LEAD FAQs

Each Diplomate has the opportunity to answer 20 questions per quarter. All Diplomates must complete a minimum of 12 quarters during each five-year period within their 10-year cycles.

View your program requirements.

ABFAS uses your Foot Surgery certification date to determine your participation requirements. You must still meet separate MDT requirements for your Foot Surgery certification and your RRA Surgery certification. For example, if your Foot Surgery certification expires in 2031 and your RRA Surgery certification expires in 2030, you must meet your RRA Surgery MDT requirement in 2030.

If you hold both certifications, your LEAD assessment is still 20 questions in the quarter:10 Foot Surgery questions and 10 RRA Surgery questions.

Yes, all ABFAS Diplomates must participate in LEAD, even if you have administrative, inactive, or surgically inactive status.

For Diplomates holding time-limited certificates, your participation requirements are dependent upon your Foot Surgery certification expiration date. Please take a look at the LEAD Program requirements page on our website to learn your specific requirements. Your individual requirements will provide guidance as to when you should start LEAD to ensure you meet the participation requirements.

For Diplomates holding lifetime certificates (those certified prior to 1991), your first five-year cycle started in January 2022. You must complete 12 quarters by June 30, 2027.

ABFAS encourages all Diplomates to start participating in LEAD as soon as they can, rather than waiting until the last minute. 

If you don’t participate and have a lifetime (pre-1991) certification, your ABFAS status will show as non-compliant. If you have a time-limited certificate, your certification will expire on your current expiration date, not renew.

The LEAD design allows you flexibility in when you participate, as long as you meet your certification expiration year’s participation requirements. Please see the interactive tool on our website. You will see the number of quarters you must participate over a certain time period. There is no requirement to answer in contiguous quarters.

ABFAS offers accommodations for LEAD participants. You will find the information on the ADA Accommodations webpage.

LEAD questions are multiple choice, with four possible answers to each question.

Yes. If you fall below the MDT p-value standard, you can improve your performance by continuing to answer questions in any remaining quarters, even if you have already met the participation requirements.

You must be at or above the MDT p-value standard of 0.1 by June 30 of your ABFAS Board Certification expiration year to meet requirements for board certification renewal. ABFAS evaluates MDT only on June 30 of each certificate’s expiration year.

If you were certified in foot and ankle surgery prior to 1991, you still need to participate in LEAD and will become non-compliant if you do not. You will see your MDT p-value, but it will not impact your certification status.

ABFAS will review the MDT p-value standard annually in consultation with our psychometrician.

MDT analyzes the probability that you are keeping up with topics relevant to the practice of foot and ankle surgery. Unlike a pass/fail exam, LEAD is not a fixed length and there is not a required number of correct responses required to pass. Instead, LEAD is continuous and self-paced where you are given an updated MDT p-value after you answer each question. There is always an opportunity to improve your MDT p-value.

Every time you answer a question, your MDT chart will update automatically to show your most recent MDT p-value. For more information, please see page 9 of the LEAD Program Manual.

Measurement Decision Theory (MDT) is the method ABFAS uses to analyze Diplomates’ performance on the Continuous Certification LEAD assessment.

No. Each five-year period, Diplomates with time-limited certificates must attest to having performed surgery in the last two years. ABFAS will periodically audit attestations, and those we select for audit must must provide documentation of active surgical privileges from one hospital or surgery center.

The ABFAS Continuous Certification Committee reviews all feedback received through the LEAD program. ABFAS staff, in consultation with an independent psychometrician, also regularly monitors the performance of LEAD questions. In response, the committee may edit or remove a question (or its rationale) from future LEAD assessments. Please note that due to the volume of feedback, you will not receive a direct response to your individual comment(s).

The LEAD program emphasizes continuous, lifelong learning and provides an educational benefit to Diplomates. ABFAS designed the LEAD program to be less burdensome—not more—than the now-retired ABFAS recertification and self-assessment exams.

LEAD is not a pass/fail exam, and Diplomates no longer need to travel to a testing center; you can complete each quarter’s questions where and when you choose on your own computer, laptop, or mobile device.

ABFAS’ mission is to protect public health. Prior to certification, we focus on ensuring high standards in foot and ankle surgery. Post-certification, we augment our mission by also supporting Diplomates in keeping their knowledge, judgement, and skills current over the course of their careers—and the LEAD program represents a powerful tool to help ensure the continued success of Board Certified foot and ankle surgeons. The public benefits by ABFAS Diplomates participating in LEAD.

The desire to explore alternatives to the traditional, once-every-ten-year recertification and self-assessment examinations stems from recent trends in the recertification processes for member boards of the American Board of Medical Specialties (ABMS).

One of the main features of the new LEAD program is your opportunity to demonstrate continual competence through bite-sized learning assessments. LEAD replaced the traditional, once-every-ten-years recertification and self-assessment examinations.

All 24 ABMS Member Boards have implemented formative assessments for continuing certification. Seventeen—including the American Board of Orthopaedic Surgery—have implemented longitudinal assessments, like the LEAD Continuous Certification program.

Yes, only you have access to your MDT p-value and participation information. ABFAS does not share this information. 

The ABFAS Board of Directors appointed a task force to work on this change in 2018. In 2019, ABFAS announced the shift to Continuous Certification and conducted a survey of all Diplomates regarding their preference for a Continuous Certification program to replace ten-year recertification exams. More than 70 percent of survey respondents were in favor of a Continuous Certification program. The ABFAS Board of Directors approved the shift to Continuous Certification, which went live on January 10, 2022.

The shift to Continuous Certification does not change your current certification cycle. Your certification is valid through your current expiration date. If you participate and meet program requirements, your certificate will renew at the ten-year date.

The LEAD program of Continuous Certification is funded through your annual fee, not an additional, separate recertification examination fee.

While you can use your smartphone to participate in LEAD, there may be images that are difficult to see on a small screen, so we recommend using a tablet or computer to access the assessment.

LEAD provides for self-directed study. We recommend that you review the What to Expect on the LEAD Assessment webpage to become familiar with the assessment structure and topics. If you answer a question incorrectly or aren’t sure why the answer was the best answer, you will see a rationale and references so that you can learn more about the particular topic. 

Your performance will improve as you answer more questions correctly.

ABFAS has a team of Diplomates who serve as item (question) writers. After undergoing training on how to develop an item, the writers research an assigned topic and develop a question, citing references in order to ensure they have identified the best answer. They also provide the rationale for the answer. A separate team of reviewers vet and refine the question to make sure it meets psychometric standards.  If you are interested in becoming an item writer, please contact us at info@abfas.org.