Supracondylar Fracture Practice Improvement Module
The study “Assessing Quality and Safety in Pediatric Supracondylar Humerus Fracture Care” published in this issue of the Journal of Pediatric Orthopaedics utilized the supracondylar practice improvement module (PIM) developed by the Pediatric Orthopaedic Society of North America (POSNA) as part of the American Board of Orthopedic Surgery (ABOS) Maintenance of Certification (MOC) process. Founded in 1934 as a private, voluntary, nonprofit, autonomous organization, the ABOS exists to serve the best interest of the public and the medical profession by establishing educational standards for orthopaedic residents and by evaluating the initial and continuing qualifications and competence of orthopaedic surgeons (ABOS Website).1 The ABOS is one of 24 member specialty societies which compose the American Board of Medical Specialties (ABMS) and like all the participating specialty boards, the ABOS has agreed to abide by the policies and decisions made by the ABMS.
Advancement in medicine has evolved from an approach relying on individual knowledge and skill, to a strategy emphasizing practice-based learning and improvement with a growing body of evidence demonstrating that practice improvement activities improve patient care.2–4 The ABMS and its member specialty boards have committed themselves to a process of ensuring that practice-based learning and improvement is an essential component of the recertification process, referred to as MOC. The MOC process centers around 4 components:
The ABOS, in collaboration with the American Academy of Orthopaedic Surgeons (AAOS) and orthopaedic subspecialty societies, have developed PIM’s for the purpose of satisfying MOC requirements. In June of 2011, a Practice Improvement Summit was held at the AAOS headquarters, which 55 representatives from 15 subspecialty societies attended. Following the Summit, POSNA attendees began the process of building a Supracondylar Humerus Fracture PIM. A 33 question data collection tool was developed; 6 questions record data pertaining to the preoperative assessment, 14 questions are related to treatment, and 13 questions collect information regarding follow-up.
The study by Iobst et al5 utilizes the supracondylar PIM to evaluate the outcomes and variations in care for pediatric supracondylar humerus fracture patients among a group of 35 pediatric orthopedic surgeons. The survey responses from the surgeons at 6 different hospitals demonstrate that there is considerable variation in care among surgeons, even for such a routine injury. The authors conclude that the variations in operating room time, anesthesiology time, number of postoperative visits, number of radiographs ordered and initial intraoperative immobilization all point to opportunities for standardization and lowering of costs. These results support the usefulness of PIM’s to compare a surgeon’s practices and outcomes with the practices of peers. The individual surgeon can then evaluate the results and decide if there is potential for outcome improvement and cost savings through practice modification.
The ABOS has approved the Supracondylar PIM for 20 Part II MOC Self-Assessment Examination (SAE) credits. Twenty SAE credits are required in Part II during the first 3 years of each ABOS Diplomate’s 10 year MOC cycle. An additional 20 SAE credits are required of each Diplomate before taking a secure cognitive examination. Part II involves lifelong learning and self-assessment. The decision to accept the Supracondylar PIM in place of a scored and recorded self-assessment examination reflects the ABOS commitment to practice-based learning and improvement. This PIM has not been approved for ACCME CME credit and will not meet the requirements of organizations outside of the ABOS that require ACCME certification of education activities. We encourage ABOS Diplomates participating in MOC to use the Supracondylar PIM and become involved in practice-based learning. The Supracondylar Humerus Fracture PIM is offered free of charge and can be accessed through the ABOS website at: www.abos.org/moc/other-sae-options/practice-improvement-modules.