Staged Pathway to Initial Certification Launched

Staged Pathway to Initial Certification Launched

By Lela A. Lee, M.D.*

In July, 547 candidates took the ABD’s first APPLIED Exam, the final step in the Staged Pathway to Initial Certification.  

The era of traveling to the Holiday Inn O’Hare or the American Board of Pathology in Tampa is officially over!  It was inevitable that technological advancements would eventually allow the ABD to dispense with the pencil-and-paper answer sheet, slide projectors, and microscopes in favor of computer-based exams, digital images, and virtual dermatopathology.

But the new certification pathway represents much more than that - it represents a fundamental change in direction.  The Certification Exam has historically emphasized visual diagnosis and knowledge base.  While these are essential components of becoming a good dermatologist, they are not sufficient.  The ability to apply knowledge to make good clinical decisions is critical. 

In the mid-2010’s, the ABD Board of Directors began an initiative to change the Certification Exam, to make it a better test of clinical competence.   We developed a draft proposal, consulted ABMS Boards that had changed their exam structure, solicited input from dermatology residency program directors, and worked with technology vendors to build the required infrastructure.  The question-writing committees began the task of writing and vetting new types of questions to test application of knowledge and clinical judgment.  Not surprisingly, these were much more difficult to compose than visual diagnosis and knowledge base questions. 

The structure of the new staged exam is based on a natural progression of learning the basics (the BASIC Exam), acquiring more advanced knowledge (the CORE Exam), and learning how to apply that knowledge in realistic clinical situations (the APPLIED Exam).  More detail about these exams, including more information about content, is available through the links below.

The BASIC Exam is taken in the spring of a dermatology resident’s first year.  It tests fundamentals such as visual recognition of common conditions, management of uncomplicated conditions, and familiarity with simple surgical procedures.  It is not required for certification.  Its purpose is to measure progress, identify residents who are having difficulty, and ensure that residents learn the basics that we sometimes take for granted that they know.  The four-hour exam contains approximately 200 multiple-choice questions and is administered at the residency training program.

The CORE Exam modules assess whether candidates have attained the core knowledge a practicing dermatologist is expected to have. These modules cover four major clinical areas: medical, pediatric, surgical and dermatopathology.  Basic science related to the clinical areas is included within each module.  This exam is given during residency.  Candidates may begin taking the modules after 1.5 years of training.  Each two-hour module consists of 75-100 multiple-choice questions. Candidates must pass all four modules but may choose in what order they take them and how many they take at one time. These exams are offered four times during residency.  They can be taken either at a Pearson VUE test center or via online proctoring at the resident’s choice of location. Candidates who do not pass a CORE module can take it again in a few months.  In the first cohort of residents in the new certification pathway, the residents who graduated in June 2021, more than 90% passed a module on their first try, and 99% passed all four modules by the end of residency.  Those who do not complete all modules by the end of training have up to five years to do so. Candidates must pass all four modules to be eligible for the APPLIED Exam.

The APPLIED Exam is the centerpiece of the new pathway.  It assesses how well a candidate for certification can apply their knowledge in clinical scenarios relevant to the practice of general dermatology. It is an eight-hour exam with approximately 200 multiple-choice items.  It tests a range of skills such as selecting appropriate therapy, knowing when to order tests and when not to, recognizing when referral is indicated, modifying management depending on response to therapy, and recognizing and managing complications.  The characteristics of an individual patient, including comorbidities, patient preferences, ability to comprehend and communicate, and other concerns, need to be considered as part of the decision-making.  The first APPLIED Exam recently concluded; results will be available in early Fall.

It has been a long, and sometimes bumpy, process to get to this point. It has involved so many people and moving parts including question writers and reviewers, editors, exam draft reviewers, psychometricians, item bank software developers, virtual dermatopathology software developers, website developers, exam publishers, online proctors, online proctoring software, and test center administrators.  A great deal of credit goes to our talented and hard-working seven-member ABD office staff, my wonderful colleagues on the Executive staff, Tom Horn and Randy Roenigk, and the volunteer 17-member boots-on-the-ground Board of Directors, past and present, who’ve spent many hundreds of hours working toward this goal.    

I have some fond and not-so-fond memories of the old days at the Holiday Inn O’Hare, from schlepping my borrowed microscope from Denver for my own certifying exam (stored in the pilot’s cabin for safekeeping!), to years of supervising the exam when there was concurrently a dog show (fond memory), a debutante ball (neutral), and an odoriferous nail polish convention (not-so-fond).  I am looking forward to seeing how the new certification pathway evolves, and to assist the new leadership crew as they work to continuously evaluate and improve our exams.


 *About the Author:

Lela Lee, M.D., is the ABD Senior Executive Consultant. During more than three decades of service to the ABD, Dr. Lee has experience in nearly every aspect of certification – from item (question) writing, to communications, to exam development. She was the chief architect of the staged pathway to initial certification – originally called “The Exam of the Future.”

Now, she provides continuity during the transition to a new executive leadership team.

During her tenure as ABD Associate Executive Director (2013-2021), she led the initiative to transform the ABD’s initial certifying examination, placing more emphasis on application of knowledge and clinical decision making. She initiated the practice of providing materials -- including study guides, content outlines, and sample items for the new exams -- to help examinees better anticipate the content on which they will be tested.