ABOS GME Chair Message
Every orthopaedic surgery residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME) now has access to the American Board of Orthopaedic Surgery Knowledge, Skills, and Behavior (ABOS KSB) Program.
We have gotten to this point thanks to the dedication of former and current ABOS Directors, dedicated residency programs, ABOS staff, the ABOS Resident Advisory Panel (ABOS RAP), with our partners at the American Orthopaedic Association’s Council of Orthopaedic Residency Directors (AOA/CORD), the Association of Residency Coordinators in Orthopaedic Surgery (ARCOS), the American Academy of Orthopaedic Surgeons (AAOS), and the ACGME.
As you hopefully know by now, participation in the ABOS KSB Program is required for those residents planning to enter the ABOS Board Certification process and take the ABOS Part I Examination (the first step toward ABOS Board Certification) beginning in 2026. You can learn more about the requirements here.
Even though the participation requirements do not begin until July 1st, I recommend that you begin utilizing these valuable educational tools now. In addition to learning about how the system works, any completed assessments done prior to July 1st will count toward your total requirement. Early participation will not be “wasted.”
The new requirements allow for flexibility. You only need to meet the total requirements by June 30th of the year that you will take the ABOS Part I Examination—the ABOS has not set weekly or monthly requirements, but residents must have completed 3 OITE examinations(K), 320 surgical skills assessments (S), and 24 completed professional behavior assessments (B) over 4 years of residency education. Similar to the way the ABOS requires 46 weeks of residency education per year (but averaged over 5 years), the ABOS KSB requirement allows averaging to meet the requirements, thus accommodating needs for residents to be away for life events. As the requirements start in the 2025-2026 academic year, they will be prorated by the number of years of residency education—see the table below:
The ABOS has multiple methods of communicating about how the ABOS KSB Program works and to notify residents and residency program leadership about resident progress toward the requirements. You will hear from us in multiple ways. If you still have questions, feel free to contact us at ksb@abos.org.
Steven L. Frick, MD
Chair, ABOS Graduate Medical Education Committee
Executive Director Report
The mission of the American Board of Orthopaedic Surgery (ABOS) is to ensure the safe, ethical, and effective practice of orthopaedic surgery. The ABOS maintains the highest standards for education, practice, and conduct through examination, certification, and maintenance of certification processes for the benefit of the public. The ABOS believes that all orthopaedic surgeons who meet the highest standards of orthopaedic knowledge, surgical skills, and professional behavior should be able to earn and maintain ABOS Board Certification. Over the last several years, the ABOS has worked hard to make sure that there are no potential biases that would restrict qualified orthopaedic surgeons from attaining and maintaining ABOS Board Certification.
Much of the Board’s work to minimize (and hopefully eliminate) bias in ABOS processes and procedures has come with the support of experts in implicit bias, psychometrics, examination writing, and others. For instance, a consultant conducted an audit of all ABOS practices to determine if potential biases existed. The consultant sent an email to orthopaedic surgery residents, ABOS Diplomates, ABOS Volunteers, and ABOS Staff. In addition, several listening sessions were conducted to allow the ABOS to hear directly from practicing orthopaedic surgeons. In general, participants in these processes felt that the ABOS is committed to maintaining a high standard of excellence for all board certified orthopaedic surgeons, while intentionally ensuring that ABOS Diplomates are assessed fairly and justly, feel represented, and have opportunities for bi-directional feedback. The audit concluded that the inclusive ABOS culture engendered an effective board certification process, opportunities for innovation within the specialty, surgeon satisfaction, and good patient outcomes.
While there was a feeling that the ABOS continues to “do the right thing,” the ABOS Board of Directors indicated that data was needed to demonstrate the validity of that evaluation.
The Board has been working hard to eliminate potentially biased questions on the ABOS Part I Examination. Unless absolutely necessary, the Board is moving toward eliminating race and gender from examination items. A group of examination experts reviewed more than 2,000 questions that were administered over the past few years. Items were flagged that were identified as potentially exhibiting implicit bias. Next, a diverse group of practicing orthopaedic surgeons reviewed the flagged questions and determined that most were reasonable as written and did not appear to be biased. The ABOS will continue to proactively review examination questions. Like the process that is utilized for ABOS Oral Examiners, the ABOS has conducted training with ABOS Question Writers, instructing them on methods of writing effective questions that are free of unconscious bias.
Historically, the ABOS has offered examinations only one time each year. If a Candidate or Diplomate was unable to make that date, they have needed to take the examination the following year. To assist Examinees with significant life events, whether a pregnancy or a last-minute medical emergency, the ABOS has added alternate dates for both the ABOS Part I and Part II Examinations. Examinees who are interested in using the alternate dates submit a request that is reviewed by the ABOS Credentials Committee. Candidates and Diplomates approved for the alternate date Oral Examinations do have the same initial application submission deadlines and the same document and image upload deadlines as do the Candidates and Diplomates who do not utilize the alternate dates. The only difference is when and where the examinations are administered. The ABOS Part II Oral Examination Alternate Dates have taken place in Raleigh, North Carolina in 2023 and Dallas, Texas in 2024. The Board plans to continue to offer alternate dates to those Examinees who experience life events.
Another way the ABOS has helped those with life events, especially with pregnancy and childbirth, is with residency rotation requirements. While the ABOS is now using competency-based medical education methods with the ABOS Knowledge, Skills, and Behavior (ABOS KSB) Program, educational time requirements are still in place. The ABOS requires an average of 46 weeks of orthopaedic residency education each year over a 5-year program. This allows flexibility for pregnancy, adoption, caring for family members, or other issues that a resident may encounter. While it is important for residents to receive 230 weeks of residency education, the ABOS also knows that life can be unpredictable.
Another area where the Board wanted to gather data was with the ABOS Part II Oral Examinations—the Examiners see Examinees when they are being evaluated. While it is hoped that Examinees are scored based on their surgical cases and orthopaedic knowledge, there is always the risk for implicit bias. The Examiner may truly believe that he or she is not biased, but the Board needed to evaluate that in a data-driven way.
For several years, the ABOS has conducted research using Virtual Practice Evaluations (VPE). The idea of the VPE is to conduct an Oral Examination without the Candidate being present. Can examiners fairly score a Candidate based solely on the Candidate’s documents and images, without asking questions and without the Candidate being present?
By conducting VPEs at the same time the traditional Oral Examination was given, the ABOS found that yes, an “oral” examination can be given without the Candidate present. Interestingly, the scores of the Candidates were on average lower in VPEs than traditional, in-person Oral Examinations. The Board has several theories about that, including more time being given for Examiners to look through the documents and images for each surgical case. In addition, Candidates are not present and do not have the opportunity to explain issues.
The VPE was a great asset to the Board during the COVID pandemic. Unlike some other Boards that paused their examinations, thus delaying Board Certification for many physicians, the ABOS was able to use the VPE to confidently award ABOS Board Certification to orthopaedic surgeons.
The ABOS saw that Black and Latino Candidates generally had a lower pass rate on the ABOS Part II Oral Examination than White Candidates. This brought up the question: was the examination biased against these groups? The ABOS used the VPE with redacted documents and images that blinded Examiners to Candidate race. If the ABOS Part II Oral Examinations were biased, then Black and Latino Candidates would score relatively higher on VPE—where their race was unknown.
The ABOS matched these Candidates with a similar group of White Candidates. As stated above, candidates generally have scores on the ABOS VPE that are lower than on the traditional in-person ABOS Oral Examination. That was found to be true for both White Candidates and Black and Latino Candidates when the blinded VPE data was evaluated. The ABOS believes that this is one indication that the Oral Examinations are limited in bias toward Blacks or Latinos. However, further investigation needs to be conducted as to why certain ethnic groups score lower than others on the ABOS Oral Examination.
Despite those positive findings, the Board continues to believe that it is important to provide implicit bias training each year for ABOS Oral Examiners. Implicit bias can certainly involve more than race and sex. Where an individual trained may invoke an implicit bias that is either positive or negative. The examination needs to be based solely on the knowledge, surgical skills, and professional behavior of the surgeon being examined.
Through all the initiatives mentioned above, the Board still insists on having the highest standards to protect patients and the public. It is not fair to patients, or the orthopaedic profession, if the “bar” is lowered. However, the ABOS wants to make sure that all competent orthopaedic surgeons have an equivalent chance to become ABOS Board Certified, regardless of their background, gender, or race.
David F. Martin, MD
Executive Director, American Board of Orthopaedic Surgery
How the ABOS Part I Examination is Developed
Producing the American Board of Orthopaedic Surgery (ABOS) Part I Examination requires a great deal of expertise, time, effort, and expense. The ABOS depends on a dedicated group of staff, business partners, and volunteers.
The first step in creating a valid examination is the development of an examination blueprint. The ABOS Part I blueprint is shared with the American Academy of Orthopaedic Surgeons (AAOS) Orthopaedic In-Training Examination (OITE). The ABOS constructs examination blueprints with diverse groups of subject matter experts from across the country. In the case of the ABOS Part I Examination Blueprint, the subject matter experts include many orthopaedic surgery residency program directors and representatives from the AAOS Education Council. This process ensures that the ABOS Part I Examination content accurately represents what orthopaedic surgeons completing residency should know. The blueprint is cyclically reviewed and modified to accurately reflect changing trends in practice.
The ABOS contracts with the American Board of Medical Specialties (ABMS) in the test development process, specifically the item-writing process by which examination questions are written, edited, and placed into the ABOS Examination Item Bank and ultimately placed on the final version of each examination. Over many years, the ABOS has created a large bank of questions. New questions are composed by volunteers of the ABOS Question Writing Task Force (QWTF). The ABOS QWTF is made up of approximately 40 members, all experienced ABOS Board Certified orthopaedic surgeons, who each submit up to 12 new questions annually (in addition to reviewing questions in the Item Bank on a regular basis). In addition to images and/or diagrams, each question is accompanied by the appropriate references. While some members of the ABOS QWTF have experience of as much as 20 years or more, the ABOS ensures that new volunteers are added each year. Some years, members spend time reviewing old questions to keep the bank up to date.
New questions are reviewed by professional editors prior to the ABOS QWTF meeting. At the ABOS QWTF meeting, the new questions are reviewed and discussed among orthopaedic surgeons who specialize in the subspecialty corresponding to the question content area. If a question is approved by this peer review process, it will be added to the Item Bank. Each new question accepted, along with questions that have performed well on previous examinations, is designated for use on one or more examinations, including the ABOS Part I Examination or any of the ABOS Subspecialty Certification or Practice-Profiled Recertification Examinations.
The ABOS Part I Examination is constructed based on the blueprint using items from the Item Bank. It is then administered and reviewed accordingly during a 1-day meeting by the ABOS Field Test Task Force (FTTF), which is comprised of approximately 20 ABOS Diplomates. Another level of review is performed by the ABOS Written Examination Committee, followed by a final review by the Chair of the Written Examination Committee. Prior to being administered at testing centers, the questions on the examination have gone through five levels of review. In addition, all questions in the bank are re-reviewed on a rolling 3- to 5-year schedule to ensure that each question remains current, applicable, and accurate.
Candidates take the ABOS Part I Examination in July, with an alternate date in August available for those with life events.
After the examination is administered, psychometricians summarize the statistical performance of each examination question. A Key Validation Subcommittee reviews the data, and poorly performing questions are deleted before scoring. The psychometricians then analyze the degree of difficulty of each question and the overall examination itself to ensure that the examination is valid, reliable, and produces scoring that is scalable from 1 year to the next. With this information, the ABOS Written Examination Committee meets to review the analysis data and determine the passing standard. Examinees whose score meets or exceeds the standard will pass the examination. Thus, the examination is developed so that a Candidate would have the same statistical likelihood of passing or failing no matter the year the examination is taken. The ABOS does not set an over-all pass rate, only a standard that can be scaled across numerous years.
Once the passing standard score is set, letters are drafted to each Candidate letting them know if he or she is successful. In addition, all Candidates receive a report showing how they performed in the various content areas.
The entire process is monitored by the ABOS Associate Executive Director and the ABOS Written Examination Committee. The goal is a fair, standardized, valid method of measuring orthopaedic knowledge.
ABOS KSB FAQs
The website for the American Board of Orthopaedic Surgery Knowledge, Skills, and Behavior (ABOS KSB) Program includes many documents and videos that explain the ABOS KSB Program. As all orthopaedic surgery residency programs now have access to the ABOS KSB Program, here are some of the questions we receive regularly.
What is the ABOS KSB requirement?
Starting July 1, 2025, all residents who wish to be ABOS Board Certification Candidates must participate in the ABOS KSB Program to be eligible to take the ABOS Part I Examination (the first step in the ABOS Board Certification process). Currently, it is a participation requirement only. The ABOS is only looking at participation levels, not at levels of achievement on the assessments. Participation requirements based on your current PGY can be found here.
What happens if I do not meet the ABOS KSB requirement?
You will be required to remediate in fellowship or in your first year of practice, requesting surgical skills and professional behavior assessments from individuals in those settings until you meet the ABOS KSB requirements in which you have a deficit. Once you meet the requirements, you can reapply for the ABOS Part I Examination.
How do I submit Surgical Skills and Professional Behavior assessment requests?
Requests can be made either through the ABOS KSB+ app or the web portal. You can use whichever method is most convenient for you. If you have log in issues, make sure you are at www.abos.org/ksb and not the main abos.org site. There are links if you have forgotten your username or password. If you do not receive an email with your username or password link, contact your program coordinator to ensure the email in our system is the one that you want the ABOS to utilize in your ABOS accounts.
Is the requirement based on assessments requested or assessments completed?
The requirements are based on the number of assessments completed by faculty.
What’s new with the ABOS KSB Program?
Changes will be coming to the ABOS KSB+ platform. In July, you will be able to track your participation requirements on the platform. Recently, ACGME Case Minimums changes have been reflected in the ABOS KSB+ platform.
ABOS KSB–From a Resident’s Perspective
You have read about the American Board of Orthopaedic Surgery Knowledge, Skills, and Behavior Program (ABOS KSB) for some time. You know about the participation requirement. You might have even used it. But what does it mean as a resident to participate? How can you use the program to help you become a better orthopaedic surgeon?
On a recent episode of the ABOS Podcast, Dr. Erik Van Eperen describes his experience of using the ABOS KSB Program as an orthopaedic surgery resident. The ABOS Podcast is available on most podcast apps including Spotify, Apple, and Amazon.
Apply to be a Visiting Scholar
Once again, the American Board of Orthopaedic Surgery (ABOS) has partnered with the American Board of Medical Specialties (ABMS) in sponsoring the Visiting Scholars Program for early-career physician specialists and research professionals.
ABOS-ABMS Visiting Scholars remain at their home organizations and work with self-selected mentors. They participate in interactive webinars, where they provide research project updates to their peers and a select panel of subject matter experts. Visiting Scholars alumni provide guidance, support, and solutions to barriers current Scholars may be experiencing in their research work.
The program is open to early-career physicians, medical and surgical specialists, and research professionals, junior faculty, fellows, and residents, as well as individuals holding master or doctorate degrees in public health, health services research, educational evaluation and statistics, public health policy and administration, or other relevant disciplines.
The program facilitates research projects related to Board Certification and Maintenance of Certification and allows Scholars to be exposed to research on professional assessment, medical education, health policy, and quality improvement.
Visiting Scholars are selected based on the quality of their proposed research project, the relevance of their research to the ABMS certification community priorities, and the likelihood of making substantial progress on the project during the year.
To learn more about previous ABOS-ABMS Visiting Scholars and the type of research they conducted, go to https://www.abos.org/research/visiting-scholars/. The ABMS is hosting an informational webinar on April 15th. The 2025-2026 application deadline is June 23rd.
ABOS Announces Its 2024-2025 Board of Directors
The Board of Directors of the American Board of Orthopaedic Surgery (ABOS) recently selected its 2024-2025 Officers and elected two new Director-Elects.
Kevin L. Garvin, MD, the L. Thomas Hood, MD, Professor and Chair, Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska, will serve as ABOS President. Dr. Garvin, along with the President-Elect, Vice President, and Secretary, hold their offices for a 1-year term.
Wayne J. Sebastianelli, MD, the Kalenak Professor in Orthopaedics at Penn State Health Milton S. Hershey Medical Center and Medical Director, Penn State Sports Medicine, will serve as ABOS Vice President.
Charles L. Nelson, MD, Chief of Adult Reconstruction Surgery at the University of Pennsylvania Health System and Professor of Orthopaedic Surgery at the Hospital of the University of Pennsylvania, will serve as ABOS President-Elect.
Lisa A. Taitsman, MD, MPH, Professor of Orthopaedics and Sports Medicine, University of Washington School of Medicine, will serve as ABOS Secretary.
Kyle J. Jeray, MD, Chair of the Department of Orthopaedic Surgery at Prisma Health-Update, has been re-elected as ABOS Treasurer for a 1-year term.
“Once again, the Board has elected an outstanding group of Officers,” said David F. Martin, MD, ABOS Executive Director. “They are all leaders in the field, and the Board is lucky to have them serve, as they are all busy practicing orthopaedic surgeon leaders.”
The Board elected Dawn M. LaPorte, MD, Professor of Orthopaedic Surgery at Johns Hopkins Hospital and School of Medicine, and Jennifer Moriatis Wolf, MD, PhD, Professor and Chair of the Department of Orthopaedic Surgery at The University of Chicago, as new Director-Elects of the American Board of Orthopaedic Surgery.
“The American Medical Association and the American Academy of Orthopaedic Surgeons both supplied outstanding slates of nominees from which the Board could select,” said Martin. “Dr. LaPorte and Dr. Wolf bring a tremendous amount of energy and significant skills to the organization.”
The ABOS Board of Directors consists of 21 members, which includes 12 Active Directors, six Senior Directors, two Directors-Elect, and one Public Member Director. ABOS Board Members serve one 10-year term, while the Public Member Director serves a 3-year renewable term. Nominations to the ABOS Board of Directors come from the American Orthopaedic Association, the American Academy of Orthopaedic Surgeons, and the American Medical Association. Officers are current Board members elected by other Board members. For a full list of ABOS Board Members, go to www.abos.org/about/board-of-directors/.
ABOS Roadmap
The American Board of Orthopaedic Surgery (ABOS) has an easy-to-understand roadmap that explains each step in the ABOS Board Certification and Maintenance of Certification process—from residency to retirement. Visit abosroadmap.org throughout your orthopaedic surgery career to make sure that you remain on schedule.
