ABO certification in the age of evidence and enhancement

The American Board of Orthodontics (ABO) phase III certification examination was originally constructed and recently modified to "help the Board determine the candidate's knowledge of clinical orthodontics and provide a basis to assess the quality of the candidate's clinical treatment results." For the most part, the ABO phase III examination measures the orthodontic treatment-induced changes in occlusion in a limited and biased patient sample. The process and outcome measures used in the current model-the discrepancy index and the objective grading system-are so narrowly focused that an orthodontist might lack up-to-date clinical knowledge, psychomotor and critical thinking skills, diagnostic acumen, patient management ability, and patient-centered ethics, and still pass the examination largely because of mechanically morphing the patient's teeth into the board's construct of ideal occlusion. The goal of this article is to provide provocative insight into the core concepts that drive the ABO phase III certification process and to recommend an alternative paradigm predicated on a patient-centered, evidence-based clinical practice model.