Frequently Asked LEAD Questions

ABFAS has prepared a question-and-answer that lists several questions Diplomates frequently ask about the shift to the new LEAD program of Continuous Certification. More information is available on the LEAD webpage. If you have additional questions about the program, feel free to email ABFAS.


Participation Requirements

  • When do I need to start participating in LEAD?
    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. LEAD started on January 10, 2022. Your individual requirements will provide guidance as to when you should start LEAD to ensure you meet the participation requirements.

    Those time-limited Diplomates whose certification expires in 2022 will receive an automatic one-year extension of their expiration date (through August 31, 2023) if they complete the 30 assessment questions in LEAD’s first quarter of 2022.

    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. 
  • I understand that, now that LEAD has started, you are phasing in participation requirements. How do I find out my requirements for my certification expiration year?
    ABFAS has an interactive tool on its website. Enter the year your ABFAS Foot Surgery certification expires, and it will show you your requirements.
  • My current ABFAS certification expires in 2022. Are there special rules for me during the first year?
    To give Diplomates a smooth transition to the LEAD program, the ABFAS Board of Directors has approved an automatic one-year extension of certification for Diplomates with time-limited certificates who are in the tenth year of their certification cycles in 2022. If you fully participate in the first quarter of LEAD in 2022 (answer all 30 LEAD questions), ABFAS will extend your certification expiration date to August 31, 2023. If you complete four quarters of LEAD and meet the MDT standard by June 30, 2023, your certification renews to 2032. ABFAS will provide documentation of the extension to hospitals and credentialers. If you need a new label for your certificate that shows the extension, please contact the ABFAS office and we will send you one.
  • What happens if I don’t participate?
    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.
  • Why are all Diplomates starting this now, rather than waiting for their recertification year?
    The LEAD program is a philosophical switch–emphasizing continuous learning. The ABFAS Board of Directors believes the switch to LEAD for all Diplomates in 2022 is in the best interest of its Diplomates and for public health and safety.
  • What happens if I miss a quarter?
    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.
  • I currently have an inactive status with ABFAS. Do I need to participate in LEAD?
    Yes, all ABFAS Diplomates must participate in LEAD, even if they have administrative, inactive, or surgically inactive status.
  • What happens if I have different certification years for my Foot Surgery and RRA Surgery certifications?
    To make the process easier, 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. E.g., 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. And please remember, even if you hold both certifications, your LEAD assessment is still 30 questions in the quarter: 20 Foot Surgery questions and ten RRA Surgery questions.
  • How many questions do I need to answer to complete the LEAD program?

    The program is broken down into three-month quarter intervals in which each Diplomate will have the opportunity to answer 30 questions per quarter. All Diplomates must complete a minimum of twelve quarters during each five-year period within their ten-year cycles.


  • What if I have a disability and have previously had an accommodation for standardized tests? Is there still accommodation under LEAD?
    ABFAS offers accommodations for LEAD participants. You will find the information on the ADA Accommodations webpage.

Types of Questions

  • What is the LEAD question format? Multiple choice, fill-in-the blanks, true/false, or something else?
    At the current time, the LEAD questions are multiple choice, with four possible answers to each question. The Continuous Certification Committee is researching other assessment types for possible future use, such as article-based questions.

Measurement Decision Theory (MDT)

  • What is MDT?
    Measurement Decision Theory (MDT) is the method ABFAS uses to analyze Diplomates’ performance on the Continuous Certification LEAD assessment.
  • How can I interpret my MDT p-value?
    Your MDT p-value is the probability you are keeping up with topics relevant to the practice of foot and ankle surgery. ABFAS bases this probability calculation on how you answer LEAD questions.
  • Why is ABFAS using the MDT method?
    ABFAS is using MDT based on research and analysis of medical specialty boards that have adopted MDT for their own Continuous Certification programs.
  • What is the minimum standard I must meet and by when do I need to meet it?
    For Diplomates with time-limited certificates (certified after 1990): The current LEAD Performance Requirement is an MDT p-value of 0.1. This means if a Diplomate’s calculated MDT p-value is lower than 0.1, there is a probability of less than ten percent the Diplomate is keeping up to date with their knowledge. All Diplomates must be at or above the MDT standard by the end of their ten-year Foot Surgery certification cycle (by June 30 of their certification expiration year). There is a separate MDT p-value for RRA Surgery, so if a Diplomate holds an RRA Surgery Certification, they must be at or above the RRA Surgery MDT p-value standard on June 30 of their ten-year RRA Surgery certification cycle (by June 30 of their certification expiration year).

    For Diplomates with a lifetime certificate (certified before 1991): Diplomates will be able to track their performance on the LEAD site and use the results to guide their continuing medical education. ABFAS does not require that lifetime certificate holders meet the MDT performance requirement to maintain certification.
  • Why am I so far above the MDT standard?
    Historically, ABFAS Diplomates have very high rates of successful completion of the previous Maintenance of Certification (MOC) requirement of recertification exams. Therefore, we expect that most Diplomates are keeping up with emerging surgical knowledge and will have a high MDT p-value (i.e., ABFAS anticipates a high probability that they are keeping up).
  • What happens if I fall below the MDT standard? How can I improve my MDT p-value?
    For all Diplomates regardless of certificate type: You have multiple opportunities to improve your MDT status by answering questions in any upcoming quarters available in your certification cycle. Please note that a Diplomate can answer a maximum of 30 questions per quarter. 

    For Diplomates with time-limited certificates (certified after 1990): Your MDT p-value is evaluated only on June 30 of your certification expiration year. You can instantaneously track your MDT p-value in your online LEAD dashboard at any time during your certification cycle. If your MDT p-value falls below the standard before June 30 of your certification expiration year, you may still have an opportunity to improve your MDT p-value by improving your performance on the LEAD assessment. Your ability to improve depends on how many quarters you have left until June of your certification expiration year and the action you take to improve your surgical practice knowledge.  

    If your MDT p-value is below the 0.10 standard on June 30 of your certification expiration year, your certification will expire on August 31 of your certification expiration year.
  • How often does my MDT p-value change?
    Every time you answer a question, your MDT chart will update automatically to show your most recent MDT p-value. The system calculates your MDT p-value from the last 120 questions you have answered—what we call “the rolling 120.” For more information, please see page 9 of the LEAD Program Manual.
  • If I still have to exceed a certain MDT level, isn’t this the same as a pass/fail exam?
    The LEAD program is educational and provides you with continuous performance feedback (unlike a pass/fail exam). After you answer a question, you see the best answer, the rationale for why it’s the best answer, and references. Moreover, MDT analyzes the probability that a Diplomate is keeping up with topics relevant to the practice of foot and ankle surgery, as opposed to a pass/fail exam for which there is a required number of correct responses required to pass. You can also see your MDT p-value each time you answer a question. The goal is that you identify areas of improvement so that over the ten-year period, you will increase your knowledge and MDT p-value.
  • Does ABFAS anticipate raising the MDT p-value over time?
    ABFAS will review the MDT p-value standard annually in consultation with our psychometrician.
  • If I have 18 quarters in my renewal period and am not meeting the MDT minimum after completing 12 quarters, can I complete additional quarters to raise my MDT?
    Yes. Even if you meet the MDT p-value standard, you can continue to answer questions if you wish.
  • Why do Diplomates who became certified prior to 1991 not need to meet MDT requirements?
    ABFAS Diplomates who were certified in foot and ankle surgery prior to 1991 hold lifetime certificates. They need to participate in LEAD and will become non-compliant if they do not. As the lifetime certificate holders previously took a scored self-assessment that was not a pass/fail exam, their approach to LEAD is similar. They will see their MDT p-value, but it will not impact their certification status.

Other Recertification Requirements

  • Do I need to send in surgical logs?
    ABFAS requires Diplomates to attest to having performed surgery in the last two years before their certification expires. We will periodically audit the attestations, and those we select for audit must send in their case logs. ABFAS does not have a requirement for a minimum number of cases.
  • What if I no longer perform ankle surgery?
    If you have an RRA Surgery certification or hold a Foot and Ankle Surgery certification, your LEAD assessment will have 20 Foot Surgery questions and ten RRA Surgery questions, regardless of what type of surgery you perform in your practice.

General LEAD Questions

  • Is my LEAD dashboard information private?
    Yes, only you have access to your MDT p-value and participation information. Your dashboard shows you the number of questions you have answered in the quarter, a graph showing your MDT p-value, and the number of questions you’ve answered correctly. It also shows your progress in meeting LEAD cycle participation and MDT requirements.
  • Are other medical boards doing something similar?
    The American Board of Medical Specialties (ABMS) requires that all of its member boards change to a Continuous Certification model. 
  • I have a lifetime certificate and just retired from active practice. What are the pros and cons of LEAD in my near future?
    We have found that many Diplomates volunteer or return to work part-time after “retirement” and still need certification for insurance or hospital privileging purposes. Participating in LEAD keeps your certification active, in addition to keeping your knowledge up to date when you’re not seeing patients daily.
  • When did the LEAD program begin?
    ABFAS launched the LEAD program on January 10, 2022. All Diplomates can begin participating now, regardless of certification expiration date.
  • Why did ABFAS shift to the LEAD program?
    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 new 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 has replaced the traditional, once-every-ten-years recertification and self-assessment examinations.
  • When and how did ABFAS approve the LEAD program?

    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.

  • I recently recertified. Why do I need to start the LEAD program now?
    The LEAD program emphasizes continuous, lifelong learning and provides an educational benefit to Diplomates. ABFAS has 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; they can complete each quarter’s questions where and when they choose on their own computer, laptop, or mobile device.
  • I already get CEs and educate myself, and I already met your recertification requirements recently. Why do I need to do this additional program?
    The LEAD program represents a shift from the now-retired ABFAS recertification and self-assessment exams to one of continuous, lifelong learning. LEAD is a powerful new tool to help ensure the continued success of Board Certified foot and ankle surgeons. Now that ABFAS has launched the program, we want every Diplomate to participate right away. Diplomates receive instantaneous feedback on questions, keeping their skills sharp and protecting the public by ensuring rigorous standards. Other medical specialty boards are also moving in this direction.
  • I am certified in both Foot and RRA. Do I need to complete the LEAD program twice, once for each certification?
    No, the program accounts for both certifications. You can see a combination of Foot Surgery and RRA Surgery content when completing the assessments.
  • Does the shift to the LEAD program change my certification expiration date?
    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.
  • What is the cost of the LEAD program?
    The LEAD program of Continuous Certification is funded through your annual fee, not an additional, separate recertification examination fee.

Pilot Program

  • How will ABFAS translate my pilot program percentage-answered-correctly score to an MDT p-value?
    If you participated in the pilot program, you can see your MDT p-value from your pilot experience by reviewing your dashboard. There is no direct correlation between the number of questions you answered correctly and your MDT p-value. The MDT p-value is a statistical measurement of the probability you are keeping up to date in your knowledge. Answering items correctly is one of the factors involved in determining your MDT p-value, along with question difficulty levels.
  • I participated in the pilot. Will I receive credit for my participation for the four quarters?
    Yes, all pilot participants will receive credit for each quarter during which they answered all 30 questions. You can see this credit when you access your LEAD dashboard.

Equipment Needs

  • Do the questions rely heavily on images that might be difficult to see, for example, radiographic details on a smartphone?
    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.

Assessment Preparation

  • Is a sample or practice assessment available?
    The LEAD platform includes a practice assessment that can help you become more familiar with the assessment experience and help you navigate the platform. You can access the practice assessment now.
  • How should I prepare or study for LEAD? How can I improve my MDT?
    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. You can improve your MDT p-value by improving your performance on the LEAD assessment by answering questions within the quarters remaining in your certification cycle.
  • How does ABFAS develop the LEAD questions?
    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