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Editorial  |   April 2019
The Evolution of Osteopathic Board Certification
Author Notes
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Daniel Williams, DO, Vice President of Certifying Board Services, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864. Email: dwilliamsdo@osteopathic.org
     
Article Information
Medical Education / Professional Issues
Editorial   |   April 2019
The Evolution of Osteopathic Board Certification
The Journal of the American Osteopathic Association, April 2019, Vol. 119, 224-226. doi:10.7556/jaoa.2019.037
The Journal of the American Osteopathic Association, April 2019, Vol. 119, 224-226. doi:10.7556/jaoa.2019.037
In the early 1900s, it was difficult for osteopathic physicians (ie, DOs) to achieve board certification through allopathic channels. Thus, in 1939, the American Osteopathic Association (AOA) approved its first specialty board, the American Osteopathic Board of Radiology, and along with it the certification examination in radiology.1 In keeping with its mission to advance the distinctive philosophy and practice of osteopathic medicine, the AOA then became the primary certifying body for DOs. Today the AOA's 16 boards offer certification in 29 specialties and 77 subspecialties.2 While AOA board certification has expanded since 1939, its core focus has remained constant. It provides an objective, psychometrically defensible standard by which the osteopathic medical profession regulates itself and establishes the criteria by which one reaches “expert” status in a given discipline of medicine. Another aspect that is unchanged is the AOA's commitment to its members and all DOs. Through board certification, the AOA serves as their partners in lifelong learning and supports them throughout their careers. 
One strength of AOA board certification is that the boards are made up of practicing physicians dedicated to certifying practicing physicians. The certifying board members are often engaged in full-time practice and connected to the practice of medicine. Their engagement is reflected in their practical approach to assessment of knowledge, clinical skills, and professionalism. As the health care environment continues to change, boards are also enhancing osteopathic continuous certification to ensure that it aligns with current practice. 
What Is Board Certification?
In the osteopathic medical profession, board certification indicates that a physician has met a peer-established standard to be considered excellent in his or her chosen medical specialty. The initial examination encompasses the full spectrum of the specialty, and it is often taken shortly after the conclusion of postgraduate training. Becoming board certified serves as an important marker to external stakeholders, such as patients, employers, hospitals, and third-party payers. 
Board certification, like a license to practice medicine, needs to be renewed. As a marker of distinction, certification standards are higher than those required by medical licensing boards, which ensure basic competence. The expectation is that diplomates will demonstrate a commitment to increase their skills in their chosen disciplines. The high standard typically involves more continuing medical education (CME), knowledge assessments, and various evaluations of professionalism to help assure external stakeholders that the previously granted marker of distinction is still valid. 
It is also important to note the wide variety of external stakeholders who have a vested interest in physician board certification. The most obvious example is the fact that most employers require board certification as a condition for physician employment. As noted above, employers, health care insurance panels, and patients often look at board certification to ensure physicians meet the highest in professional standards. In short, board certification is not just for physicians—it also serves an important signifier for other active participants in the health care system. 
Evolving Initial Board Certification
American Osteopathic Association board certification has changed substantially since its inception in 1939. Today, board certification is almost universally required for new physicians who wish to be on insurance panels or employed in health care systems. With the single accreditation system, all DO and MD residents will have a choice between the 2 major physician board certification organizations with broad acceptance: the AOA and the American Board of Medical Specialties. It is important that the AOA continues to evolve its certification offerings not only to serve external stakeholders, but to also meet the needs of new physicians in practice. 
Residents have expressed a desire for a high-quality board certification program that embraces technology to be more convenient. While rigorous cognitive assessment will always remain essential to board certification, technology will help eliminate the need for diplomates to travel to oral examinations, which will save time and money. This year, the AOA is piloting test systems supporting in-home, remotely proctored examinations, with the goal of moving all oral examinations to this format. 
According to market research conducted by the AOA, residents also desire flexibility and need a board certification program that will meet their individual practice goals. The AOA Board of Trustees approved a resolution on February 26, 2019, to provide 2 options to serve a growing and increasingly diverse osteopathic community. One pathway will focus on specialty certification that includes assessment of the full practice of osteopathic medicine, including osteopathic manipulative treatment. Each board will also offer a certification pathway that will embrace osteopathic medicine's unique holistic thinking, yet will not require expert-level skill in the principles and practice of osteopathic medicine. 
The AOA's market research also indicated that this new AOA board certification option is sought after by osteopathically trained physicians who do not regularly use osteopathic manipulative treatment in their practice. The format will allow AOA board certification to maintain its unique identity while offering high-quality certification to a wider range of diplomates. 
Evolving Continuous Certification
Continuous certification is likely here to stay, but it will look vastly different in the future. While physicians would prefer a process that grants enduring, lifelong certification, external pressure is too great to allow lifelong certification at this time. However, it is possible to realign ongoing board certification so that it is more relevant to practice and yet reduces the burden and friction of having to complete continuous certification modules. 
In 2019, the AOA will begin pilot testing a new format of longitudinal assessment. This format will replace the high-stakes recertification examination currently given every 7 to 10 years. The goal will be to integrate assessment with learning, so that as physicians engage in lifelong learning and CME, they are automatically and conveniently completing the requirements for continuous certification via specialized digital applications. 
With the adoption of such technology, the potential also exists for some specialties to tailor assessment to the specific diplomate. One example is in the field of family medicine. Although obstetrics is within the scope of practice for a family physician, not all family physicians continue to practice obstetrics outside of residency. In the new testing format, it would be possible for the diplomate to attest to how much of his or her practice is dedicated to obstetrics and have his or her examination reflect this in the weight and number of questions allotted to the topic of obstetrics. 
The pediatric and neuromusculoskeletal medicine boards have conducted pilot studies to examine how the continuous certification process can be rolled out in a seamless process whereby diplomates can receive CME credit, complete cognitive testing, and complete practice improvement requirements, all from attending a single CME event. The AOA will be reaching out to some of its specialty colleges to further refine this model in an effort to reduce the burden of completing continuous certification requirements. 
Evolution of the Osteopathic Family
As the house and practice of medicine have evolved, it is vital that board certification evolves as well to maintain relevance. As the AOA looks to the future, it is important to remember our past. Osteopathic medical training produces a distinctive type of physician—and that physician is in demand. Patients and employers alike notice the DO difference, which is reflected in the growth of the profession. With growth comes change, and the AOA is making exciting new changes in our physician specialty board certification system to support the physicians and practice trends of the 21st century. 
The AOA has deep, established roots as a membership organization and a strong desire to partner with diplomates to develop a meaningful, high-quality board certification process. The AOA is committed to supporting its diplomates in their lifelong learning to provide outstanding, quality health care, and some of these changes are just around the corner. 
References
Tilley RM. Certification of osteopathic specialists. J Am Osteopath Assoc. 1939;39(4):219.
AOA board certification. American Osteopathic Association website. https://osteopathic.org/life-career/aoa-board-certification/. Accessed March 1, 2019.