4 years of medical school and 3 years of general residency training. In addition, some have 1 to 2 additional years of fellowship training in sports medicine and a Certificate of Added Qualification (CAQ). Primary care sports medicine doctors diagnose, treat, and manage musculoskeletal and medical problems, including the following: Sprains and strainsDislocationsLigament injuriesFracturesApophysitisTendinitisOveruse injuriesCartilage injuriesExercise-induced asthmaConcussions... Copyright © 20122012American Academy of Pediatrics You do not currently have access to this content.

Factors Affecting Orthopedic Sports Medicine Surgeons' Online Reputation.

Physician rating websites (PRWs) rate physicians based on experiences of previous patients. Although a high rating is desirable, it may not correlate with quality of care, experience, or other physician-specific variables. This study examined the impact of physician-specific variables, such as American Board of Orthopaedic Surgery Sports Certificate of Added Qualification (CAQ) status, years in practice, sex, and geographic location, on the PRW patient satisfaction rating and number of ratings. A list of orthopedic sports medicine surgeons was obtained from the American Orthopaedic Society for Sports Medicine database. Demographic data were recorded. Surgeon profiles were gathered from the most commonly used PRWs (Healthgrades and Vitals), and a mean rating value was recorded on a 1- to 5-star scale. The t test and analysis of variance were used for comparisons. Multivariable linear regression was used to identify factors contributing to PRW ratings. Female sex had the biggest positive effect on PRW rating (R=0.04, P=.029). The PRW rating was positively affected by the number of ratings (R=0.04, P<.001) and negatively affected by an increase in years of practice (R=0.04, P<.001). Surgeons with fewer than 10 years in practice had higher PRW ratings than surgeons practicing longer than 10 years. The PRW ratings were not affected by sports CAQ status or geographic location. Fewer years in practice, female sex, and greater number of reviews were associated with higher PRW ratings. Number of reviews was the only modifiable factor. There was no observed association between sports medicine CAQ status and PRW rating. [Orthopedics. 2021;44(2):e281-e286.].

Making the diagnosis of midgut volvulus: Limited abdominal ultrasound has changed our clinical practice

PurposeTo assess the diagnostic accuracy of limited abdominal ultrasound (US) examination for midgut volvulus (MGV) and to evaluate how clinical practice has changed in a free-standing children's hospital leading to the near obsolescence of upper GI (UGI) studies for the diagnosis of MGV. Materials and methodsAll patients with suspected MGV who underwent abdominal US during 2016–2017 were identified using keyword search tools in the radiology information system. Retrospective, blinded image review was performed by a certificate of added qualification (CAQ), board certified pediatric radiologist. US images were evaluated for the presence of the superior mesenteric artery (SMA) cutoff sign and twisting of the bowel and mesentery around the SMA (whirlpool sign). The results were compared with the operative reports. Results195 US studies were performed from 2016 to 2017. The most common presentations were vomiting (44%), abdominal pain (7%), and suspected malrotation (10%) 195 US studies were reviewed, of which 16 were nondiagnostic. The remaining 179 diagnostic studies showed MGV in 14 patients. Those 14 patients were surgically explored and confirmed to have midgut volvulus. 7 of the 16 nondiagnostic US studies were further evaluated with UGI examination with 1 patient demonstrating malrotation without volvulus, which was confirmed at surgery. 2 had CT exams which were normal. 4 were followed clinically. The remaining 3 patients went to surgery, all of which did not show MGV. There were 164 negative US, none of whom went to surgery. US was diagnostic in 92% of patients and when diagnostic the positive and negative predictive values of US were 100%. ConclusionLimited abdominal US is a highly accurate examination for the diagnosis of midgut volvulus. UGI exposes patients to ionizing radiation and should be reserved for patients in whom US is nondiagnostic or inconclusive. Type of studyRetrospective review. Level of evidenceLevel 3.

Practice Patterns of Family Physicians With and Without Sports Medicine Certification.

To update information regarding practice patterns of family physicians with a certificate of added qualifications (CAQ) in Sports Medicine (SM), because it has been over 10 years since the last comprehensive study. Cross-sectional analysis of 2017 and 2018 American Board of Family Medicine (ABFM) Family Medicine Certification and SM CAQ examination registration practice demographic questionnaire data. N/A. Family physicians with a CAQ in SM [sports medicine family physicians (SM-FPs)] and family physicians without a CAQ registering for the ABFM Family Medicine Certification or SM CAQ examinations. N/A. Self-reported time spent practicing SM, activities in SM, scope of practice, and practice setting. Sports medicine family physicians are predominately men (78.7%) and below 49 years (65.8%). Most SM-FPs spend 60% of their time or less practicing SM and the scope of practice of SM-FPs is only slightly narrower than that of their family physician counterparts without a CAQ. In addition, 92.8% of SM-FPs are practicing in an urban setting. The similarity of scope of practice for SM-FPs and family physicians without a CAQ and the time spent practicing SM by SM-FPs suggests that most SM-FPs are spending a significant amount of time continuing to practice their primary specialty. Sports medicine family physicians are largely attracted to urban practice settings, most likely because of the higher likelihood of employment opportunities. Finally, factors that may be dissuading women from entering the field of SM deserve further investigation.

Primary Residency Training and Clinical Practice Profiles Among Board-Certified Hand Surgeons

This study seeks to identify the relationship between the type of residency training (general, plastic, or orthopedic surgery) and the clinical practice profiles of hand surgeons in the United States. Membership applications to the American Society for Surgery of the Hand (ASSH) from 2011 to 2015 were analyzed. Data on type of residency training, practice type, the percentage of hand surgery in practice, and the time to application were collected. Total cases and the number of cases in each key clinical category were collected from surgical case logs. From 2011 to 2015, a total of 451 hand surgeons applied for ASSH membership. Of these, 73.8% were orthopedic surgeons, 16.0% plastic surgeons, and 10.2% general surgeons. The median times to application after fellowship graduation and completion of the Certificate of Added Qualifications (CAQ) were 5 and 1 years, respectively and were similar between groups. Orthopedic surgeons are more likely to be in a private practice and perform the highest volume of cases. Plastic surgeons are most likely to be in an academic practice but perform nearly 20% of their cases outside of the field of hand surgery. Failure to meet the minimum case requirement inthe joint contracture (40.7%), congenital (80.5%), and microvascular surgery (47.6%) categorieswere the most common for all applicants. Orthopedic surgeons were most likely toperform bone and joint, nerve, tendon and muscle, and tumor cases. Plastic surgeons were themost likely to perform skin and wound, congenital, and microvascular cases. Orthopedic-, plastic-, and general surgery-trained hand surgeons early in their career have varied practice types and have different clinical case profiles. Differences in case profiles may be due to surgeon interest and/or training experience. Promoting a collaborative relationship between hand surgeons of varied backgrounds is crucial to the training of future hand surgeons and the continued advancement of the field.

Correction to "Family Physicians with a Certificate of Added Qualifications (CAQs) in Sports Medicine Spend the Majority of Their Time Practicing Sports Medicine".

In the above-mentioned article,1 the electronic version differs from the print version due to data errors in the figure. Consequently, the original title no longer accurately reflects the findings after correcting the data errors and has been changed to: "Family Physicians with a Certificate of Added Qualifications in Sports Medicine Spend an Increasing Amount of Time Practicing Sports Medicine." The electronic version on the Journal of the American Board of Family Medicine website has been corrected. We apologize for the error, and we regret any confusion or inconvenience it may have caused.

Added Qualifications in Microsurgery: Consideration for Subspecialty Certification in Microvascular Surgery in Europe.

Background While implementation of subspecializations may increase expertise in a certain area of treatment, there also exist downsides. Aim of this study was, across several disciplines, to find out if the technique of microsurgery warrants the introduction of a "Certificate of Added Qualifications (CAQ) in microsurgery." Methods An anonymous, web-based survey was administered to directors of microsurgical departments in Europe (n = 205). Respondents were asked, among other questions, whether they had completed a 12-month microvascular surgery fellowship and whether they believed a CAQ in microvascular surgery should be instituted. Results The response rate was 57%, and 33% of the respondents had completed a 12-month microvascular surgery fellowship.A total of 61% of all surgeons supported a CAQ in microsurgery. Answers ranged from 47% of support to 100% of support, depending on the countries surveyed. Discussion This is one of the few reports to evaluate the potential role of subspecialty certification of microvascular surgery across several European countries. The data demonstrate that the majority of directors of microsurgical departments support such a certificate. There was significantly greater support for a CAQ in microsurgery among those who have completed a formal microvascular surgery fellowship themselves. Conclusion This study supports the notion that further discussion and consideration of subspecialty certification in microvascular surgery appears necessary. There are multiple concerns surrounding this issue. Similar to the evolution of hand surgery certification, an exploratory committee of executive members of the respective medical boards and official societies may be warranted.

Family Physicians with a Certificate of Added Qualifications (CAQs) in Sports Medicine Spend an Increasing Amount of Their Time Practicing Sports Medicine

While family physicians holding certificates of added qualifications in sports medicine practice in multiple settings, little is currently known about the proportion of their time devoted exclusively to the practice of sports medicine. We found that most spend a majority of their time doing so, and this number has been increasing over the past decade.

Family Physicians with a Sports Medicine Certificate of Added Qualification (CAQ): Well Prepared to Meet a Significant Patient Care Need.

<h3>Introduction</h3> Gender inequality has been associated with child mortality; however, sex-specific mortalities have yet to be explored. The aim of this study is to assess the associations between gender inequality and the child mortality sex ratio at country level, worldwide and to infer on possible mechanisms. <h3>Methods</h3> Data on sex-specific under-five mortality rates (U5MR) and the corresponding sex ratio (U5MSR) for the year 2015, by country, were retrieved from the Unicef database. Excess under-five female mortality was derived from previous published work. Gender inequality was measured using the Gender Inequality Index (GII). Additional biological and social variables have been included to explore potential mechanistic pathways. <h3>Results</h3> A total of 195 countries were included in the analysis. In adjusted models, GII was significantly negatively associated with the U5MSR (β=−0.29 (95% CI −0.42 to –0.16), p&lt;0.001) and borderline significantly positively associated with excess under-five female mortality (β = 3.25 (95% CI −0.28 to 6.67, p=0.071). The association between GII and U5MSR was strong and statistically significant only in low-income and middle-income countries and in the Western Pacific area. <h3>Conclusion</h3> The more gender unequal a society is, the more girls are penalised in terms of their survival chances, in particular in low-income and middle-income countries. In order to decrease child mortality and excess girl mortality, global policy should focus on reducing gender inequality surrounding measures of reproductive health, women’s political empowerment, educational attainment and participation in the workforce.

Is There a Place for PAs in Psychiatric Practice?

Is There a Place for PAs in Psychiatric Practice?

Diagnostic errors in interpretation of pediatric musculoskeletal radiographs at common injury sites

Extremity pain represents one of the most common reasons for obtaining conventional radiographs in childhood. Despite the frequency of these examinations little is known about the incidence of diagnostic errors by interpreting pediatric radiologists. The purpose of this study was to develop a standard error rate of pediatric radiologists by double-reading of extremity radiographs (elbow, wrists, knees and ankles) in children presenting with a history of trauma or pain. During a 6-month period all major extremity radiographs (excluding digits) obtained at a large pediatric referral hospital for evaluation of pain or trauma were reviewed by two senior pediatric radiologists and compared to the official interpretation. All radiographs were interpreted initially by a board-certified pediatric radiologist with a Certificate of Added Qualification (CAQ). We reviewed 3,865 radiographic series in children and young adults 2-20years of age. We tabulated misses and overcalls. We did not assess the clinical significance of the errors. There were 61 miss errors and 44 overcalls in 1,235 abnormal cases and 2,630 normal cases, for a 1.6% miss rate and a 1.1% overcall rate. Misses and overcalls were most common in the ankle. Interpretive errors by pediatric radiologists reviewing certain musculoskeletal radiographs are relatively infrequent. Diagnostic errors in the form of a miss or overcall occurred in 2.7% of the radiographs.

TU‐E‐137‐01: In‐House Credentialing

The issue of in‐house credentialing has taken on added importance with more complex procedures and the recent emphasis on safety, especially in imaging and radiation oncology procedures. Medical Physicists have been categorized as Allied Health Professionals on most hospital and facility rosters with little more than proof of board certification as their chief credentialing statistic. Now, medical staff credentialing bodies have required more specific training in specialty procedures such as IMRT, SRS, SBRT, IGRT and specialized brachytherapy procedure like HDR, eye plaques, prostate seed implants, etc. Vendor training both on and off site for complex planning and treatment delivery systems like VMAT, RapidArc, TrueBeam, Tomotherapy and GammaKnife/ CyberKnife, to list but a few of the new technologies, are paramount in understanding the accurate and safe use of these systems. Societies offer guidelines and standards that may be useful in their applications and should be considered required reading. Departmental guidelines may require proctoring on a minimum number of cases. Although Board Certification bodies credential candidates over a broad range of specialty procedures, practitioners are more and more called on to have a greater detailed knowledge base of these complex systems and procedures. Many Medical Physicists have limited themselves to becoming proficient at one or two of these more specialized technologies. Indeed, the radiological community has answered this call by instituting additional certifications, the CAQ (Certificate of Added Qualification). These are achieved through spending an additional year of fellowship training to attain this detailed training. And, perhaps, Medical Physicists need to look to this additional fellowship training to achieve similar proficiency in one or more of these fields. Perhaps CAMPEP could take on sanctioning of these specialty fellowships. However it is structured, each department will have the onus of deciding on a program to credential Medical Physicists in these new specialty categories.Learning Objectives:1. Understand the structure of hospital and facility credentialing procedures2. Make use of guidelines and standards to apply new technologies properly3. Understand the departmental evaluation of skill sets for complex procedures, proctoring number of case, etc.4. Finally, explore the possibility of a medical physics fellowship to gain more skills and experience in focused specialties

Louisville or Bust

Louisville or Bust

Profile of Physicians in the Nursing Home: Time Perception and Barriers to Optimal Medical Practice

To describe physician medical practice in nursing homes, including actual time spent for routine encounters with nursing home residents and demographic characteristics of the physicians who serve as medical directors; to determine the congruence between actual time spent for routine encounters with nursing home residents and the physician's view of the optimal time; and to identify barriers to providing optimal visits. A mail survey of a national random sample of 200 medical directors of all Medicare-certified nursing facilities using the Dillman Total Design mail survey methodology. 100 medical directors (50% response rate). The survey consisted of open- and closed-ended items on the following: the demographic characteristics of the medical director; demographic characteristics of the nursing home; the extent of the medical director's nursing home practice, including the ideal and actual time spent in nursing home visits for 4 common types of visits; and perception of barriers to providing optimum visits in the nursing home. Medical directors were most likely to be primary care physicians, the majority of whom were male; had practiced in long-term care for more than 18 years; were medical directors in 2 facilities; provided, on average, primary care in 4 facilities; spent 31 hours per month in the nursing home with nursing staff; and devoted 44% of their practice to nursing homes. Most, (74%) were members of the American Medical Directors Association (AMDA), 41% were certified medical directors (CMD), 42% had a certificate of added qualification (CAQ) in geriatrics, and only 15% had fellowship training. Reports of actual time spent on 4 common types of nursing home visits were significantly less than optimal visit times, but fellowship-trained physicians reported significantly greater discrepancies between the optimal and actual time spent for the 30- to 60-day reviews and readmissions compared with physicians who were not. A parallel pattern was seen comparing physicians with and without CAQs. Nursing support and accurate/accessible information were recorded as most problematic and reimbursement the least problematic barrier to providing optimal nursing home visits. The present study provides a snapshot of current physician practice in US nursing homes. Such information is needed as the debate over the physician's role in the nursing home continues and new policy is framed that will ultimately define the future of medical practice in the nursing home. That 74% of the national survey respondents were members of AMDA suggests that the AMDA membership is representative of the national medical director population.

Pineocytoma Mimicking a Pineal Cyst on Imaging: True Diagnostic Dilemma or a Case of Incomplete Imaging?: Fig 1.

Pineocytomas have been described as well-circumscribed, homogeneously enhancing masses. However, there is considerable variability in this appearance, and certain pineocytomas may have a predominantly cystic appearance on imaging. This has led some to suggest that differentiation between pineocytomas and pineal cysts may not be possible. We have attempted to determine if cystic pineocytomas could be found in a series of these tumors evaluated by CT and MR imaging. We searched the radiology literature as well as the medical records from our own institution for pathologically proved pineocytomas with available preoperative imaging or imaging reports, with specific focus on whether postcontrast MR imaging was included. In cases in which images were available, they were evaluated by a Certificate of Added Qualification (CAQ)-certified neuroradiologist and a radiology resident, who attempted to determine if the pineocytomas had any MR imaging characteristics of typical pineal cysts. To be considered a typical pineal cyst, an area of signal-intensity abnormality must be centered on the pineal recess, demonstrating internal homogeneity on T2-weighted imaging, following CSF signal intensity on T1- and T2-weighted images, without any marginal lobularity or nodular contrast enhancement and a wall thickness of <2 mm. In cases in which imaging was not available, radiology reports and/or descriptions provided in the radiology literature were reviewed by a CAQ-certified neuroradiologist. For any lesion described as cystic, we again attempted to elucidate the exact extent of imaging that was performed, note specific lesion characteristics, and determine if the lesion met the criteria described previously. Finally, for tumors in which image size was provided, the mean value of maximal tumor dimension, SD, median, and range were calculated. Forty-four pathologically proved cases of pineocytomas from the radiology literature, as well as 8 pathologically proved cases of pineocytomas from our institution with available imaging studies and/or reports, were reviewed. Of these, 23 were solid masses, and 7 were partially solid and cystic, whereas 14 tumors could not be completely characterized due to incomplete imaging evaluation. Eight were primarily cystic; however, none of these could be confidently characterized as meeting the criteria for a typical cyst. In our analysis, no truly cystic pineocytomas were identified.

Diplomate Verification Update 2007

Since 1970, when the charter class of physicians attained certification by the American Board of Family Practice(ABFM), the Board has acknowledged the accomplishment of all physicians who achieve certification and recertification as a specialist in family medicine, the nation’s twentieth primary medical specialty. For the first 26 years, the Board published an annual Directory of Diplomates as a way of honoring and recognizing certified family physicians. The printed directory was made available to all Diplomates, residency training programs, libraries, and other individuals or entities. Formal recognition beyond certification in family medicine was added in the 1990s for physicians who achieve certification in geriatric medicine and sports medicine and received a Certificate of Added Qualifications (CAQ) in those specialties. When requested, letters are sent to any person, organization, or entity requiring the Board’s assurance that a physician is certified by the ABFM. The ABFM now operates, distributes information, and facilitates interaction with candidates and Diplomates via its Web site at http://www.theabfm.org. The Web site contains a directory devoted to the continued recognition of family physicians who have attained certification, recertification, and a CAQ at any time in their professional career. Obviously, many Diplomates have retired from the practice of medicine, yet the Board continues to recognize the efforts of its past Diplomates in the same way it acknowledges current Diplomates. The online directory has become a refined extension of its predecessor, the Directory of Diplomates. The process of locating certified family physicians online is simple; the user enters a city and state into the online directory and a listing of current board-certified physicians in that geographical area is generated. Alternately, the user enters the first and last name of a physician and all family physicians with identical names are shown with city and state of residence and current and past certification status. Additionally, the online verification process facilitates the ease by which other specialists, hospitals, third-party payers, and health care consumers can verify the certification status of family physicians. By accessing the verification page of our Web site and entering the first name, last name, date of birth, and last 4 digits of the physician’s social security number, the user can search the ABFM’s database to verify a physician’s certification status. The data in the verification system is under the direct and complete control of the ABFM staff and is protected from and cannot be altered by unauthorized individuals. Written verification of a Diplomate’s status continues to be an option for Diplomates and third parties. Diplomates can obtain a verification letter at no charge by entering the Physician Portfolio with their ABFM identification and password and clicking on “Request Verification Letter.” Others seeking written verification of a Diplomate’s status can have a letter generated by ABFM staff for a $25 fee, or they can access the ABFM’s online verification system at no charge. The ABFM grants permission to copy the information provided by the online verification system for the purpose of maintaining physician credentials or for activities related to the evaluation of physician qualifications. The same database is used for written and online inquiries. Just as recertification has evolved into Maintenance of Certification for Family Physicians (MC-FP), the online verification process is evolving in its role as the primary source for finding a family physician’s certification status. A new online verification system will be launched later this year in 2 phases. The first phase, expected to be available in July 2007, will display certification information in a grid format. The second phase, expected to be available by the end of the 2007, will expand verification to include a physician’s standing within MC-FP, a program designed to enhance the clinical excellence of family physicians through continuous measurement of physician competencies. The 4 components of MC-FP—Professionalism, Self-Assessment and Lifelong Learning, Cognitive Expertise, and Performance in Practice—must be successfully completed for renewal of certification. The revised online verification system will display information in 5 categories.

Parapharyngeal Space Schwannomas

To determine if preoperative radiographic cross-sectional images can predict the nerve of origin of a parapharyngeal schwannoma and, specifically, whether it originates from the vagus nerve or the cervical sympathetic chain. A retrospective review. Academic medical center. The study population comprised 12 patients who underwent surgical resection of schwannomas of the parapharyngeal space. The nerve of origin was identified based on operative findings and postoperative physical examinations. Of the 12 patients, 11 underwent preoperative magnetic resonance imaging and 1 underwent preoperative contrast-enhanced computed tomography. A CAQ (Certificate of Added Qualification)-certified neuroradiologist reviewed the imaging studies, blinded to the surgically determined nerve of origin. For each case, it was predicted whether the tumor arose from the vagus nerve or sympathetic chain based on the location of the schwannoma with reference to the carotid sheath vessels. Identification of the nerves of origin using the displacement of vessels as a marker. At the time of operation, it was determined that 5 patients (42%) had schwannomas from the cervical sympathetic chain and 7 patients (58%) had schwannomas of the cervical vagus nerve. By imaging, the nerve of origin was successfully determined in 4 of 5 cases of sympathetic chain schwannoma (80%) and in 7 of 7 cases of vagal nerve schwannoma (100%). Schwannomas of the cervical sympathetic chain were found to displace both the carotid and jugular vessels without separating them. Vagal nerve schwannomas were found to separate the carotid arteries from the internal jugular vein. A vagal nerve schwannoma may also displace the sheath vessels posteriorly, without splaying them. Carotid and jugular vessel displacement, as determined by cross-sectional imaging, can predict the likely nerve of origin of a parapharyngeal space schwannoma. This determination allows for effective preoperative counseling regarding the expected sequelae of surgical resection.

AMERICAN BOARD OF FAMILY MEDICINE CO-SPONSORS NEW CAQS

The American Board of Family Medicine (ABFM) has joined with 10 fellow American Board of Medical Specialties (ABMS) Member Boards to offer a Hospice and Palliative Medicine Certificate of Added Qualifications (CAQ). This new certification was recently approved by the ABMS and marks the first time 10

Certificate of added qualification for hepatology: Vindication not vanity

Certificate of added qualification for hepatology: Vindication not vanity

Membership history of the ASSH: 1946–1970

The American Society for Surgery of the Hand (ASSH) was organized in 1946. The Founders held the first Scientific Meeting in 1947. The original qualifications for membership were: (1) clinical experience; (2) recommendation by a member of ASSH; (3) published peer-review articles; (4) presentation of a paper at the Scientific Program of the ASSH. Only a limited number of surgeons met these requirements early in their career. Thus, emphasis was on the category of Associate Members who had all the privileges of the ASSH members except for voting and holding office. Also, as the number of residents taking Hand Fellowships increased, the number of potential members in the ASSH necessarily increased. Since a Certificate of Added Qualification (CAQ) became a requirement for membership, the qualifications for membership in ASSH remained stringent. Copyright © 2003 by the American Society for Surgery of the Hand