Peer review is a common process used in many professions as a means of self-regulation. It assesses performance in areas that are difficult to measure by objective standards. Peer review may be used by professions to assess and maintain quality, improve performance, determine adherence to standards, and maintain credibility to those outside the profession. Many professions have established peer review processes including law, accounting, and engineering. In academic professions, peer review is the well accepted method to assess scientific work.
Similar to several other member boards of the American Board of Medical Specialties (ABMS), the American Board of Orthopaedic Surgery (ABOS) uses a rigorous peer-review process as an important part of credentialing applicants and diplomates. For the ABOS, peer review assesses performance in practice, a key area of physician competence as defined by the ABMS. Most would agree that performance in practice should be central to a medical credentialing process but it is difficult to measure and benchmark through means other than peer review.
The ABOS recertification examination application asks for the names and email addresses of diplomates of the ABOS and others who are familiar with the applicant’s work and are located in the same geographical practice area as the applicant. Peer review information from at least seven physicians/surgeons, five of which are Board Certified orthopaedic surgeons, is required. When applying for an ABOS examination, the email addresses of references should be double checked by the applicant as that's how they receive the peer review form. This simple quality assurance step by the applicant can assist in a smooth credentialing process.
Peer reviewers will receive an email from the ABOS that includes a link to complete a 14-question review covering the six areas of competency, which include patient care, surgical skills, and professionalism. Each question has a four-point scale, with scores ranging from unsatisfactory to excellent. There is also an “unable to evaluate” option for each question. The questionnaire also asks the reviewer’s relationship to the applicant, how familiar the reviewer is to the applicant, and whether the applicant should be allowed to sit for an examination. There is a box to explain why not, if applicable and also an area for comments.
Ninety-eight percent of applicants meet the ABOS adequate peer review criteria and do not come to the attention of the Credentials Committee. For those applicants who do not reach the adequate level, their entire application, including the negative peer review, is assessed by the committee. When the ABOS receives negative peer review, ABOS staff will contact the reviewer to gain more information. Any additional information gained from that interaction will be included in the materials reviewed by the Credentials Committee. For those applicants that present serious concerns, the Committee decides upon the best option. Options available to the Committee include requiring the individual to take an oral examination, deferral to allow the ABOS more time to gather information, or a site visit to the actual practice of the diplomate or candidate.
Some Diplomates wonder why a competitor should be a peer reviewer. Won’t they automatically give a poor evaluation? Most diplomates take the evaluation process seriously and give a true indication of their knowledge of an individual and that individual's practice. When peer review is considered by the Credentials Committee, the source and potential conflicts of interest of the reviewer are also considered.