The exams surgeons take to keep their board certification run on software we built

A board certification is only as current as the last exam

The American Board of Facial Plastic and Reconstructive Surgery certifies surgeons in one specialty. Its stated mission is "Improving the quality of medical and surgical treatment available to the public", and a large part of that work happens after a surgeon is certified. Every year, certified surgeons complete an online exam that counts toward maintenance of certification, the process that keeps the credential their practice depends on current.

That exam runs on a platform we built. So do the practice exams that candidates use to prepare.

Two people meet on either side of this screen. One is the board's examination director, who answers for the exam being right and being available. The other is a working surgeon who opens this year's module between patients, often in whatever half hour the day allows. If the exam is confusing, or loses an answer, a credential is on the line, and the board's small staff hears about it first.

The board needed exam software, and had a website

For years, keeping a certification current meant travel. The board held its exams in person, in cities around the country, and a surgeon gave up days with patients to sit one. The board wanted to give certified surgeons a convenient way to meet the requirement online, from wherever they practice.

A yearly exam is a different thing from a web page. It changes every year. Questions are written, reviewed, retired, and replaced. Surgeons start a module one day and finish it another, sometimes on a different computer, and every answer along the way has to be where they left it.

The board also wanted the exam to teach. A surgeon who gets a question wrong should find out and have a chance to think again. That is the board's approach to assessment, and the software had to follow it faithfully.

Then there is preparation. Candidates getting ready for their exams need practice tests, and the board decides each year who is eligible to take them. Someone on staff has to manage that list, and nobody wanted a second list in a second system.

Underneath all of it sat a plain staffing fact. The board is a small office. If every new exam year, every retired question, and every change to the eligible list needed a developer and a release, exam season would run on our calendar and not on theirs.

What we built, and who each decision was for

Staff run the exam. Each year's exam, its modules, and every question live in ordinary editing screens inside the system the board's staff already use for their website. They build next year's exam, retire a question, or fix a typo themselves, so the examination director never waits on us to get an exam ready.

A missed question gets a second chance. When a surgeon answers incorrectly, the exam says so and offers one more try. The surgeon learns something in the moment, and the board still sees which questions trip people up the first time, which helps it write better exams. The design is the board's. Our job was to build it exactly as they described it.

An update never disturbs someone partway through. Exams change, sometimes during the year. When the board publishes a new version of a module, anyone who has already started finishes the version they began, with every answer intact. A surgeon who is halfway through a module on Tuesday finds it just as they left it on Friday, whatever staff published in between.

Practice exams open only to the people the board has approved. Staff upload the year's approved list on the main website, and the practice site checks it when a candidate arrives. Staff keep one list in one place. A candidate who is not on it sees a polite note pointing them to the board office, because the board asked that nobody be met with a cold refusal.

Surgeons also sign in to the exam with the same account they use on the board's main site. That connection is its own story.

Exam season is quiet

The examination director and the rest of the staff put together each year's exam on their own and open it when the board is ready. Surgeons meet the requirement from their own office, with no flight and no days away from patients. They work through their modules in the gaps of a clinical day and pick up where they stopped. Candidates on the approved list get into the practice exams without a phone call to the office.

We hear from the board when they want something to work differently, and that is the right amount. Our part is the quiet work underneath: hosting both exam sites, keeping them updated, and answering when staff have a question. For software that a surgeon's credential passes through once a year, uneventful is the goal, and it is what the board has come to expect.