SPORTS
MEDICINE CONJOINT
EXAM
FOR RECERTIFICATION
OF
ADDED
QUALIFICATIONS
APPLICATION PACKET – 2012 Exam
CONTACT: AOA – Certifying Board Services
Phone: (312) 202-8195
Email:
ekraynak@osteopathic.org
Examination Date Tuesday, April 17, 2012
During
AOASM 27th Annual Clinical Conference
April
18-22, 2012
Location Marriott Louisville Downtown Hotel
in
First Application Deadline Postmark – Tuesday, January
17, 2012 (no penalty)
Final Application Deadline
Postmark – From January 18 – February 17, 2012 ($100.00 penalty)
INFORMATION
FOR THE SPORTS MEDICINE EXAMINATION FOR
CERTIFICATION
OF ADDED QUALIFICATIONS
The Sports Medicine Examination process for recertification
of added qualifications is conjointly developed by interested osteopathic
specialty boards and the American Osteopathic Academy of Sports Medicine. A Sports Medicine Conjoint Examination
Committee has representation from each participating specialty board and
academy.
This process is designed to recognize excellence among those
who provide care to persons who participate in athletics or exercise
programs. The examination evaluates an
understanding of the scientific basis of the problems involved in Sports
Medicine, the familiarity with the current advances in Sports Medicine, the
possession of sound judgment and of a high degree of skill in the diagnostic
and therapeutic procedures involved in the practice of Sports Medicine.
Definition
Sports Medicine is that branch of the healing arts
profession that utilizes a holistic, comprehensive team approach to the
prevention, diagnosis, and adequate management of sports and exercise-related
injuries, disorders, dysfunctions and exercise-related disease processes.
The specialty
of Sports Medicine consists of the following:
A. The comprehensive medical management of the
athlete which requires an understanding across a broad scope of
specializations.
B.
An understanding of performance aids, coaching techniques and training
skills.
C.
The science of injury prevention and recognition, advanced
rehabilitation techniques and
epidemiology.
D.
The application of wellness through cardiovascular training of the
general public as well as
athletes with disability.
E.
The application of sports science in improving the health care of
athletes.
F.
The recognition of the special medical problems of athletes.
G.
The application of osteopathic principles to athletes.
H. The term
athlete refers to an individual who is engaged in sport, exercise or physical activity at the
recreational, competitive, industrial, professional or elite level.
Eligibility
Applicants
must meet the following minimum requirements:
-
Primary certification and Sports Medicine CAQ is current and in good
standing.
-
Hold a full, unrestricted license to practice medicine in state where
practice is conducted.
A suspended or revoked license in any jurisdiction at the time of application
will not be admitted to the examination.
-
Current member in good standing of the AOA for at least
the two consecutive years immediately prior to application.
-
Current practice to include at least 20% in Sports
Medicine.
-
Documentation on the AOA Activity Report for 2010-2012
and the current cycle of at least 120 CME hours for the previous three years
with 50 of those hours in approved Sports Medicine courses; 25 hours must be
from AOASM sponsored programs. The
remaining 25 hours may be distributed among the following sources –
§
AMSSM sponsored programs.
§
ACSM Team Physician Course.
§
AAFP or ACOFP Sports Medicine course.
§
Presenting Sports Medicine lectures at state or
national conferences; a maximum of 3 hours per lecture (for speaking and
preparation) will be awarded by the Committee with a maximum total of 9 hours
for 3 lectures. Original documentation
required would be confirmation from the sponsoring organization or a program
schedule with date and location noting you as a speaker along with the lecture
title.
§
Sports Medicine preceptor hours; up to a maximum of
10 hours given by the Committee (1 hr. given for every 5 hours recorded on the
AOA activity report, up to a maximum of 50 recorded hours). Original documentation from an institution
confirming these hours would be necessary, as the Activity Report does not
classify preceptor hrs. by specialty area.
§
Home study hrs. in Sports Medicine, including
self-testing quizzes, up to a maximum of 5 hrs.
§
Attendance at AOA or
Examination
Dates/Location
The CAQ recertification examination in Sports Medicine
will be offered at a time and site as determined by the Committee, but no less
than once every two years.
Fees/Deadlines
The nonrefundable application fee of $50 must accompany
the application by the published postmark deadline date. The registration period ends at least ninety
days prior to the examination date. The
examination fee will be $750 and payment is requested after approval of a
candidate for examination and is due by a published postmark deadline date of
at least 45 days prior to the examination date.
There is a nonrefundable penalty fee of $100 for withdrawal later than
at least 14 days prior to the examination date.
Format
The
examination will be a proctored half-day examination consisting of 100 multiple-choice questions of the
"one best answer" type.
Questions will cover the following four major categories:
Basic
Science – 15% Injury
Management/Prevention – 20%
A.
Anatomy A.
On-site immediate acute care
B.
Physiology B.
Post event care
C.
Pharmacology C.
Sports knowledge, sports rules
D.
Nutrition D.
Protective equipment
Diagnostics - 30% Treatment
– 25%
A.
History A.
Pharmacological
B. X-ray & lab B. OMT
C.
Performance C.
Rehab modalities (acute and
reinjury prevention)
D.
Consultation D.
Psychological
Miscellaneous – 10%
Preparation
No
specific recommendation about study methods or review courses may be made. However, extensive self-study of Sports
Medicine in texts and journals and participation in continuing medical
education programs and review courses in Sports Medicine should be useful.
Results
Candidates will be informed of the results of the
examination within 90 days following the examination date. Successful candidates will receive a
certificate for Recertification of Added Qualifications in Sports Medicine
notating an expiration date of ten years thereafter. The certificate will be awarded after the AOA
Bureau of Osteopathic Specialists gives final approval of the exam process for
each candidate. This approval process
may take about six months following the notification of successful completion
of the examination. Upon written request
and payment of a fee of $50, candidates may obtain rescoring of the examination
within a year of receiving the results.
The answer sheets of candidates will be destroyed three years after
administration.
Reexamination
Candidates may reapply for the next scheduled
examination upon submitting a letter of intent, updated application information
and the examination fee of $750.
Application Process
The Sports
Medicine Conjoint Examination Committee will review applicant files after the
close of the registration period.
Candidates will be notified in writing by the Certifying Board Services
(CBS) of their eligibility.
APPLICATION FOR ADMISSION TO SPORTS
MEDICINE EXAMINATION
FOR
RECERTIFICATION OF ADDED QUALIFICATIONS
The
application and supporting documents must be directed to the participating
specialty board from which you have received primary certification. Check one of the following to indicate your
primary specialty board:
AOBNMM AOBEM
AOBIM AOBP
AOBPMR ____
AOBFP
The
application may be legibly printed or typed and accompanied by the required
application fee of $50 in the form of a check.
The application fee is nonrefundable.
Application Date ___
1. Name
_____________________________________________________________
Last First MI
2. ____________________________________________________________________
Home Address City State Zip Code
____________________________________________________________________
Office Address City State Zip Code
Mailing
Address - Use Home or Office_____
E-Mail
Address __________________________________________
____________________________
(Area Code) -
Office Tel. No. (Area Code) - Home Tel. No.
Cell phone
number: __________________________
3. Are you a
member of the AOA? Year joined? AOA No. ___________
4. Primary Board
Certification - Certificate No. ___________
5. In what states
are you licensed to practice? (state
license no.)
___________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Initial CAQ Eligibility
6. AOA-Approved training in Sports
Medicine? Yes No
______
Training institution
_____________________________________________________
Completion of Clinical Practice
Pathway? Yes _____ No _____
7. Certificate number __________ Date of Certificate _____________
Expiration date ________________________
Hospital Affiliation
8. Principal hospital staff membership(s). Please list the name and address of the
Medical
Director at the institution where you hold
your staff membership(s).
A. ___________________________________________________________ Medical Director Institution
_________________________________________________________________
Address Membership
Dates
________________________________________________________________
City State Zip Code
B.
___________________________________________________________
Medical
Director Institution
_________________________________________________________________
Address Membership
Dates
________________________________________________________________
City State Zip Code
Professional Affiliations
9. List professional society memberships -
Society Membership
Dates
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
10.
Please answer each of the following questions. If the answer to any is yes, please append full details to this
application.
No Yes
Has your license to
practice, in any jurisdiction, ever
been revoked,
restricted or suspended? ____ ____
Have you been the
subject of any disciplinary action
by any medical society
or staff within the past five years? ____ ____
Has a hospital
appointment been terminated or restricted
or have you resigned
after being notified you would be
terminated or
restricted within the past five years? ____ ____
Have you ever been
convicted of a crime other than a
minor traffic
violation? ____ ____
Have you ever been
involved in a proceeding in which
professional
malpractice on your part was alleged? ____ ____
Have you been subject
to disciplinary action for
substance abuse? ____ ____
American
Osteopathic Conjoint Sports Medicine Examination Committee:
Fee
Payable via check or credit card
Make check
payable: AOA - Certifying Boards
Services
Credit card type:
________________________________________
Name on credit
card:
____________________________________
Account number: _______________________________________
Expiration Date:
_____________________
Security code (3
numbers found on the back of your credit card):
__________
APPLICANT RELEASE STATEMENT
The following statement of
release is required of each applicant by the AOA.
I
hereby make application to the American Osteopathic Association (AOA) Division
of Certifying Board Services (CBS) for examination leading to recertification
of added qualifications in Sports Medicine.
This action is made in accordance with and subject to the Constitution,
Bylaws, Regulation and Requirements of the CBS and the American Osteopathic
Association (AOA). I understand that the
examination is a proprietary document of the CBS and the AOA and that I do not
and will not have the right to review the examination or any examination
questions at any time prior to or following the administration of the
examination.
I
agree to disqualification from examination or from issuance of CAQ status or to
the surrender of such certification as directed by the CBS and/or the AOA in
the event that any of the Bylaws, Rules, Regulations and Requirements governing
such examinations are violated by me or in the event that I did not comply with
any of the provisions of the Constitution, Bylaws, Regulations and Requirements
of the CBS and/or the AOA.
I
agree that my professional qualifications, including my moral and ethical
standing in the osteopathic medical profession and my competence in clinical
skills, will be evaluated by the Committee and that the Committee may make inquiry of the persons named in my
application and of other persons, such as authorities of licensing bodies,
hospitals, program directors or other institutions as the Committee may deem
appropriate with respect to such matters; and I agree that the sources and all
information furnished to the Committee in connection with its inquiry shall be
confidential and not subject to disclosure, through legal process or otherwise,
to me or to any person acting on my behalf.
I agree that the Committee and the American Osteopathic Association
shall be the sole judges of my credentials and qualifications for admission to
the examination and for recertification of added qualifications.
I
hereby authorize the CBS to release my grade or grades given with respect to
any examination in accordance with the guidelines as set forth within the
Handbook of the AOA Bureau of Osteopathic Specialists and the CBS.
I
hereby release, discharge, exonerate and agree to hold harmless the American
Osteopathic Association, the American Osteopathic Association Division of
Certifying Board Services, their members, examiners, trustees, officers,
representatives and agents and free from any action, suit, obligation, damage,
expense, claim, demand or complaint by reason of any action they or any one of
them may take in connection with this application, such certifying
examinations, the grade or grades given with respect to any certifying
examination and/or the failure of the CBS to recommend issuance to me of such
CAQ status, or the revocation of any certification issued pursuant to this
application. It is understood that the
decision as to whether my performance on any recertification examination
qualifies me for recertification rests solely and exclusively with the CBS and
the AOA, and that their decision is final.
In the
event that any dispute shall arise concerning the CAQ examination's content
and/or administration, or any other issue relating to the recertification
process, I understand that the AOA has an administrative appeal process
available and I agree to first pursue all available administrative appeals and
internal reviews before pursuing any other forms of relief.
I
further agree that
I have
hereunto set my hands this ____________ day of ____________________,
20_________.
_____________________________________________________________
Signature
APPEALS
POLICY OF THE
AMERICAN OSTEOPATHIC CONJOINT SPORTS
MEDICINE EXAMINATION COMMITTEE
The American Osteopathic Conjoint Sports Medicine
Examination Committee (AOCSMEC) is committed to assuring that aggrieved
candidates for certification have access to an appeal process to address
concerns regarding all certification and recertification examinations and other
decisions of the AOCSMEC. In accordance
with the policies of the American Osteopathic Association (AOA), candidates for
certification may appeal decisions of the AOCSMEC to the AOA Bureau of
Osteopathic Specialists (BOS).
Thereafter, where necessary, candidates may appeal the decision of the
BOS to the Board of Trustees. BEFORE
PURSUING AN APPEAL WITH THE AOA, CANDIDATES FOR CERTIFICATION/RECERTIFICATION
FROM THE AOCSMEC SHALL FIRST APPEAL DECISIONS RELATED TO ANY EXAMINATION TO THE
AOCSMEC AS SET
I. Scope of Appeal
A. Appealable Issues. Candidates may appeal to the AOCSMEC to raise
concerns relative to the examination’s administration (i.e., alleged
bias/prejudice/unfairness of the exam or of a member of an examination team or
failure to follow established examination procedures).
B. Non-Appealable Issues. The AOCSMEC will not consider appeals based
on examination content, sufficiency or accuracy of answers given to examination
questions, scoring of the examination, scoring of answers to individual
questions, and/or the determination of the minimum passing score.
II. Procedure for Appeal.
A. Appeal Request Form. In order to appeal concerning the
examination, a candidate must set forth the basis for his/her appeal on an
Appeal Request Form and submit the form to the Examination Proctor. Appeal Request Forms will be provided to all
certification/ recertification candidates prior to the commencement of the
examination. Additional copies of the Appeal Request Form will be available
upon request to the Examination Proctor. The appellant must submit the
completed Appeal Request Form to the Examination Proctor within two hours after he/she has
completed the examination.
B. Late Appeals. All appeals submitted after the two hour
deadline for submission of the Appeal Request Form will be denied.
C. Evaluation of Appeal. Each appeal submitted on an Appeal Request
Form within two hours of completion of the examination will be considered by
the AOCSMEC. A majority vote of the
Committee will determine whether the AOCSMEC accepts or denies the appeal.
D.
Notification of Candidates. Candidates will be advised by the AOCSMEC of
the decision within 10 working days by certified mail.
III. Effect of Decision.
A. Decision to Accept Appeal.
1. No Scoring or Recording of Exam. If the Committee accepts an appeal, then the
candidate’s examination will not be scored and recorded.
2. Right to Retake Examination. A candidate whose appeal is accepted shall
have the right to a new examination at the next scheduled examination date at
no additional application or examination fee.
(All other fees incurred are the responsibility of the candidate.) At that time, the examination will be
conducted by a different examination team.
The candidate’s original log may be utilized and the examination will be
conducted in accordance with the format for the current examination.
3. Failure to Retake Examination. If for any reason the candidate elects NOT to
retake the examination at the next scheduled date, his/her appeal shall be
considered null and void and the candidate will be required to reapply for the
certification/recertification examination and his/her application shall be
considered in accordance with the criteria in effect at the time he/she submits
the new application. Exceptions (for
good cause) to this stipulation will be considered on an individual basis by
the Committee.
4. Further Appeals.
a. Current Examination. The candidate whose initial appeal is
accepted by the committee shall not have the right to further appeal of the
current examination results, either within the AOCSMEC or to the AOA.
b. Subsequent Examination. The candidate whose initial appeal is
accepted shall not have the right to appeal the next scheduled examination to
the AOCSMEC under this Policy. However,
the candidate shall have the right to appeal to the AOA.
B. Decision to Deny Appeal. If the initial appeal is denied by the
AOCSMEC, the candidate shall have the right to appeal (within 30 days) to the
AOA. Candidates interested in appealing
to the AOA should contact Cheryl Gross at the American Osteopathic Association,
Department of Education, Division of Certification, at
Your signature
indicates that you have read and understand the above:
_______________________________________
Print Name:
_______________________________________
Signature:
_______________________________________
Date:
RETURN ALL APPLICATION MATERIALS
WITH POSTMARK DEADLINE DATE OF NO LATER THAN Tuesday, January 17, 2012 TO:
American
Osteopathic Association Division of Certifying Board Services
142
East Ontario Street, 4th floor
Ellie
Kraynak : (312) 202-8195
NOTE:
Final Application Deadline Postmark
- Between Wednesday, January 18, 2012 through Friday,
February 17, 2012 ($100.00 penalty)
APPLICATION
MATERIALS:
n
Application fee in the amount
of $50 (check made payable to AOA – Certifying Board Services) plus $100.00
late fee if applicable (between January 18-February 17, 2012)
n
Completed legible application
signed and dated by applicant
n
Signed statement by applicant
on office stationery that a minimum of 20% of current practice is devoted to
the practice of Sports Medicine.
n Two (2) original passport-size
photos
n
AOA Activity Reports for
2010-2012 and current cycle outlining required 120 CME hours (inc. 50 Sports
Medicine hrs.; minimum of 25 AOASM)
n
Copy of unrestricted state
medical license(s) with expiration date
n
Written verification from the
AOA confirming membership in good standing for two consecutive years; contact
AOA Membership Services Dept. (800) 621-1773
n
Questions: Once your
application is approved, question topics will be sent to you via email
by Certifying Board Services. Each
applicant must submit five (5) multiple choice Sports Medicine questions with
references and page numbers
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