LEAD Program MDT Requirement

ABFAS uses the science of Measurement Decision Theory (MDT) to analyze Diplomates' performance on the LEAD assessment. MDT comes from a branch of data science focused on educational measurement.  

LEAD is not a pass/fail examination, and how a Diplomate answers the quarterly assessment questions does not produce a pass/fail score. Instead, LEAD gives Diplomates immediate and continuous feedback on how they are performing as they answer the multiple-choice questions.

ABFAS uses MDT to determine the probability a Diplomate is keeping up with topics relevant to the practice of foot and ankle surgery. This probability is the Diplomate's MDT p-value, the metric that tells the Diplomate (and ABFAS) how well they are doing. 


How to Find the LEAD MDT p-value

The Progress page of the LEAD Diplomate site shows the Diplomate's current MDT p-value, as well as which cycle they are in, how many quarters they need for their participation requirement, and the cycle expiration date. Here’s a video on how to access LEAD Progress and History.


How LEAD MDT Works

Diplomates who hold Board Certifications in both Foot Surgery and RRA Surgery, including Diplomates holding Lifetime certificates, will see two MDT p-values and two MDT graphs, one for each Board Certification, in their LEAD Diplomate site dashboard.

Diplomates who hold Time-limited certificates should make sure their MDT p-value is at or above the standard of 0.1 (ten percent) at the end of the ten-year Board Certification cycle (June 30 of their expiration year). Anything lower than 0.1 indicates a probability of less than ten percent they are keeping their knowledge current. Periodically, ABFAS will review—and potentially update—this standard.

ABFAS does not require that Diplomates who hold Lifetime certificates meet the MDT performance requirement to maintain Board Certification, and their performance does not impact their Board Certification status. However, they do need to participate in LEAD and will become non-compliant if they do not. While it is not a requirement, tracking performance can be a helpful tool in guiding the continuing medical education of Lifetime certificate holders. 

We know that about 95 percent of ABFAS Diplomates are keeping up with surgical practice knowledge because about 95 percent of Diplomates passed the now-retired recertification exams. So, ABFAS starts Diplomates off with an initial MDT p-value of 95 percent.


Program Start: 0.95 MDT p-value

As a Diplomate answers questions, the MDT algorithm updates their personal MDT p-value based on how they answer and that question’s difficulty level.


Probability varies as you answer questions.
ABFAS evaluates MDT only on June 30 of each certificate’s expiration year, so a Diplomate who finds they have fallen below the standard can improve their MDT status by answering questions in any quarters remaining before their Board Certification expires, even if they have met the participation requirements.


Cause for Concern: Falling below 0.1

If a Diplomate's MDT p-value is below the 0.1 standard on June 30 of the corresponding Board Certification expiration year, that Board Certification will expire two months later, on August 31. 

ABFAS wants its Diplomates to succeed—and to keep learning! In future quarters, ABFAS may re-introduce questions the Diplomate answered incorrectly, allowing them additional opportunities to learn and raise their p-value.

Diplomates who fall below the MDT standard have an opportunity to improve.