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skeleton and its form and function, but it also makes it better by ways and means of applying cuttingedge research and clinical knowledge to those who sustain musculoskeletal injuries and present with other conditions. The newest advances in total joint replacement and limb salvage whether caused by cancer or trauma are some examples. Orthopedics is a very versatile specialty of surgery and includes the following areas2 : (1) pediatric orthopedics: care of injuries, deformities, and diseases of the bone, joints, muscles, and tendons in children; (2) sports medicine: care of injuries related to athletic activities; (3) joint replacement and surgery in arthritis: care of patients with advanced arthritis including medical treatment, joint replacement, and a newer procedure that aid with longevity of joint form and function; (4) foot and ankle: care of injury and diseases of the foot and ankle; (5) hand surgery: surgical and nonsurgical treatment of the hand and wrist; (6) shoulder and elbows: care of musculoskeletal conditions and injuries of the shoulder and elbow; (7) spine: surgical and nonsurgical treatment of deformities, injuries, and disorders of the back and neck; (8) trauma and fractures: treatment of traumatic injuries to the arms, legs, pelvis, and spine; (9) musculoskeletal oncology: treatment of benign and malignant tumors of bones, joints, and muscles; (10) rehabilitation: programs, whether short- or long-term that help improve strength and mobility and optimize recovery of injuries, diseases, or * Corresponding author. Tel.: 701-323-6140; fax: 701-323-8920. E-mail address: lgehrig@mohs.org Manuscript received March 11, 2011; revised manuscript March 28, 2011 0002-9610/$ - see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.amjsurg.2011.06.007 The American Journal of Surgery (2011) 202, 364 –368 musculoskeletal conditions; and (11) arthroscopy and arthroscopic surgery: diagnosis and treatment of joint diseases and injuries using arthroscopic methods.2 The following are the training requirements: 1. Residency requirements: residency requirements consist of 5 years after successful completion of an accredited 4-year medical school. 2. Residency: have a minimum of 5 years (60 months) of an accredited orthopedic residency training program in the United States or Canada. Generally, 1 year of internship is required. The internship year may include a concentration of surgical and orthopedic rotations. After completion of successful internship, 4 years completion of residency is required with required exposure to all subspecialties. Depending on the program, various amounts of time and training may differ in each of these orthopedic areas. 3. Board certification in orthopedic surgery is done by the American Board of Orthopaedic Surgery (ABOS) founded in 1934. Being certified means the orthopedic surgeon has met the specified educational, evaluation, and examination requirements of the Board. This includes a written test (part I) after the completion of orthopedic residency and an oral assessment (part II). A surgeon who has passed part I has 5 years during which to pass part II. If part II is not completed within 5 years, the candidate must retake part I.3,4 Furthermore, board certification is a voluntary process on the part of any physician in orthopedic surgery. Maintenance of Certification Since 1986, the ABOS has issued time-limited certificates. Those orthopedic surgeons who were certified in 1986 and thereafter must maintain their certification by completing 120 hours of pertinent continuing medical education, undergoing a stringent peer-review process to make certain they are respected by their peers and practicing ethical orthopedic surgery, and taking and passing a written or oral examination. This maintenance of certification (MOC) process must be performed every 7 to 10 years. Beginning with certificates that expire in 2010, all ABOS diplomates with time-limited certificates who wish to remain board certified will be allowed to do so by complying with requirements of the MOC program established by the ABOS. The MOC program has 4 components. These components consist of the following: 1. Evidence of professional standing, which is currently evaluated with periodic peer review, and confirmation of full and unrestricted licensure in all jurisdictions where a license is held and hospital credentials. 2. Evidence of life-long learning and self-assessment, addressed through two 3-year cycles of 120 credits of category 1 continuing medical education (CME) that include a minimum of 20 CME credits of Self-Assessment Examinations. 3. Evidence of cognitive expertise, which occurs through one of the same secure recertification examination pathways currently required at 10-year intervals. 4. Evidence of performance in practice, focuses on a quality improvement model and includes a stringent peerreview process. The process involves the submission of case lists and patient survey information. The Board also obtains peer review of the candidate from certified orthopedic surgeons who are familiar with their work. Evaluations from the hospital chief of staff, chief of orthopedics, surgery, anesthesia, and nursing staff in the operating room and orthopedic wards are also obtained. This information is reviewed by the Credentials Committee of the ABOS, who will decide which applicants are
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