Certification and maintenance of certification in surgery

The impetus for specialty board certification began in the early 1900s, when concerns about the quality of medical practice paralleled concerns about the quality of medical schools that culminated in the Flexner Report. As with the Flexner Report, many of these concerns arose from within the medical community. The first specialty board, the American Board of Ophthalmology, was incorporated in 1917. Other specialty boards formed in the ensuing decades, with a relatively large number of new boards emerging in the 1930s. At first, many of these new boards functioned in relative isolation, but it soon became apparent that there was a lot to gain by sharing experiences. This led to the formation of the Advisory Board for Medical Specialties in 1933, which in turn became the American Board of Medical Specialties (ABMS) in 1970. Table 1 lists the current 24 member boards of the ABMS, with their dates of incorporation. The formation of the American Board of Surgery (ABS) was a result of the extraordinary leadership of Graham [1,2]. He was able to successfully navigate some stormy political waters and achieve acceptance of an independent ABS among groups that either opposed its formation or wanted the ABS to be under their control. Those interested in the history of activities within the ABS should also read the early history by Rodman [3] and the more recent history by Griffen [4]. These works detail the changes over time in! the methods by which the ABS determined surgeons' qualifications for certification. What has not changed is the ABS commitment to apply the best available standards on an equitable basis. This article outlines the basis and rationale of current certification, as well as recent changes in certification pathways. It also details two very important events in the evolution of certification: the change from lifetime (indefinite) certification to time-limited certification; and, more recently.. the advent of Maintenance of Certification (MOC).