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The concept of “certification” was introduced to American Medical Specialties in 1908 when the American Academy of Ophthalmology and Otolaryngology launched the first program to measure “competence.” Other specialty medical boards were founded during the following decades. The American Board of Orthopaedic Surgery was founded 75 years ago and issued the first orthopaedic certificates in 1934.Orthopaedic Board Certification and Recertification are voluntary processes offered to orthopaedic surgeons who have completed the educational requirements for orthopaedic residency in the United States or Canada. In effect, however, it has become the de facto measure of quality and is a requirement for hospital privileges and participation in most health plans.The certificates issued by the various Boards of the American Board of Medical Specialties (ABMS) were initially without time limit. Each of the ABMS Board has moved into recertification processes and the certificates have time limits ranging from 6 to 10 years. Recently, social, political, and regulatory forces have pushed for more frequent demonstrations of ongoing knowledge and performance. From this came a working group of the ABMS to try to define “competence.” After several years of deliberation, it became clear that a single definition was not possible, but that the characteristics of a competent physician could be defined, and agreed upon. These 6 competencies include medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. These competencies have become the core of an evaluation process that is now being implemented by the Association of American Medical Colleges at the medical school level, the Accreditation Council on Graduate Medical Education at residency level, the Accreditation Council on Continuing Medical Education, the Joint Commission, and most recently, individual hospital credentialing committees, as well as others.Evaluation of these 6 competencies has also become the goal of the revised board recertification process, known as Maintenance of Certification (MOC). To accomplish this evaluation, all the ABMS member boards have agreed to design the MOC process around 4 components: an Evaluation of Professional Standing, a Commitment to Lifelong Learning, Evaluation of Cognitive Expertise, and an Evaluation of Performance in Practice. Each board developed its own MOC program. By agreement of all the member boards of the ABMS, all the MOC programs are to be fully implemented by 2016. Changes in the maintenance of the recertification process have already incorporated the core competencies in the written exams, questions by oral examiners, and the peer review evaluation forms for credentialing.For ABOS diplomates, Part I professional Standing involves a credentialing process. A minimum standard is an unrestricted state medical license. Part II Commitment to Life-Long Learning requires cyclic documentation and reporting to the ABOS of a specified number and type of continuing medical education (CME) activities, including 20 credits of true self-assessment exams (SAE), each valued at a minimum of 10 category 1 credits and scored by the issuing body as well as 120 hours of regular CME credits. Part III tests Cognitive knowledge and consists of the recertification examination. ABOS currently offers 6 different recertification examination pathways. These include 4 computer-based tests in general orthopaedics, adult reconstructive orthopaedics, sports medicine, and spine surgery. Each of these examinations consists of 80 core questions common to all examinations and approximately 120 specialty-specific questions. For the orthopaedic hand surgeons who hold a CAQ in surgery of the hand, the CAQ along with the same 80 orthopaedic core questions, is an option to recertify in both orthopaedics and in surgery of the hand.