The 100th Anniversary of the American Board of Ophthalmology John G. Clarkson, MD1,2 This is a special year for the American Board of Ophthalmology (ABO) as we celebrate 100 years of board certification. To mark this occasion, this supplement is being published, which provides an update on initial and continuous certification provided by the ABO. This editorial highlights a variety of changes in physician selfregulation through board certification. Ophthalmology 2016;123:S1-S2 ª 2016 by the American Academy of Ophthalmology.
Psychometrics Psychometric analysis and assessment of all American Board of Ophthalmology (ABO) examinations has become routine. The topic content of all examinations is available through a public content outline.1 Every examination question is subjected to a weighted assessment. All written examinations have a psychometrically determined cut score, whereas each item on the oral examination receives a similar assessment to determine an individual candidate’s passing score.2
Continuous Certification In 1986, the ABO developed a process of recertification, similar to what already was in use by the American Board of Surgery and the American Board of Family Medicine. Since 1992, all ABO diplomates have been required to participate in a process to maintain board certification. Initially, this was a second so-called snapshot that required a time-limited certificate to be updated every 10 years. This has evolved into a continuous process that requires some board-related activity every year. The American Board of Medical Specialties (ABMS) established the ABMS maintenance of certification in 2005 and updated the requirements in 2015.3 However, the process of assessing physician practice (part IV) and holding a mandatory cognitive closed book examination every 10 years led to considerable diplomate dissatisfaction.4 The ABO has joined with most ABMS member boards to create other methods to assess continuous medical education, physician practice, and cognitive knowledge. The ABO is collaborating with the American Academy of Ophthalmology (AAO) to use the IRIS registry to develop a seamless data entry system that will satisfy requirements for both the Center for Medicare and Medicaid and the ABO.5 In 2017, the ABO will undertake 2 pilot programs for this purpose. One pilot is based on the maintenance of certification assessment developed by the American Board of Anesthesiology.6 A single clinically relevant question is delivered online each 2016 by the American Academy of Ophthalmology Published by Elsevier Inc.
week, with the correct answer and 3 distractors. The question must be answered in 60 seconds. Then, the correct answer is provided along with a brief explanation and appropriate references from the current literature. A second pilot will provide questions based on selected current articles published in major ophthalmology journals.7 If approved, satisfactory performance on either alternative process could obviate the need for a closed book examination. Two other pilots are under serious consideration: a remotely proctored Demonstration of Ophthalmic Cognitive Knowledge examination that would permit candidates to take the Demonstration of Ophthalmic Cognitive Knowledge online at home or in the office and a phone app presenting maintenance of certification assessment-like questions on mobile devices.
Oral Examination Although the oral examination has been a fixture of the ABO since 1916, the Board considered eliminating it in 2009 because of high dollar and human resource costs. But after thoughtful discussion, the ABO decided to retain the oral examination and to adapt new technology through the use of the iPad (Apple, Cupertino, CA) to provide improved photographic quality and video capability. After successful pilots, the oral examination was administered with the iPad in 2015. In 2016, videos including surgical assessment will be included in the oral examination.
Patient Safety The ABO long has been interested in patient safety, but has accelerated that interest in recent years. In July 2015, the ABO and the AAO cosponsored a session on improving patient safety in ophthalmology. All ophthalmic subspecialties, the Association of University Professors of Ophthalmology, the Veterans Statement of Potential Conflict of Interest and Funding/Support: See page S2. http://dx.doi.org/10.1016/j.ophtha.2016.06.020 ISSN 0161-6420/16
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Ophthalmology Volume 123, Number 9, Supplement, September 2016 Administration, the Department of Defense, the National Patient Safety Foundation, and the Ophthalmic Nurses Association were represented. The group developed a value statement that was widely approved.7 One highlight of the centennial ABO symposium held in March 2016 was the keynote address by Robert Wachter, MD, a patient safety expert. This was followed by a panel discussion on patient safety in ophthalmology. Both the ABO and the AAO intend to continue to identify common diagnostic and medical errors and to develop educational processes to reduce and, it is hoped, to eliminate errors from ophthalmic practice.
Public Directors of the American Board of Ophthalmology Since 2001, the ABO has included public members on the board of directors. To date, 5 individuals have served in this capacity. Public directors offer a unique perspective on board governance, organizational design, quality improvement, conflict of interest, and most importantly the patient’s perspective. The ABO also has endeavored to improve the diversity of its directors. Currently, there are 25 directors, including 21 clinically active ophthalmologists, 3 public members, and 1 executive director who is also an ophthalmologist. Eighteen directors are men, 7 are women, and 3 are in private practice. Our goal is to continue to enhance the diversity of the directors.
International Certification International certification is a new initiative through ABMS International.8 In 2015, ABMS International in Singapore administered the first written ophthalmology examination for candidates seeking board certification. The ABO provided items and expertise for examination development. The Accreditation Council for Graduate Medical Education International is investigating opportunities to accredit training programs in Qatar, Panama, and Haiti that may result in future international ABMS certification.9 The explosion of medical information and technology and advances in educational techniques, including
gamification and online learning, demand that the ABO strive for continuous improvement while adhering to the purpose and principals of board certification established by our founders 100 years ago: “To improve the practice of ophthalmology through a process of certification which fosters continual learning.”10
References 1. American Board of Ophthalmology. Maintenance of Certification content outline. Available at: http://abop.org/maintaincertification/part-3-assessment-of-knowledge,-judgment-skills/ moc-content-outline/. Accessed March 31, 2016. 2. Angoff WH. Scales, norms and equivalent scores. In: Thorndike RL, ed. Educational Measurement. Washington, DC: American Council on Education; 1971:508–600. 3. American Board of Medical Specialties. Built upon professional standards. Available at: http://www.abms.org/board-certification/ a-trusted-credential/built-upon-professional-standards/. Accessed April 14, 2016. 4. Yurkiewics S. MOC watch: society leaders give ABIM an earful. MedPage Today. July 17, 2014. 5. Gebhart F. IRIS registry begins to transform ophthalmology. Ophthalmology Times. 2015. Available at: http:// ophthalmologytimes.modernmedicine.com/ophthalmologytimes/ news/iris-registry-begins-fransform-ophthalmology-practice. Accessed March 31, 2016. 6. American Board of Obstetrics and Gynecology. ABOG begins innovative pilot program to enhance Maintenance of Certification process [news release]. Dallas: American Board of Obstetrics and Gynecology; 2015. Available at: http:// www.prnewswire.com/news-releases/abog-begins-innovativepilot-program-to-enhance-maintenance-of-certification-process300190500.html. Accessed March 31, 2016. 7. Custer PL, Fitzgerald ME, Herman DE, et al. Building a culture of patient safety in ophthalmology. Ophthalmology 2016;123:S40–5. 8. American Board of Medical Specialties International. About ABMS International. Available at: http://www.abms-i.org/ about-abms-international. Accessed April 14, 2016. 9. Accreditation Council for Graduate Medical Education International. About us. Available at: http://www.acgme-i.org/ About-Us/Mission. Accessed April 12, 2016. 10. American Board of Ophthalmology. ABO mission statement. Available at: http://abop.org/about/mission-goals/. Accessed March 31, 2016.
Footnotes and Financial Disclosures Originally received: April 18, 2016. Final revision: June 3, 2016. Accepted: June 3, 2016. 1
Author Contributions: Conception and design: Clarkson Manuscript no. 2016-788.
American Board of Ophthalmology, Bala Cynwyd, Pennsylvania.
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Analysis and interpretation: Clarkson Data collection: Clarkson
Dean Emeritus and Professor of Ophthalmology, University of Miami, Miller School of Medicine, Miami, Florida.
Obtained funding: none
Presented at: American Board of Ophthalmology 100th Anniversary Symposium, March 2016, San Francisco, California.
Abbreviations and Acronyms: ABO ¼ American Board of Ophthalmology.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Correspondence: John G. Clarkson, MD, American Board of Ophthalmology, 111 Presidential Boulevard, Suite 241, Bala Cynwyd, PA 19004. E-mail: jclarkson@ abop.org.
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Overall responsibility: Clarkson