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
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.
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