1. OB/GYN Board Certification process
Travis W. McCoy, MD
June 10, 2009

2. OB/GYN Board Certification process
All of the following information is available on the ABOG website, published and updated annually in the ABOG Bulletin.
At the start of your Chief year, download a copy, review the timelines and requirements

3. ABOG- American Board of Obstetrics and Gynecology
ABOG- American Board of Obstetrics and Gynecology -- a Corporation formed in 1930 to:
Arrange and conduct examinations
to test the qualifications of voluntary candidates for certification and recertification in Obstetrics and Gynecology
Issue Certificates
which may be valid only for a limited period of time, of professional knowledge to eligible physicians who have demonstrated special knowledge and professional qualifications relating to Obstetrics and Gynecology
Determine whether physicians who have been issued Certificates have continued to maintain their professional qualifications
and to issue Certificates for Recertification, Maintenance of Certification to those physicians who successfully demonstrate continued maintenance of such qualifications

4. In general, the role of the Board is to:
Test
Approve
Re-test

5. Some ABOG terms: ABOG Registered - Residency Graduate
Status after application to the Board, and after they rule that you have fulfilled the requirements to take the written examination.
Active Candidate “Board Eligible”
Active Candidate status achieved by passing the written examination.
Must fulfill all requirements for admission to the oral examination and must not have exceeded the limitations to admissibility for the orals
Active Candidate status which has expired may be regained by repeating and passing the Board's written examination.
Diplomate
An individual becomes a Diplomate of the Board when the written and oral examinations have been satisfactorily completed and the Board's certifying diploma has been awarded.
Certificates have limited duration of validity (Six years).
Expired Certificate
Failed to complete the maintenance of certification process
Diplomate status reinstated by successfully completing the ABOG Maintenance of Certification process.
Retired Diplomate
Revoked Certificate
Restricted

6. The ABOG Examination/Certification Process
The examination process is voluntary. The ABOG will not contact you. You are responsible for completing applications and submitting required materials by their deadlines
Certification by ABOG is a dual examination process
Written examination followed by an oral examination
Written Exam given the last Monday in June of Chief year
Oral Exam can follow standard timeline or accelerated process (for some)
There are two fees, an application fee AND an examination fee
BOTH the written and the oral examination
BUDGET ACCORDINGLY!!!
Certificates have a limited valid duration for a max of 6 years
Diplomate must undergo a Board-approved method of maintenance of certification (MOC) in order to receive a new certificate

7. ABOG Certification
Residency Fullfillment Requirements- Laid out in Bulletin
Of note:
Program director is required to attest on behalf of the program, to the resident's satisfactory performance, competence and completion of the program
Limits of leave of absence/vacation- time gone (e.g., vacation, sick leave, maternity or paternity leave, or personal leave) cannot exceed:
Eight (8) weeks in any of the first three years of graduate training, or
Six (6) weeks during the fourth graduate year, or
a total of twenty (20) weeks over the four years of residency, then,
If exceeded, the Residency must be extended for the duration of time the individual was absent in excess

8. Testing Timeline Standard Certification Process
Final year of residency
September-November -- Apply for general written examination
June -- Take general written examination- June 29, 2009
First year of practice (July 1, June 30, 2010)
No General Board activities
Second year of practice (July 1, June )
July 1, 2010 to June 30, 2011 – Collect Case list
September Apply for general oral examination
Third year of practice
August Submission of case list and Examination Fee
Winter Take general oral examination

9. Testing Timeine If enrolled in a Fellowship in Subspecialty
First year of fellowship (July 1-June 30)
No Board activities
Second year of fellowship (July 1-June 30)
No general Board activities
Third year of fellowship (July 1-June 30)
September-November -- Apply for subspecialty written examination
June – Take subspecialty written examination
Fourth year -- First year of practice (July 1- June 30)
July 1- June 20- Collect General Oral Case List
Apply for the general oral examination
Fifth year -- Second year of Practice (July 1- June 30)
August -- Submission of case list for general oral examination
November, December or January -- Take general oral examination
May -- Apply for the subspecialty oral examination
January 1-December 31—Collect Subspecialty case list
Sixth year -- Third year of Practice (July 1- June 30)
January -- Submission of thesis
February -- Submission of subspecialty case list
March or April -- Take oral subspecialty examination

10. Written Exam Taken the last Monday in June of Chief year
Must apply in September of Chief Year, Budget for costs!
Examination Fees:
Remember, there is an application AND Examination fee for both the Written and Oral Exams
Written Exam- $1410
Application fee (November 15th of Chief year)- $735
Late fee- up to 2 wks late- $330
Late fee- 2wks to 4wks late- $790
Examination fee (February of Chief year)-$675

11. Written Exam Taken at a standard computerized testing center
(Newburg Rd exit of I-264)
Test results should be received by August 1st (According to ABOG)
Lists PASS or FAIL, and gives a numerical score
The score has no reference and is not comparable to any other score you are familiar with. ABOG does not report the scoring system, thresholds or scale

12. Exam Format 230 questions, 3 ½ hours
Many of the questions are “Beta” test questions and won’t be scored. All exams different, and may not have same questions or cover same topics
Consists of single, best answer, multiple-choice questions
Many (nearly all) of the questions are constructed to be thought provoking and/or problem solving in contrast to “recall” type questions
They contain a continuum of answers. Specifically, all possible answers may be plausible, but only one answer is the MOST correct
A lot of “the most” or “the least” questions
The format of the test is not conducive to last minute cram studying

13. Topics Covered in Examination
Approximately 30% of the questions are from topics listed under each of the general headings
Gynecology
Obstetrics
Office practice-preventive/primary care
The remaining 10% of the questions are based on cross-content topics, such as, genetics, immunology and pharmacology
Topics are laid out in the Bulletin, and expanded upon in the "Educational Objectives for Resident Education in Obstetrics and Gynecology", published by CREOG
Basically all of your 4 years covered in 3 ½ hours

14. Preparation: Don’t take it for granted
Start studying MONTHS ahead of time. The knowledge needed can’t be crammed
Prolog has a good format, but time consuming
If reviewing old tests, focus on WHY the incorrect answers are incorrect
On the Written, nearly all answers are correct, so you have to take the thought process to a deeper level
Recommend:
“Wall exam rememberences”
“Wall Written Exams”
Precis likely too general
Prolog good but time consuming.
May be a good choice if having >3 months to study

15. The Oral Exam
Given in Dallas each year, 2nd week of November, December, and January
Two Oral Examination Process timeframes
Standard Oral Exam Certification Process
Accelerated Oral Exam Process

16. Standard Oral Exam Certification Process
Start collecting case list in July of 2nd year of practice. Take the Oral Exam in the winter of the 3rd year of practice

17. Accelerated Oral Exam Process
Start collecting case list immediately after residency in 1st year of practice. Take the Oral Exam in the winter of the 2nd year of practice. (As opposed to the 3rd year in the Standard Process)
For those in fellowship using the accelerated process, they may collect cases in the 1st or 2nd year, and take the exam in their 2nd or 3rd year of fellowship (As opposed to taking the exam in their 2nd year following fellowship)
Can be done in Fellowship, but up to the individual Fellowship Director
Highly recommended if available!!

18. Accelerated Oral Exam Process
Why do the Accelerated Process?
Information fresher in your mind right out of residency
Especially if limited focus practice
Will likely have more time to study (Less busy practice)
Board Certification usually required for consideration for partnership (sooner the better)
The length of time between successful completion of the written examination and the oral examination may be shortened.
Graduating residents who pass the written examination will be notified prior to August 1 that they have passed and are eligible to apply for the accelerated process. The Pass notification has a notice about applying for accelerated plan

19. Criteria for the Accelerated Process:
An active hospital practice must be established prior to Sept 1
Must have completed residency by Aug 31
No late applications accepted, and all deadlines and requirements must be met to participate
Those candidates that have just graduated from residency, may begin collection of cases ON July 1, but must start prior to September 1
Application deadline ~September 15. So only about 6 weeks to decide!
300 applicants accepted, lottery system if more apply
Notified by October 1 if they are among the 300 candidates chosen
For those not selected, application fees refunded and case collection can stop

20. Examination Fees:
Remember, there is an application AND Examination fee for both the Written and Oral Exams
Written Exam- $1410
Application fee (November 15th of Chief year)- $735
Late fee- up to 2 wks late- $330
Late fee- 2wks to 4wks late- $790
Examination fee (February of Chief year)-$675
Oral Exam- $1740
Application fee- September of year of case collection- $805
Examination fee- Submit with case list, August before exam- $935
Late fee- up to 11 days late- $330
Travel + Hotel in Dallas (Southwest flies directly to Love Field) $550 total 

21. The Oral Examination
Evaluate the mode and rationale for the clinical care of patient management problems in obstetrics, gynecology and women’s health
Expected to demonstrate that they have acquired the capability to perform, independently, major gynecologic operations, spontaneous and operative obstetric deliveries, to manage the complications of and to perform the essential diagnostic procedures required of a consultant in obstetrics, gynecology and women’s health.
The fund of knowledge required for passing the oral examination is similar to those categories listed in regard to the Written Examination.
Expected to demonstrate a level of knowledge which allows them to serve as consultants to physicians who are non-obstetrician-gynecologists

22. Requirements for the Oral Examination
Passing grade on the written examination prior to applying
Must pass the oral examination within six (6) years of passing the written and may take the oral exam only three (3) times
Board-approved fellowship excluded from six (6)-yr limitation
If a candidate fails the oral examination three (3) times, or fails to pass the oral examination within six (6) years of passing the written examination, must repeat the written examination to take the oral exam again
Good moral and ethical character.
If involved in litigation or investigation regarding practice activities, ethical, or moral issues, the individual will not be scheduled for examination. The Board usually will defer such a decision for one year to gain further information.
Unrestricted license to practice medicine. Actively engaged in unsupervised practice of ob/gyn

23. Oral Exam Format
The examination completed in one-half day in Dallas, TX. Everyone stays in the same hotel, and you are taken to the testing center by bus
Assigned to AM or PM session, occurring in the 2nd week of November, December, or January. Date randomly picked by computer
Three hour examination; three one-hour blocks
Obstetrics
Gynecology
Office Practice
Held in small testing rooms (about exam room size), tested alone, sitting behind a desk. Examiners sit in chairs on other side of desk near door, computer monitor on side wall, camera surveillance

24. Oral Exam Format
Three separate pairs of examiners, usually one generalist and one specialist (MFM+Gen, REI+Gen, Onc+Gen, Gen+Gen)
They receive your case list the night before to review
Very formal, very to the point, very business. No information given about the examiners or about you to the examiners. Given list of examiners at start of exam to review any possible conflicts of interest
You are given a blank pad and pen and take along a clean copy of case list (must be identical to the one given to the examiners). No additional notes allowed on the case list
Free to take restroom break at any time, but the clock keeps running. Best to only go between blocks. (Consider fluid limitations, and even using zofran/immodium!)

25. Oral Exam Format Each block one hour long
30 minutes spent on 3-4 standardized cases, 3-4 subparts of each case.
Everyone that session gets the same cases. May vary from day to day, but same ideas recur in a given year
30 minutes for review of case list
May ask you about any topic brought up on your list
Questions are about general ideas, not as much about specific patients
Strict time limits for all parts, buzzer goes off at the end, and you’re stopped midsentence
Examiners thank you, shake your hand, and walk out
Next set of examiners immediately walk in minutes between examiner sets

26. Oral Exam Format Tales of pathology slides- non-existant now
Examining team scores candidate individually and discuss each one at the end of the day to decide on result. Scored as pass, borderline, or fail. If conflicting scores, usually side with more senior examiner
Numerical score given for each section 2=Pass, 1=Borderline, 0=Fail. Must have a total score at end of the day of 4 to pass the overall exam
Ie. 2 Pass + 1 fail, or 1 Pass + 2 Borderline
Results mailed out Monday of the following week

27. The Case List Three separate lists: OB, GYN, and Office Practice
OB and GYN must include All patients dismissed from care in all hospitals during the case collection period
Must list all hospitalized patients, as well as all outpatient and inpatient surgery
A Practice that consists of ambulatory care exclusively is not considered adequate to fulfill requirements
The case lists must have sufficient numbers and sufficient breadth and depth of clinical experience.
The case list must include a minimum of 20 inpt/outpt GYN and 20 inpt/outpt OB patients with significant problems

28. The Case List
If, but only if, a minimum of 20 patients in GYN and OB cannot be obtained during the collection period, the candidate may:
Submit a complete 18-month case list extending an additional 6 months prior
Submit a list of patients obtained from their senior year of residency
Case lists may not be comprised solely of cases from the senior residency year
Case lists limited to office practice plus obstetrics or gynecology can be submitted only by those individuals who limit their practice to either gynecology or obstetrics
In this case, the appropriate number and types of gynecological or obstetrical cases must be obtained from the candidate’s chief residency year
The candidate will be examined in all three areas

29. The Case List Lists must be de-identified under HIPAA
(Basically can include initials only, no other identifying information)
Patients must be only those for whom the candidate has had personal responsibility for professional management and care
The completeness and accuracy of submitted case lists are subject to audit by the ABOG.
About 1 in 25 lists randomly audited, or on suspicion of fraud
You must bring a copy of the case list to the oral examination for your reference, but you cannot have anything additional written on it.
Carelessly prepared or incomplete case lists are one of the most common reasons for failure!

30. Case List Preparation Specific format for case lists
ABOG offers software free annually to collect cases in
Somewhat clumsy for daily use, but ok for final formatting
Other companies have slightly easier to use software, but charge for it
Probably easiest to make an Excel spreadsheet for routine use and then enter into ABOG software or format printing directly
Only approved abbreviations, are acceptable. This list is short and these may not be the same you use, and other common ones are not allowed
A&P Repair, Ab, AIDS, BS&O, CD, cm, D&C, D&E, DHEAS, E, FSH, gms, HIV, HRT, IUD, Kg, PAP, PROM, PTL, SVD, T, TAH, TSH, TVH, VBAC  

31. Office Practice Patients
List of 40 and only 40 patients from the office practice categories
No more than two (2) patients from any one category
Cannot include any patients who appear on the hospital OB or GYN lists.

32. Office Practice Patients
OFFICE PRACTICE CATEGORIES
1. Preventive care/health maintenance
2. Smoking cessation & tx of obesity
3. Sexual dysfunction
4. Contraception
5. Psychosomatic problems
6. Genetic counseling
7. Primary/secondary amen.& hirsutism
8. Infertility
9. Hyperprolactinemia
10. Endometriosis
11. Perimenopausal & menopausal care
12. Office surgery
13. Abnormal uterine bleeding
14. Evaluation & mgt of pelvic pain
15. Vaginal discharge
16. Vulvar disease
17. Breast disease
18. Eval. of urinary/rectal incont
19. Urinary tract infections
20. STDs
21. Immunizations
22. Pediatric gynecology
23. Sexual assault
24. Spousal abuse
25. Dysmenorrhea
26. Premenstrual syndrome
27. Benign pelvic masses
28. Ultrasound
29. Back pain
30. Respiratory tract diseases
31. Gastrointestinal diseases
32. Cardiovascular diseases
33. Endocrine diseases
34. Hypertension
35. Dx/Mgt of dyslipidemias
36. Recognition / counseling of substance abuse
37. Depression
38. Geriatrics
39. Infertility evaluation & management
40. Pelvic floor defects

33. Gynecology Patients
List all GYN patients managed during the case list collection period (12 or 18 mo)
A minimum of twenty (20) gynecological patients is required, and a candidate cannot count more than two (2) patients from each of the categories listed below
For example, if a candidate has five (5) patients who have had Dx LSC, they all must be reported on the case list, but only two (2) of the five (5) will be counted as meeting the minimum requirement of twenty (20) gynecological cases.
If, but only if, a candidate cannot acquire the necessary twenty (20) gynecological cases in the above categories, they may use an 18-month case list and/or select an appropriate number of cases from their fellowship or senior residency case list

34. Gynecology Patients
The preoperative diagnosis should appear for all major and minor surgical procedures
The size of ovarian cysts and neoplasms must be recorded
For non-surgical conditions, the admission diagnosis should be recorded
The treatment recorded should include all surgical procedures, as well as primary non-surgical therapy
Surgical diagnosis refers to pathology diagnosis. For hysterectomy specimens, the uterine weight in grams must be recorded. In cases without tissue for histologic diagnosis, the final clinical diagnosis should be listed.
Days in hospital is the arithmetic difference between date of discharge and date of admission

35. GYNECOLOGICAL CATEGORIES
Gynecology Patients
GYNECOLOGICAL CATEGORIES
1. Abdominal hysterectomy
2. Laparotomy (other than tubals)
3. Vaginal hysterectomy (including LAVH)
4. Diagnostic laparoscopy
5. Operative laparoscopy (other than tubals)
6. Operative hysteroscopy
7. Uterine myomas
8. Defects in pelvic floor
9. Endometriosis
10. Tubal sterilization
11. Invasive carcinoma
12. Carcinoma in situ
13. Urinary incontinence
(medical management)
14. Urinary and fecal incontinence
(operative management)
15. Ectopic pregnancy
16. Operative mgt of pelvic pain
17. Congenital abnormalities of the
reproductive tract
18. Pelvic inflammatory disease
19. Adnexal problems except
ectopic pregnancy and PID
20. Abnormal uterine bleeding
21. Vulvar masses
22. Vulvar ulcers
23. Adenomyosis
24. Postoperative wound complications
25. Postop thrombophlebitis or embolism
26. Postop fever for greater than 48 hours
27. Rectovaginal or urinary tract fistula
28. Abn cervical cytology and colposcopy
29. Preop evaluation of coexisting conditions
(respiratory, cardiac, metabolic diseases)

36. Obstetrical Patients
Must list every delivery, as well as any other OB surgery or hospitalization
A minimum of twenty (20) obstetrical patients is required, cannot count more than two (2) patients from each category
In addition, a total of the number of normal, uncomplicated obstetrical patients managed during the same time period should appear on the obstetrical summary sheet
These normal, uncomplicated obstetrical patients should not be listed individually pregnancy, labor, delivery and the puerperium uncomplicated,
between 37 and 42 wks GA; vertex
membranes ruptured or were ruptured after labor began
position was occiput anterior or transverse,
labor was less than 24 hours in duration;
delivery was spontaneous or by outlet forceps, from an anterior position;
Infant had a 5-min Apgar score of >=6 and weight between 2500 & 4500 gms
placental delivery was uncomplicated
blood loss was less than 500 mL
All deliveries not fulfilling these criteria must be listed individually

37. OBSTETRICAL CATEGORIES
Obstetrical Patients
OBSTETRICAL CATEGORIES
1. Breech & other malpresentations
2. Intrapartum infection (amnionitis)
3. Puerperal infection
4. Third trimester bleeding
5. Multifetal pregnancy
6. Cesarean hysterectomy
7. Premature ROMat term
8. Preterm premature ROM
9. Preterm delivery
10. Hypertensive disorders of preg
11. Second trimester SAB
12. CV and/or pulmonary dz complicating preg
13. Renal or neurological dz complicating preg
14. Hematological or endocrine dz compl.preg
15. Infections complicating pregnancy
16. Postterm pregnancy
17. Abnormal fetal growth
18. Vaginal birth after cesarean delivery
19. Maternal complication which delayed
hospital discharge >48 hrs
20. Neonatal complication which delayed
neonatal discharge >48hrs
21. Pregnancies complicated by fetal anomalies
22. Pregnancies complicated by HIV
23. Primary cesarean delivery
24. Repeat cesarean delivery
25. Inductions or augmentations of labor
26. Puerperal hemorrhage
27. Readmit for mat. Comp. <6 wks PP
28. Vaginal lacerations (3rd/4th deg)
29. Trauma in pregnancy (car accidents)
30. Coexisting malignancies
31. Preconception evaluation, prenatal
and genetic diagnoses

38. General Case List Hints
Track ALL of your cases, especially surgical cases in your chief year
You may need them in the future!
Especially track LSC, Cysto, and Laser cases, may be needed for hospital privileges
Get into the habit of collecting all the information needed
No need to keep H&Ps or OP notes, but include a lot of pertinent details to remind you of the patient
Can include as much info as you want, but everything mentioned is open to questioning
Want enough to clarify the reason you provided the type of treatment
Don’t want too much to open yourself to obscure questions
Don’t, Don’t, Don’t falsify or leave out “bad” cases
Collect and enter them as you go, don’t wait until the list is due
Especially for Office Practice!!
Keep a list of topics in your pocket, copy relevant chart notes and info

39. General Case List Recommendations
Allow time to prepare, review, and recheck!!
List has to be verified by the medical records of each hospital
Can take 1-2 weeks for verification
Review, Review, Review your list for errors
Have lists reviewed by and discuss with at least 2 other people
Helps to use those that are or have been examiners in the past
Start list reviews with “examiners” at least 1 month in advance of due date
Gives time to make changes
After submitted in August, no changes are allowed
Make a topic list of everything on your list, know everything about those topics

40. Board Review Courses Should I take a review course?
Most say YES, by far
Too much riding on oral boards
Can only take one time per year, high cost

41. Board Review Courses Which Ones are available?
Columbus Course
10 days, Columbus OH. $ hotel (10x$134)
Once per year, Very comprehensive, many highly recommend
Intensive, 8-10hrs per day x 10 days
Shorter 5 day course in Orlando
$ days
ExamPro
Most options, courses, DVD courses, Old exam information, insider test questions, case list review, mock exams, one on one with director
Prices vary
Dr. Wall’s Multiple options and sessions, $1500 course.
5 day course, $1600, Charlotte, NC
Less well known
Offers 3 courses per year, case list options, mock exams