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From the Departments of Obstetrics and Gynecology (Dr Ayres) and Psychiatry (Dr Scheinthal) at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine in Stratford, where Dr Scheinthal also serves at the New Jersey Institute for Successful Aging. Also from the American Osteopathic Association (AOA) Department of Education's Division of Certification and Trainee Services (Mr Ramirez and Ms Bell). Dr Ayres currently serves as chairman of the AOA Bureau of Osteopathic Specialists; Dr Scheinthal as vice chairman, and Mr Ramirez as secretary.

Address correspondence to Armando F. Ramirez, BS, CAE, Department of Education, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864. E-mail: aramirez{at}osteopathic.org

Specialty board certification, though voluntary, has become an indispensable designation for many osteopathic physicians. The authors report rates of osteopathic specialty board certification and recertification for osteopathic physicians. Earlier this year, at the recommendation of the Bureau of Osteopathic Specialists, the American Osteopathic Association Board of Trustees approved the use of an osteopathic continuous certification model by member boards. This model firmly establishes osteopathic specialty board certification as an ongoing process that ensures physician competence and patient safety. The various components involved in the implementation of this new methodology are outlined, including practice performance assessment. As the healthcare environment continues to evolve, the American Osteopathic Association, the Bureau of Osteopathic Specialists, and the 18 osteopathic specialty boards continue to adapt to meet the professional needs of osteopathic physicians.

The AOA has 18 approved specialty certifying boards, each of which elects one representative to the BOS. The American Osteopathic Board of Radiology, the first approved certifying board, was established in 1939. Thereafter, additional certifying osteopathic specialty boards were created in response to the evolving needs of the osteopathic medical profession (Figure 1). Since 1939, the Bureau has issued a total of 30,529 general, special, and added qualification certifications.

View larger version (45K): [in this window] [in a new window]   Figure 1. The American Osteopathic Association's 18 approved certifying specialty boards by year founded. *From 1940 through 1996, the American Osteopathic Boards of Ophthalmology and Otolaryngology were known as the American Osteopathic Board of Ophthalmology and Otorhinolaryngology. The American Osteopathic Board of Anesthesiology was formerly under the American Osteopathic Board of Surgery, as was the American Osteopathic Board of Orthopedic Surgery. The American Osteopathic Board of Family Physicians was known as the American Osteopathic Board of General Practice from 1972 through 1993. The American Osteopathic Board of Neuromusculoskeletal Medicine was originally known as the American Osteopathic Board on Fellowship of the American Academy of Osteopathy from 1977 through 1990. Then, from 1990 to 1999, they were known as the American Osteopathic Board of Special Proficiency in Osteopathic Manipulative Medicine. //In 1982 and 1983, the American Osteopathic Board of Preventive Medicine was known as the American Osteopathic Board of Public Health and Preventive Medicine.

	Evolution of the Osteopathic Certification Process

Top Evolution of the Osteopathic... The Quality Movement and... What Lies Ahead for... Conclusion References

 
The process of receiving osteopathic board certification has traditionally involved the use of comprehensive examinations. These examinations, in addition to other stringent board-specific requirements,² are written and formulated by subject matter experts in the respective specialties. Through the years, enhancements to this process have begun addressing the issue of continued physician competence—namely through the physician recertification process and issuing time-limited certification. In July 1992, all osteopathic specialty boards were directed by the AOA BOT to offer a recertification mechanism to diplomates by January 1, 1995.¹

In conjunction with implementation of the recertification process, many osteopathic specialty boards began issuing time-limited certification (ie, certification with expiration dates). In fact, effective January 1, 2004, the BOS mandated this change for all member boards that had not yet restricted certification to 10 years or less. Certification issued before time-limited certification was introduced is valid for the life of the physician—provided that he or she meets the other requirements of certification. However, all diplomates are eligible to sit for recertification examinations—even if they currently hold lifetime osteopathic specialty board certification.

The use of time-limited certification reflects the Bureau's view that it is not enough to test specialists only once in their professional careers; to help protect the public, continued physician competence should be assessed on a periodic basis.

In addition, to ensure that AOA board–certified physicians keep up with the latest advances in medicine, AOA specialty certifying boards also mandate that physicians meet board-specified continuing medical education (CME) requirements. Certificate holders are required to complete no less than 50 credit hours in their respective specialties for each 3-year CME cycle.⁴

When combined, these changes (ie, recertification, time-limited certificates, and CME requirements) reflect an evolution in osteopathic specialty board certification: osteopathic continuous certification (OCC).

	The Quality Movement and OCC: Why—and Why Now?

Top Evolution of the Osteopathic... The Quality Movement and... What Lies Ahead for... Conclusion References

 
To understand why continuous certification is the next evolutionary step in the model for board certification of physicians, one must take into consideration the influence "the quality movement" has had over the medical community in the past several years.

Concerns over medical errors, patient safety, and the quality of healthcare have been noted in numerous reports from the Institute of Medicine (IOM).^5,6 In particular, the report published in 2000, To Err Is Human: Building a Safer Health System,⁷ prompted a number of influential groups from government, medicine, the public interest, and industry to address the quality of the nation's healthcare system by supporting a reduction in the number of medical errors.^5,6

This coalition led the medical community to implement various initiatives designed to improve the quality of patient care. Numerous initiatives—such as the teaching of core competencies at the residency level—have been adopted by medical residency programs.^6,8

The introduction of continuous certification models by the BOS and the American Board of Medical Specialties is another step intended to ensure quality of care.⁶ Adding to these efforts, the Federation of State Medical Boards (FSMB) has been active in the discussion to assess continued physician competence for the maintenance of licensure, enacting stricter requirements for renewal.^6,9

The intentions of the quality movement are clear and understandable and have a noble purpose: to protect patients and assist the medical community in ongoing improvements to healthcare delivery. For this reason, during the past 4 years, the Bureau has been engaged in high-level discussions regarding how best to implement a certification process that addresses the challenges of ensuring continual physician competence.

The OCC process is currently under development and, at the recommendation of the BOS, was recently approved by the AOA BOT at their February 2008 meeting (Resolution [No. pending] [M/2008]—Implementation of Osteopathic Continuous Certification Process by 2012). This AOA policy change not only addresses concerns launched by the quality movement, it is consistent with the Bureau's long-standing objective of helping to protect the public through assessment of physician competence.

Consistent with the quality movement's emphasis on continuous improvement in the delivery of quality healthcare, the BOS believes certification should be an ongoing process rather than an episodic one. To that end, the Committee on Implementation of OCC has proposed the creation of a four-component process to address the assessment of continued physician competence and improvement (Figure 2).

View larger version (39K): [in this window] [in a new window]   Figure 2. Four components of the proposed osteopathic continuous certification process.

Practice performance assessment—probably the most challenging component of the OCC model to implement—will involve the use of national benchmarks and will be determined by each member board. Some of the methodology the boards may use to establish their performance assessment models could include such innovative tools as the AOA Clinical Assessment Program (CAP), which acts as a repository of quality benchmarks and provides feedback on improvement to participating physicians.⁸

	What Lies Ahead for AOA Board–Certified Physicians?

Top Evolution of the Osteopathic... The Quality Movement and... What Lies Ahead for... Conclusion References

 
Implementation of OCC is under way. As is the case with any critical initiative, some details on OCC are yet to be resolved. Implementation of this process is a goal of the BOS. As previously noted, the Bureau presented the OCC concept to the AOA BOT for their approval at their February 2008 meeting, recommending that all 18 member boards implement this process by 2012. How each of the four components outlined is handled or addressed will be left to the discretion of the 18 approved specialty certifying boards.

In the coming years, AOA board–certified physicians will receive more detailed information on the transition from the traditional recertification model to the OCC model. The intended objective of OCC is to assist physicians in maintaining competency—enhancing the quality of healthcare nationwide.

	Conclusion

Top Evolution of the Osteopathic... The Quality Movement and... What Lies Ahead for... Conclusion References

 
Much in the same way as it responded to the needs of osteopathic physicians in its early days, the AOA's certification program continues to respond to the needs of the osteopathic medical profession and to the interests of public health. Osteopathic board certification will undoubtedly continue to adapt to the changes of the healthcare environment while also providing a valuable mechanism to help assess ongoing physician competence.

Submitted January 4, 2008; accepted January 17, 2008.

	References

Top Evolution of the Osteopathic... The Quality Movement and... What Lies Ahead for... Conclusion References

 
1. American Osteopathic Association. Handbook of the Bureau of Osteopathic Specialists. Chicago, Ill: American Osteopathic Association; 2007.

2. Ramirez AF, Bell EC. Osteopathic specialty board certification. J Am Osteopath Assoc. 2007;107:117-125. Available at: http://www.jaoa.org/cgi/content/full/107/3/117. Accessed March 6, 2008.

3. Maintenance of Certification (MOC) page. American Board of Medical Specialties Web site. Available at: http://www.abms.org/About_Board_Certification/MOC.aspx. Accessed March 2, 2007.

4. Rodgers DJ. AOA continuing medical education. J Am Osteopath Assoc. 2008;108:141-156. Available at: http://www.jaoa.org/cgi/content/full/108/3/141.

5. Brennan TA, Horwitz RI, Duffy FD, Cassel CK, Goode LD, Lipner RS. The role of physician specialty board certification status in the quality movement. JAMA.2004; 292:1038 -1043.[Abstract/Free Full Text]

6. Federation of State Medical Boards – Special Committee on Maintenance of Licensure. Draft Report. Dallas, Tex: Federation of State Medical Boards of the United States Inc; 2007. Available at: http://www.fsmb.org/pdf/Draft%20report%20FSMB%20Special%20Comittee%20on%20Maintenance%20of%20Licensure.pdf. Accessed February 28, 2008.

7. Kohn LT, Corrigan JM, Donaldson MS, eds; for the Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. Washington, DC: Institute of Medicine; 2000. Available at: http://darwin.nap.edu/books/0309068371/html/. Accessed April 18, 2006.

8. Tunanidas AG, Burkhart DN. American Osteopathic Association commitment to quality and lifelong learning. J Am Osteopath Assoc. 2005;105:404-407. Available at: http://www.jaoa.org/cgi/content/full/105/9/404. Accessed February 28, 2008.

9. Adams D. Stricter requirements sought for relicensure as medical boards draft proposal. amednews.com [serial online]. Chicago, Ill: American Medical Association; December 24/31, 2007. Available at: http://www.amaassn.org/amednews/2007/12/24/prl21224.htm. Accessed March 28, 2008.

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				D. J. Rodgers AOA Continuing Medical Education J Am Osteopath Assoc, March 1, 2008; 108(3): 141 - 156. [Abstract] [Full Text] [PDF]

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