The American Board of Dermatology – Background and Overview
Certifying Exam – Content
Certifying Exam – Requirements + Scheduling Issues
Certifying Exam – Grading/Passing
Maintenance of Certification
QUESTIONS + ANSWERS
The American Board of Dermatology – Background and Overview
What does it mean to be board certified?
Becoming Board certified is a process that involves much more than preparing for and passing an examination. Certification by the American Board of Dermatology (ABD) is the public’s assurance that the certified individual has satisfactorily completed rigorous training in an accredited program, as well as having passed a comprehensive examination. Initial certification is simply the portal into a career-spanning process of maintenance of certification (MOC) to continue that assurance to the public.
Who are the certifying and accrediting organizations in dermatology?
The ABD certifies dermatologists who meet qualifications in dermatology, dermatopathology, and pediatric dermatology. The ABD is a Founding Member of the American Board of Medical Specialties (ABMS), an organization consisting of 24 Member Boards. The ABMS reviews and approves Member Board maintenance of certification processes. The ABMS Member Boards certify the majority of medical specialists in the US.
The major accrediting organization for training programs in the US is the Accreditation Council for Graduate Medical Education (ACGME). The ACGME, in concert with its Residency Review Committees (RRC), sets and maintains national standards of graduate medical training. In dermatology, it currently accredits 138 residency programs, 53 dermatopathology fellowships, and 78 Micrographic Surgery and Dermatologic Oncology fellowships. The ABD is involved in the process through the contributions of members of its Board of Directors who serve on the RRC along with appointees from the AMA.
Who are the educational and advocacy organizations in dermatology?
There are many specialty and subspecialty groups that function as educational and advocacy organizations. The largest of these is the American Academy of Dermatology (AAD). These educational and advocacy organizations are independent of the ABD. For more information, see What is the difference between the ABD and the AAD? For a discussion of the differences between certifying Boards and professional Societies refer to the following article: Boards Evaluate, Societies Educate by Harry Hurley.
What is the American Board of Dermatology? Who are its directors?
The American Board of Dermatology (ABD) is one of 24 medical specialty boards that make up the American Board of Medical Specialties (ABMS). It exists to assure safe, high quality dermatologic care for the public by setting, promoting and assuring standards of excellence in the practice of our specialty. The ABD is a voluntary, non-profit organization formed for the primary purpose of protecting the public interest by establishing and maintaining high standards of training, education and qualifications of physicians rendering care in dermatology.
The ABD is composed of 17 Directors (16 dermatologists and one Public Member), an Executive, Associate and Assistant Executive Director, and 5 staff members. Each director is elected to the board and serves a 9-year term.
For further information, see About the American Board of Dermatology.
What is the difference between the American Board of Dermatology (ABD) and the American Academy of Dermatology (AAD)?
The American Board of Dermatology (ABD) is an autonomous body that acts as the certifying agency for the specialty of dermatology.
The American Academy of Dermatology (AAD) is the largest national professional society for the specialty of dermatology. Its purposes are to educate dermatologists and the public, and to represent the specialty on issues concerning other professional organizations, the public, industry, and the government. Membership in the AAD is not limited to Board certified dermatologists, but includes other dermatologists, other physicians and health care providers from all over the world who have an interest in the field of dermatology.
For more information, see What is the difference between the ABD and the AAD?
For a discussion of the differences between certifying Boards and professional Societies refer to the following article: Boards Evaluate, Societies Educate by Harry Hurley.
What are the ABD’s expectations of professionalism in its diplomates?
Please refer to the American Board of Medical Specialties Definition of Medical Professionalism.
When I attend program-approved dermatology conferences like the American Academy of Dermatology Annual Meeting, do I count that towards my 6 weeks (30 weekdays) per year or 14 weeks (70 weekdays) total time away from training?
Residents may have up to 1 week (5 weekdays) per year for educational leave and anything beyond that would be at the discretion of the program director.
Certifying Exam - Content
Is the board secretive about the content areas we should expect on the certifying examination?
The ABD has created a content grid that maps the various subjects found on the certifying examination. This content grid is used when constructing the examinations of the ABD, and is made available for review by residents and diplomates (see Primary Certification Exam – Examination Content).
Not every item on the content grid is represented equally on the test. There are subspecialty competency percentages defined for each examination. Examples for the Certification Exam include medical dermatology (55%), pediatric dermatology (10%), dermatopathology (15%), surgical dermatology (10%), and dermatology basic sciences (10%).
Strong effort is made by the ABD to include timely and evidence-based questions with one best answer. All questions are created using evidence-based review, revised and reviewed thoroughly by the test review committee, and re-reviewed by the final examination committee.
Does the certifying examination contain a lot of minutia, like genes and rare syndromes, and things that are clinically irrelevant to practicing dermatologists?
The basic sciences are an important part of the training of dermatology residents (see Residency Training – Core Competencies). Basic science topics are included on the certifying examination. During the question writing, reviewing and test assembling processes, emphasis is placed on testing concepts that have applicability to clinical medicine, as well as those that test a candidate’s comprehension of basic science function, rather than rote memorization.
Clinical diagnosis in dermatology includes knowledge of not only common diseases but also those that are rarer, including syndromes that have skin manifestations. Common and rare skin diseases may share common clinical features, and thus a knowledge of rare syndromes is important in order that the clinician can make a correct diagnosis. The ABD believes it is important for board certified dermatologists to be able to diagnose and manage uncommon skin disorders so that they are correctly identified as the experts of choice to diagnose and manage these patients.
Do I need to study radiographs for the certifying exam?
Certain dermatologic disorders have associated radiographic findings. However, the ABD does not feel that it is within the scope of dermatology training or practice for dermatologists to independently read radiographs, and therefore, candidates will not be asked to identify radiographic findings. Nevertheless, when a dermatologic disease requires further evaluation by other specialties for diagnosis or treatment, candidates must be able to request an appropriate study or consultation. This could include not only radiology, but also ophthalmology, hematopathology, vascular surgery and others as well.
Do I need to know disease eponyms for the certifying examination?
Many dermatologic diseases are known by several names or synonyms. Certain dermatologic disorders are frequently associated with a name that includes an eponym in the title (for example, a “Becker’s nevus”). At times, the eponym name and the alternative non-eponymous name are used in the dermatology literature at about the same rate. In either circumstance, identification of the disease eponym would be a reasonable expectation. However, in cases in which the disease name containing an eponym is infrequently used, the candidate can be assured that the more common name will be included as the choice.
Will I need to identify fungal plates on the certifying examination?
Certain infections have characteristic findings when grown on culture media. However, the ABD does not feel that it is within the scope of dermatology training or practice for dermatologists to independently read culture plates, and therefore, candidates will not be asked to identify culture plates of fungal, bacterial or other organisms growing on culture media. Nevertheless, candidates are expected to understand what diagnostic studies are appropriate with various infections, for example which infections will not grow in standard media, and how to interpret diagnostic study results. Such diagnostic approaches are not limited to infectious diseases, but could also include hematopathology, radiology, genetics, therapeutic indices (for example, drug metabolism enzyme activity levels) and others as well.
Will all the dermatopathology questions on the certifying examination involve glass slides?
A significant percentage of the dermatopathology portion of the examination involves glass slide review using microscopes. There will not be any immunofluorescence glass slides for interpretation. Other portions of the exam will contain questions about dermatopathology that may or may not involve digital images, including questions about direct or indirect immunofluorescence studies.
Why doesn’t the Board share more examples of certifying exam questions with us?
The ABD maintains a bank of vetted test questions. Each time a question from the bank is released to the public, it becomes ineligible for future testing. The same is true of images. Many dermatology questions are associated with clinical images, and one excellent image can often serve as a basis for several future questions. Despite this issue, the ABD continues to explore ways to provide residents and diplomates with sample questions for review and study.
Certifying Exam – Requirements + Scheduling Issues
What can I do if I don’t agree with the yearly program evaluation submitted to the ABD by my program director?
Residents receive an electronic copy of the annual ABD resident evaluation completed by their program director. After reviewing it, every resident is provided with the opportunity to agree or disagree with the assessment as submitted and comment. These comments are sent to the ABD office for review and not back to the program director. In cases of significant dispute, the ABD reserves the right to make inquiries by speaking with the resident, the program director, or both.
Are there set numbers of dermatology procedures that I need to complete to be eligible to sit for my general dermatology certifying examination?
The ABD does not set requirements for procedure totals for dermatology residency training. This is the purview of the Dermatology Residency Review Committee of the ACGME. Candidates should refer to the ACGME Program Requirements for Dermatology.
I missed time during residency for medical leave (this would include maternity leave). Will I still be eligible to sit for the boards?
Any departure from continuous full time training, such as time lost for a medical leave of absence, must be documented and communicated to the Board in the resident evaluation forms filed annually by the program director. An absence exceeding six weeks in any one academic year, or a total of 14 weeks in three years, may necessitate additional training to successfully “make up” for that lost time. If the program director anticipates that this additional training will be completed in a satisfactory manner before September 1, a letter may be submitted to the Board requesting approval for the resident to sit for the July Certifying Examination. The letter must indicate the training period's anticipated completion date. The resident will not receive exam results or a certificate until the program director completes the annual evaluation at the conclusion of the extended training period. If the time is not made up, any resident approved to sit for the certifying examination despite such an absence must have completed each year of training in an above average or excellent manner as recorded on the annual residency evaluation forms. For additional information, see Requirements to Take the Certifying Exam: Guidelines for Determining Adequacy of Clinical Training.
If my training gets extended during my first year or second year, for whatever reason, will I be automatically disqualified or delayed from sitting for my certifying examination?
Residents progress at different rates through dermatology training. Residents may be delayed from progressing to the second or third year resident level by their program’s clinical competency committee. Reasons can include not attaining critical milestones, a low general performance assessment, inadequate progress with an ongoing performance improvement plan, or time away from training in excess of 6 weeks. However, it is possible for residents with slow progress during the first part of residency to accelerate in their assessed performance at a later time, and become eligible to take the certification examination at the regularly scheduled date. For specifics about leave-of-absence issues, see FAQ: I missed time during residency for medical leave (this would including maternity leave). Will I still be eligible to sit for the boards?
What happens if I am deployed on military duty when the certifying examination is scheduled to occur?
In circumstances where a resident is deployed on military duty and unable to attend the certifying examination, there is a 5 year time frame of eligibility to sit for the certifying examination, that may be extended by up to 2 years. For more details, see FAQ: How many times can a candidate take the Certification Exam?.
If I am late in finishing my residency training, can I still sit for that year’s certifying exam?
Candidates who will complete residency training after June 30 will be allowed to take the certifying exam if (i) they will finish all training by September 1, and (ii) their program director attests to successful completion. Examination results will not be provided before the ABD receives the final year evaluation form indicating successful completion of training.
If I wish to defer sitting for the certifying examination after I have already paid the fee, do I lose my money?
If a candidate withdraws within ten (10) days of an examination or fails to appear for the examination and does not provide verifiable evidence of extenuating circumstances that prevented the candidate from appearing for the examination, the candidate will forfeit their entire examination fee. On reapplying, such candidates will be required to again submit the examination fee in effect at the time of the application. Candidates must notify the Board office in writing regarding all withdrawals from examination. Withdrawals will not be accepted by phone. If a candidate withdraws prior to ten (10) days of the examination, the entire fee will be carried over to the following year for one examination only.
How many times can a candidate take the Certification Exam?
Candidates may take the certifying exam as often as the test is offered during the first five years after the completion of training. Beginning January 1, 2012, residents who complete an approved dermatology residency will not be permitted to take the certifying examination more than five years following the completion of their training. Therefore, physicians who completed dermatology residency training prior to 2012 will not be permitted to take the certifying examination after December 31, 2016. A dermatologist who has not met these requirements may not claim to be “board eligible” unless the ABD determines that the physician has been prevented from taking the examination within the applicable five year period because of military deployment or by catastrophic illness. If either of these situations exists, a dermatologist wishing to claim to be “board eligible” or wishing to take the examination after the expiration of the five year period may be granted a one or two year deferral by making application to the Board. The decision to grant or deny a deferral will be at the sole discretion of the Board. This policy also applies to diplomates completing subspecialty fellowships with certification examinations.
Certifying Exam – Grading/Passing
How is the certifying examination graded?
The ABD certification examination is a “criterion-based” test. This means that it is possible that all candidates could pass the test if they perform at a certain level. With criterion-based testing, there is no pre-defined failure rate. For example, the ABD does not state that “candidates performing X standard deviations below the mean will fail,” which would be an alternative form of testing known as “normative-based” testing. The ABD performs standard-setting exercises with the examinations to determine appropriate cut-off values for passing. The performance of each question on the examination is studied by examination scientists, called psychometricians. They calculate question performance to determine question fairness and level of difficulty. Questions that clearly do not meet testing standards of performance are identified by psychometricians, reviewed by ABD directors, and may not be included on the final calculations of pass/fail for candidates. A small percentage of psychometrically sound questions are repeated each year, to allow comparison of examination difficulty across different years of testing.
Do you define ahead of time the percentage of certification exam candidates who should fail?
No. The ABD certification examination is a “criterion-based” test. This means that it is possible that all candidates could pass the test if they perform at a certain level. With criterion-based testing, there is no pre-defined failure rate. For example, the ABD does not state that “candidates performing X standard deviations below the mean will fail,” which would be an alternative form of testing known as “normative-based” testing.
Do residents from smaller programs have a harder time passing the certifying exam?
There is no data to suggest that there is any significant variance in passing rates for the certifying exam based on residency program size.
Should I worry that other dermatology residents in the country are sharing information about the certifying exam that will hurt my chances of scoring high enough to pass?
Every dermatology candidate taking an ABD examination is asked to sign an honor code statement that includes the promise to not share information about the certifying examination with others, including those who have not yet taken the examination. In addition, residents within the same program are usually scheduled to take the certifying examination on the same day, to minimize inappropriate communication. In addition, psychometricians working for the ABD study the examination’s performance over time, to identify any potential examination “drift” for tests that are given to different candidates over multiple days. Exam drift refers to examination scores rising higher at the end of the time interval. If exam drift occurs, it would suggest that candidates taking the test earlier might be sharing test contents with those taking the examination later. To date, no examination drift has been identified on an ABD certifying examination. Significant examination drift would result in the invalidation of the entire administration. Any candidate or resident aware of another candidate sharing information about the certifying examination content with others should notify the ABD office immediately at communications@ABDerm.org or (617) 910-6400.
Maintenance of Certification
As a graduating resident taking and passing the ABD certifying examination, when do I enter MOC and when should I start completing the component requirements?
Upon passing the certifying examination, new diplomtes are automatically enrolled in the MOC program. Your MOC period begins on January 1 after the July certifying examination. Participation in MOC components prior to the onset of the MOC period is not discouraged, but diplomates are not currently eligible to count MOC credit for their activities until their MOC period commences. In your first year, you must attest by December 31 that you have a full, valid and unrestricted medical license. By December 31 you must attest to completing at least 25 CME credits and pay the $150 Annual Fee. In subsequent years, you must attest to 25 CME credits every year, complete three (3) self-assessment exercises over the 10 year cycle, and complete one portion (measure baseline, intervene to improve, and remeasure results) of Component 4 twice in the 10 years. For more details see MOC FAQ: What are the requirements for participating in MOC?.
I am doing a fellowship following my dermatology residency. When does MOC start for me?
You enter MOC the year after you pass the ABD certifying examination. However, those who enter fellowships are exempt from having to earn CME for MOC and from paying the annual $150 MOC fee for the full year after passing the certifying exam. You will be required to obtain 25 hours of CME credits per calendar year and begin paying the annual $150 fee in the year following your waived year. For example, if you took the certification examination in July 2015 and completed a fellowship from 07/01/2015-06/30/2016, then your CME accrual begins January 1, 2017 and the annual fee is due by December 31, 2017. Check your MyMOC Table or MyMOC List in the diplomate-restricted portion of the website to make sure you have received credit for your fellowship year. For more details see MOC FAQ: What are the requirements for participating in MOC?
Will the ABD remind me when I have a MOC deadline coming up? Will they tell me if I have missed a MOC deadline?
The ABD publishes timelines for MOC activities. Currently, it is the responsibility of the individual to meet those deadlines. However, the ABD sends quarterly reminder emails to notify you of what requirements you are missing and to alert you to future requirements.