Vital Steps In Preparing For ABFAS Case Review Submission

The case review component of the American Board of Foot and Ankle Surgery (ABFAS) board certification is fairly well-defined. In regard to the rules and requirements as to how to put a case together and what is required, one can easily find this information on the ABFAS website. However, in discussing this with colleagues, below are some of the items they either found helpful in compiling a case or wish they had known in hindsight. While much of this information is most relevant to those looking to submit their cases in the near future, I think all board-qualified physicians should read this list as they can incorporate many of the hints below immediately to make their lives easier when the time comes to build the case file.

Follow the guidelines. It is helpful to make a checklist for each patient. One recommendation is to read through all of the guides ABFAS provides and write down everything needed for each patient case, including determining which sections these items would go. For example, there are preferred time frames in which to obtain postoperative x-rays. Make note of this if it doesn’t happen to be your current algorithm. Then make a master folder with these sub-folders in it on the computer to keep everything in order. The hardest part of the case review was getting everything printed, scanned and organized. 

Obtain the records. Reach out to each hospital or surgery center, and ask for the whole medical record for each patient to be scanned as a PDF file. One can subsequently sort this file into the aforementioned folder system. Do not assume that this is a complete record. Make sure to go through each record carefully. Often, there may be missing information such as radiology reports, lab reports, etc. You may have to then individually print and scan these missing pieces into your case file. 

Compile the case.Make sure to only give ABFAS what they are asking for, not the entire record.

History and physical: Submit all notes for the condition as well as those of any other provider leading up to the surgery. All of these belong in the Pre-Operative section.

Labs/imaging: Obtain all pertinent labs to the case or labs that you ordered. This is especially key when considering an infection-based case. One colleague was told anecdotally that for any amputation case, pre-operative non-invasive vascular studies are expected.

Specifically, when it comes to imaging, the ABFAS only allows one to upload a finite number of files. Merging multiple images through Microsoft Paint or Adobe Photoshop onto one document will decrease the number of files, but still allow for comprehensive presentation of available imaging. Make sure to label each image as outlined in the ABFAS submission guidelines. Also make sure you are getting four-week post-operative weightbearing X-rays. This can be an overlooked detail. 

Is there anything ambiguous in your case file? Write up a quick note and save it as a PDF for things that may not be clear or need further explanation. Examples include bilateral or unilateral concurrent surgery at the same time with a practice partner.

Conduct a dry run of the submission. As soon as you have one patient file complete, upload the file as a test run. This will show you some of the nuances of the uploading process and save you time later on when you submit the rest of your cases.

Consider any possible job changes and prepare for the future. If you change jobs before you are board-certified, make sure you can still obtain the required records at a later date. This would be worth investigating with regard to both your previous employer and local facilities at which you were credentialed. Some colleagues mention keeping staff privileges at a hospital you no longer participate at in order to be able to obtain the records. Keep any correspondence with those in the medical records department stating they will allow you to obtain patient records at a later date despite not being currently credentialed at the hospital. 

Attempt to collect as much documentation as possible during your first few years of practice to limit the amount you will need to collect later. You may consider creating files for each patient both pre-operatively and post-operatively. This will allow you to start to save all relevant information, such as chart files and imaging, early. With so many young physicians transitioning into new jobs a few years into practice, one could collect all the requisite case information prior to leaving. This would eliminate needing to return to obtain the information and you are not at someone else's mercy if ABFAS selects any of those cases for review.

Important Upcoming Changes In The Board Certification Process

The ABFAS board has adopted a change to the board certification process starting in 2020 (see: https://www.abfas.org/BecomeCertified/CertificationProcessEffectiveSeptember2020.aspx). The biggest change affecting candidates deals with the case review component. Those applying for board qualification during the Fall 2020 cycle will not need to submit a case review to ultimately become board-certified. Instead, they will just perform the CBPS exam or exams for which they are qualified (i.e., Foot or Rearfoot/Reconstructive Ankle). Those who became board-qualified prior to the fall of 2020 will still need to complete both CBPS and case review sections to reach board-certification status with ABFAS.

Questions for Discussion:

• What did you wish you did differently in preparation for the case review prior to submission?
• Do you have any tips or strategies in compiling the case review information?

Dr. Hood is a fellowship-trained foot and ankle surgeon. Follow him on Twitter at @crhoodjrdpm or check out his website www.footankleresource.com, which contains information on student/resident/new practitioner transitioning, as well as links to academic and educational resources found throughout the internet related to foot and ankle medicine.

Dr. Hood would like to recognize the following physicians for their contributions to this entry.

Chima P. Akunne, DPM, is a foot and ankle surgeon at Ochsner Health System in Baton Rouge, LA. He has recently been board-certified by the ABFAS in forefoot and rearfoot/reconstructive ankle surgery. 

Aleksandr V. Emerel, DPM, is a fellowship-trained foot and ankle surgeon at Premier Orthopaedics in Malvern, PA. He has recently passed both forefoot and rearfoot/reconstructive ankle CBPS board certification exams and plans to submit his case logs fall of 2019.

Spencer J. Monaco, DPM, is a fellowship-trained foot and ankle surgeon at Premier Orthopaedics in Kennett Square, PA. He has recently been board-certified by the ABFAS in forefoot and rearfoot/reconstructive ankle surgery.

Michael L. Sganga, DPM, is a foot and ankle surgeon at Orthopedics New England in Natick, MA. He has recently been board-certified by the ABFAS in forefoot and rearfoot/reconstructive ankle surgery.