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11/30/2017    Joseph Borreggine, DPM

ABFAS Board Exam Pass Rate is Disparaging

I have been a member of both the ABFAS and ACFAS
for the last 20 years. However, I have concerns
about both organizations as it relates to the
podiatric profession and the certifying foot and
ankle surgical board exam.

If the ACFAS has been touting that we are the
"the leading experts in foot and ankle care"
based on their recent PR campaign "Take a New
Look at Foot and Ankle Surgeons", then they need
to tell us how this is a fact if the passing rate
is so low for the ABFAS board certifying exams.
The ACFAS also goes on to state in this campaign
"With more education and training specific to the
foot and ankle than any other healthcare provider
foot & ankle surgeons are the leading experts in
foot and ankle care today. "With that said, I
would have to say that this may be a hyperbole of
fact as it relates to the ABFAS scores.

To reinforce what I am saying and why I am so
concerned, the ABFAS published in their recent
Fall 2017 Newsletter the 2016-17 ABFAS Exam
passing rates for first time and re-take for the
test. The results of the Fall 2016 Part I FT
didactic and FT CBPS a total combined average
pass rate of sadly just 30% for both exams. Then
the results for the Part 1 RRA didactic and CBPS
total combined average pass rate of only 36%.
And, for the Spring 2017 Part I FT didactic and
CBPS total combined average pass rate was
markedly higher at 70% and for the total combined
pass rate for the Spring 2017 Part I RRA didactic
and CBPS was higher than the Fall 2016 results
with a total combined average pass rate of 58%.
The ABFAS 2017 Part 2 FT Surgery CBPS Exam total
average for first time and retake pass rates were
only 57% and for the Part II RRA Surgery was a
bleak 40%.

Someone at the ABFAS needs to explain why this is
the case? Why are these numbers so low as
compared to our allopathic colleagues who we are
trying to seek parity? The American Board of
Orthopedic Surgery has a resounding average 90%
pass rate for the Part I exam for 2016-17:
https://www.abos.org/certification-exams/part-
i/exam-statistics.aspx and a 95% pass rate for
Part II: https://www.abos.org/certification-
exams/part-ii/exam-statistics.aspx.

I opine that there is something truly wrong with
this picture. With the expanded curriculum that
our schools have provided our DPM students along
with the now required and mandated three year
surgical residencies how are these scores so low
for the ABFAS certification? Based on the latter,
I thought that these ABFAS test results would be
so much better than have been reported. The ABFAS
seems to have created a test that does not allow
the exam taker to show minimum competency in foot
and ankle surgery, but rather has formulated one
to exclude supposedly well trained podiatric
surgical residents for becoming board certified
by the only foot and ankle surgery certification
board recognized by CPME and JCRSB.

So, if such a low numbers are passing this exam
after the first time and then after the retake,
then why even have a three residency in podiatric
surgery if this is the case? And those that never
obtain board certification through the only
recognized certifying surgical board in podiatry
because the fail to pass the exam; what happens
to them? Do they get on staff at a hospital and
perform foot and ankle surgery if they are not
board certified in podiatric surgery? I am
confused!!

If these results are so indicative of our efforts
to obtain the parity that we so desire and the
deserved respect for our allopathic colleagues,
then these ABFAS test results as publicized are
not helping matters. Something needs to change
quite dramatically and there needs to be more
accountability for the ABFAS and the other
organizations such as the APMA and CPME who
endorse them. There also need to become
transparency for the powers that be that run
these organizations. They need explain why this
has happened in light of all the changes that
this profession has gone through over many
decades to prove that we are equal to an MD or
DO.

Joseph Borreggine, DPM, Charleston, IL

Other messages in this thread:


12/06/2017    Don Peacock, DPM

ABFAS Board Exam Pass Rate is Disparaging (Joseph Borreggine, DPM)

The complaints regarding the ABFAS board
certification process are completely unwarranted.
I say this not to be elitist but to recognize that
we all should strive to remain independent. I feel
empathy for anyone going through the board
certification process. I remember it well and it
was challenging. However, I do not feel sorry for
anyone complaining about it. The experience should
be difficult and will make you more knowledgeable
in the end. Complaining about it is silly and
serves no purpose. You should prepare and do your
best and like a boxer you need to be strong enough
to give and take a punch.

I will be taking the recertification exam in 2018
and I plan to study and pass it. If I do not I
will re-take the exam. If I never pass it I will
move on to other pastures. As a foot surgeon and
educated person we must be independent thinking
and non-emotional with stuff like this. Get tough
skinned and you will feel safer than you are now
feeling by complaining.

Never let anyone or any entity demoralize you.
When I hung my shingle to practice in my hometown
21 years ago it took me 3 years to get hospital
privileges. I am now the main provider for foot
surgery at our hospital. This initial hurdle made
me stronger and better than if I were taken in
with open arms.

The delay in hospital privilege forced me to setup
surgical ability in my office and comfortable with
office surgery including performing bunion, heel,
and nerve decompression surgeries, etc. in the
office. I can go to the hospital or stay at the
office and either way is fine with me. With or
without the hospital, ABFAS or anyone else I will
flourish and you will too. If you are qualified to
sit for the board you have nothing to complain
about.

Don Peacock, DPM, Whiteville, NC

12/04/2017    Name Withheld (TX)

ABFAS Board Exam Pass Rate is Disparaging (Joseph Borreggine, DPM)

To echo Dr. Borreggine’s concern, I am currently
sitting for my boards in both foot and
rearfoot/ankle case reviews. I have the most
recent training with the PMSR with the RRA
certification. I had my share of failures with
the CBPS portion of the exam and I found after
speaking with the board that it was not due to my
intellectual abilities to reason or make good
decisions, it was how I was taking the test which
was not explained at the time that I took that
portion of the exam. After speaking with them, a
video was posted regarding my specific issues
that I was currently experiencing which leads me
to believe that this was a common problem amongst
candidates.

Once I passed my CBPS portions, I sat for my case
review. This was the most frustrating aspect of
the process. I was failed based on what the
reviewers considered supar results regardless of
the patient’s outcome. Medicine and especially
surgery is a patient specific treatment.
Textbook treatments do not always match each
patient we encounter. However, the ABFAS board
states that only imaging can be evaluated for
outcomes and objective findings in the notes.
They also derive assumed complications as
deciding factors. What’s more is that a sheet was
sent out this last Case Review session and on
multiple cases that I “failed” I found that
incomplete review of the chart was the main
problem. The information was there but the
reviewers did not take the time to find the
information in the uploaded chart. I was told
that if this was the case, that a change in
outcome was possible.

I proved this on multiple cases but when that was
presented, I was then “failed” for other reasons
that were not present on the reviewer’s comments.
Due to the uproar of the reviewer comments that
candidates expressed, the ABFAS is going to do
away with it. I’ll let you draw your conclusions.
What I do know it that this last case review had
over 400 candidates sit. There are 13-26 cases
to review for each of those candidates. The
reviewers have a week to review all the charts
and multiple reviewers review the charts. There
are not many reviewers. They are taking on
1000’s of charts in a relatively short amount of
time. Can any one person adequately
review that many charts?

I wholly believe that the Board is trying to make
the profession better but I also don’t think they
see on the individual level what they are doing
to each surgeon trying to attain the
certification. I am involved with a hospital on
both physician review and credentialing. I have
spoken in great detail with medical staff and
credentialing and it is their belief that board
certification is a formality and something that
any minimally competent physician should be able
to attain. I could go so far as to say that it
really means nothing to them other than weeding
out the providers who are incompetent at
providing the most basic care. So, how do we
look to a hospital when many of us struggle to
earn these credentials?

The ABFAS credential means so little where I am
located that the hospital is having a non ABFAS
surgeon (me) review another AFBAS certified
surgeon’s charts for poor outcomes. Why you ask?
Because, I went ahead and sought my certification
with ABPM which has the suggestion for
credentialers that a podiatrist’s privileges
should be based solely on their training and
experience. This has allowed me to obtain a full
scope of privileges in my state and hospital
which is both foot and rearfoot/ankle. Without
ABPM, I would not be able to practice to my full
extent of training and likely have extreme
difficulty getting cases for rearfoot/ankle.

In speaking with the orthopedists in my hospital,
one which just became board certified; his
experience is very different than ours. They have
a smaller number of cases to present (over the
whole body) and outcome does not necessarily
indicate failure. One case he specifically showed
me was of a trans tib-fib oblique fracture which
he reduced with an intramedullary nail. His
final outcome showed an ankle mortise that was in
4-5 degrees of valgus without correction to the
fibula to reflect the new angle of deformity.
Pre-op, she had a normal ankle mortise alignment.
She will likely develop arthritis in the near
future because of the mal-reduction and increase
pressure of the medial and lateral malleolus with
dorsiflexion. This case was reviewed and passed
by the orthopedic board. This case would have
been failed by our board undoubtedly. This would
have been “a poor outcome”.

I agree with Dr. Borreggine’s sentiments that if
we want to be like our Allopathic and Osteopathic
counter parts, we need to reflect in every way
possible. When we set goals as a profession, we
need to set the goals at this same level as other
related surgical professions. We are not lesser
than our orthopedic counter parts because we are
limited in scope, we should be better because we
have had the opportunity to focus on a specific
part of the body. How does 7 years of focused
training compare to a one year fellowship? I
used this argument at the hospital I am employed
by when orthopedics wanted to limit me to just
the foot.

I have single handedly changed the views of the
majority of the medical community hear, fought
hard, which has resulted in ortho actually
referring to me.

Lastly, the allopathic medical board in my state
has recently changed their bylaws reflecting that
they will no longer expect licensed physicians to
maintain board certification after attained and
that it cannot be used as a deciding factor as to
whether or not a physician can maintain
privileges.

Name Withheld (TX)

12/01/2017    Matthew Williams, DPM

ABFAS Board Exam Pass Rate is Disparaging (Joseph Borreggine, DPM)

The American Board of Foot and Ankle Surgery’s
(ABFAS) mission is to protect and improve the
health and welfare of the public by the
advancement of the art and science of podiatric
surgery. As surgeons, we want the best outcomes
for our patients, and ABFAS will continue to
strive to fulfill our mission to certify high
quality surgical candidates for the betterment of
the profession.

The trending of Part I spring exam results for
first time takers shows the impact of the three-
year surgical residencies.

Year Part I Foot Surgery Didactic 1st Time
Takers Part I RRA Surgery Didactic 1st Time
Takers Part I Foot Surgery CBPS 1st Time Takers
Part I RRA Surgery CBPS 1st Time Takers
2017 74% 65%* 77% 72%
2016 74% 73% 78% 72%
2015 71% 71% 76% 65%
2014 64% 71% 76% 62%

Although there is a drop in the pass rate for the
Part I RRA Surgery didactic exam takers, 27
candidates failed by less than 10 scale score
points, and will most likely pass on re-
examination. ABFAS started offering the fall
exams to those who were unsuccessful in taking
the spring exams so traditionally those passing
rates are lower.

Each year, the ABFAS board reviews all exam
results and works to improve the exams and assist
those who will be taking it. This year, we
launched a new CBPS platform, and are making
changes to the exam development process itself.
There is also a new video to provide guidance on
how to take the CBPS exam. We have formed an
online study guide task force to develop new
tools for candidates to better prepare for the
exams. On December 1, we are meeting with
residency directors to get their input on ways to
improve the ABFAS exam process to ensure high
quality residents are successful in the future.

If we as DPMs want to be considered equal to our
counterparts in allopathic medicine, our lowest
quality of care must not be inferior to that of
our MD colleagues. Historically, ABFAS exam
passing rates have been lower than the American
Board of Orthopedic Surgery’s, but that
profession also mandates a five (5) year
residency program. The examination processes are
also different so a direct passing rate
comparison between the two organizations is not
an “apples to apples” comparison. We do,
however, note a trend toward more training and
higher exam pass rates. ABFAS wants to serve our
profession fairly and fulfill our duty to the
public in the best possible way and we will
continue to strive for improvements in our
certification process to that end.

In closing, please also note that the American
College of Foot and Ankle Surgeons (ACFAS) is the
professional membership association for those who
are ABFAS-certified. ACFAS is not involved with
the ABFAS examination development process.

Matthew Williams, DPM, ABFAS President

12/01/2017    Name Withheld

ABFAS Board Exam Pass Rate is Disparaging Joseph Borreggine, DPM

I graduated from a 3-year residency program in
2013. I passed all my NBPME exams first time, I
passed the ABFAS qualifying exams first time.
Then I bought a non-surgical practice in a small
town and set to work. I have spent 4 years
building up my case volume and then was able to
sit for the exam. I failed both the case studies
and the computer-based examination. My hospital
says I have to be board certified in a 5 year
window. I've got one more shot at it in 2018.

During residency, ABFAS lets you take yearly
practice tests to be prepared for the qualifying
exam, but not after residency. So, I went 4 years
not taking a practice test and then finally being
able to sit for it and failing it (They used to
make you wait until your case volume was built up
prior to taking the computer based exam). Just
this year, I heard that ABFAS is allowing
candidates to take the computer-based certifying
part of the exam the year after passing the
qualifying exam. This will help future graduating
residents whereas the test type and content will
be fresh on their minds. I'm pleased with this
change. However, it is discouraging to be one who
passed all NBPME exams first time, got a
residency slot first time, passed my qualifying
exams the first time and now I'm 4 years into my
career with a young family to provide for and I
have failed.

I hope that ABFAS will take appropriate steps to
approach the passing rates of the orthopedic
doctors. However, over the past 3 years the
passing rates have hovered around 70%. Again,
keep in mind, that only 70% of people who have
completed a residency program and passed their
qualifying exams are passing the certifying exam.
This is a problem I hope can be resolved. I will
study new source materials and hope for a better
outcome next year. The case studies and the
inability to discuss why a certain procedure type
was performed or how a complication was handled
is an entirely different can of worms to be
opened.

Name Withheld
Sterishoes