EDITORIAL

The American Board of Orthodontics hits ahome run

David L. Turpin, Editor-in-Chief

Seattle, Wash

The American Board of Orthodontics (ABO) hashad many articles published in the past year, butthe one in this issue, “A change in the certifi-

cation process by the American Board of Orthodon-tics,” is especially important because it proposes solu-tions to a most vexing problem. Take time to read it . . .set it aside . . . then read it again before you jump toconclusions.

For as long as I can remember, about a quarter ofAmerican Association of Orthodontists membershave been board-certified. As our orthodontic worldshrinks because of expanding information technol-ogy, professional credentials become more importantto the public. In 2001, I wrote an editorial (Am JOrthod Dentofacial Orthop 2001;120:337-8) chal-lenging the ABO to step up to the plate, noting that,“We can continue to rely on enthusiasm to increasethe percentage of certified orthodontists, or we cantry a bold new approach before someone else does itfor us.” The ABO has exceeded my expectations withthe proposed changes.

In the early years of the board (1929 to the1950s), many orthodontists obtained diplomate sta-tus by credentialing. In the 1950s and 1960s, eachapplicant wrote a thesis and presented case reports.The Phase II written examination was implementedin 1964 and the thesis requirement eliminated. Since1994, the board has worked to upgrade its objectivityin assessing clinical records. With increased empha-sis on evidence-based practice, the Objective Grad-ing System was developed. The ABO has modifiedthe examination process to increase efficiency andencourage more practitioners to become certified,but, despite these noble efforts, after 75 years ofABO existence, the percentage of AAO memberswho have attained board certification remains stuckin the mid-twenties.

Based on close scrutiny of our specialty’s mis-sion, the board now believes that every educationally

Am J Orthod Dentofacial Orthop 2005;127:274-50889-5406/$30.00Copyright © 2005 by the American Association of Orthodontists.

doi:10.1016/j.ajodo.2005.01.006

274

qualified orthodontist should demonstrate clinicalcompetency by completing the ABO certificationprocess after training and via periodic reexamina-tions. This thinking has led to a new premise: Earlyentry into certification followed by continued reex-amination throughout an orthodontist’s career willencourage a higher standard of care. This is apotentially effective means of encouraging the de-velopment and maintenance of a practitioner’s clin-ical skills. This system is intended to ensure contin-ued competency and progress toward proficiency,serving both the public and our specialty.

But how will the current board accomplish the loftygoal of engaging most of our members in the certifica-tion process?

First, the ABO will invite practicing orthodontiststo become certified via the Gateway Offer, a 1-timeopportunity between March 1, 2005, and July 1, 2007.Study this option and the alternatives for eligibleorthodontists and those who have not yet passed thePhase II examination.

For several years, the board has considered cer-tifying orthodontists after their university education.A pilot study was begun in the summer of 2002 toevaluate offering early certification to graduates byusing cases treated during their residencies. Asresults of this study become known, and with inputfrom educators, a new Phase III initial certificationexamination will be developed in 2007. A 10-year,time-limited certificate will be issued on successfulcompletion of the Phase II and Phase III examina-tions.

Don’t overlook recertification as a component ofmaintaining board certification—something now re-quired by most medical specialties. The value of thisconcept was discussed in an article in December2004.

With these changes, certification should becomethe norm for our specialty rather than the exceptionand will facilitate continuous quality assessment.Thus, the public will come to trust our system to

provide information about the competency of orth-

American Journal of Orthodontics and Dentofacial OrthopedicsVolume 127, Number 3

Editorial 275

odontists. In addition, orthodontic training programscould use the Phase III initial certification examina-tion as an “objective external outcomes measure” toevaluate their clinical curricula. The long-term out-comes of several of these tests could yield a stan-dardized North American testing system that objec-

tively evaluates the resident training process, thus

fulfilling an original objective of the ABO’s found-ing directors.

As editor of your Journal, I introduce with greatpride the ABO’s latest article. I have never seen a groupwork as hard as these dedicated ABO directors toelevate the level of care for the public we serve. This

achievement is the measure of a true professional.