Board certification

Overview
Board Certification is the process by which a physician with either a MD or osteopathic (DO) degree in the United States, documents by written, practical and/or simulator based testing a mastery of the basic knowledge and skills that define an area of medical specialization. The commonly used acronym BE/BC (board eligible/board certified) refers to a physician who is certified or is eligible to be certified to practice medicine in a particular field. The term Board Certified is also used in the nursing field, where a candidate with advanced mastery of a nursing specialty can also become eligible to be Board Certified.

Defining a medical specialty
The core body of knowledge that defines an area of medical specialization is referred to as the core competencies for that specialty. Core competencies are developed through detailed review of the medical literature combined with review by recognized experts from established medical specialties, experts within the new area of specialization and experts from outside the medical profession. This list of core knowledge and skills is then compiled into a draft Core Competency Document.

Once the Core Competency document is drafted, the certifying organization and its associated professional academy, college or society review the document against the existing literature and again solicit expert opinion regarding the Domains of Competence and Areas of Competency contained in the document. The Core Competencies are next formatted using a psychometric taxonomy such as Bloom's Taxonomy based on the core competencies required by physicians practicing in the area of specialization as non-specialists and as specialists or sub-specialists. Development of the first core competency document takes five to ten years and is a prerequisite to creating the Certification Examination.

Certification examinations
Physicians seeking board certification in a given area of specialty must successfully complete and pass an examination process designed to test their mastery of the minimum knowledge and skills contained in the core competency document. Prior to taking the examination, a physician must graduate with a degree, either MD or DO, and meet all other prerequisites to certification as set out by the certifying agency or "board."

The examination itself may consist of one or more parts. Traditionally, an exhaustive written examination is required of all candidates for board certifications in any specialty. While written examinations are adequate measures of basic knowledge, they do not test the mastery of skills or the application of knowledge as well. Many specialties have over the decades attempted to evaluate skills through "practical" examinations using "model" patients (actors) or by observing the physician candidate in a clinical environment. The practical examination has been criticized for being subjective and irreproducible even in the hands of an experienced examiner. As a result, computerized animatronic human patient simulator based examinations are now being adopted. The traditional written examination is also rapidly being replaced by computer-based testing.

Certifying agencies
Board certification is overseen by different agencies and organizations throughout the world. In most cases, these organizations are not only specific to a particular type of physician training (MD vs. DO), but a specific country or group of countries. There are three agencies or organizations in the United States which collectively oversee the certification of M.D.s and D.O.s in the 26 medical specialties recognized in the United States. These organizations are the American Board of Medical Specialties (ABMS) and the American Medical Association; the American Osteopathic Association Bureau of Osteopathic Specialists (AOABS) and the American Osteopathic Association; the American Board of Physician Specialties (ABPS) and the American Association of Physician Specialists. Each of these agencies and their associated national medical organization functions as an umbrella for its various specialty academies, colleges and societies:

All boards of certification now require that physicians demonstrate, by examination, continuing mastery of the core knowledge and skills for their chosen specialty. Recertification varies by specialty between every 7 and every 10 years.

Specialty colleges
Medical specialty colleges are societies that represent specialist physicians. Any physician may join these organizations, though most require board certification in order to become a fellow of the college and use the respective post-nominal letters.