What to Expect on the LEAD Assessment

Assessment Structure

Each quarterly LEAD assessment will consist of 30 multiple-choice questions, including some based on visual presentations. Each question includes at least four possible answers. Each question has only one best answer.

You will have three minutes to answer each question, and the questions will assess existing knowledge relevant to foot and ankle surgery.

After you answer each question, you will rate how confident you are in your response to the question, as well as how relevant the question content is to your practice.

You will then see whether you answered the question correctly, an explanation of why the current answer is the best answer, and references that support the answer.

You can take as many or as few questions at one time as you like within the quarter. All 30 questions must be completed by the end of the quarter for that quarter’s assessment to count toward the required number of quarters within each five-year period. See the LEAD Program Requirements for more information.

 

Foot Surgery Assessment Structure 

For Diplomates who hold only a Foot Surgery Certification

 

Assessment Type: Continuous.

Assessment Objective: Demonstrates the physician has the fundamental diagnostic skills, medical knowledge, and clinical judgment to provide quality care.

Time Allotted: Three minutes per question.

Item Type: Didactic/Multiple-choice.

Number of Questions per Quarter: 30 Foot Surgery questions. You can answer all or some questions at any time throughout the quarter.

 

Foot & RRA Surgery Combined Assessment Structure 

For Diplomates who hold Foot Surgery and RRA Surgery Certifications and/or Lifetime Certificates

 

Assessment Type: Continuous.

Assessment Objective: Demonstrates the physician has the fundamental diagnostic skills, medical knowledge, and clinical judgment to provide quality care.

Time Allotted: Three minutes per question.

Item Type: Didactic/Multiple-choice.

Number of Questions per Quarter: 30 questions per quarter: 20 Foot Surgery questions and ten RRA Surgery questions. You can answer all or some questions at any time throughout the quarter.

 

Assessment Topics

The first step to successful preparation for the LEAD assessment is to understand the topics or subject areas the assessment covers. The assessment topics table below details what is covered on the LEAD assessments, along with the percentage of questions in each topic.

You are welcome to prepare for the assessment as you feel necessary. ABFAS does not prohibit Diplomates from referencing documentation when taking the assessment. Through a performance tracker and pointed references and rationales after each question you answer, you will have the opportunity to see which areas require more attention to develop your knowledge and in which areas you have improved.

 

Foot and RRA Surgery Subject Areas

Problem-focused History and Physical
Diagnostic Studies/Medical Imaging
Differential Diagnosis
Surgical Principles
Surgical Procedures/Techniques
Procedural Perioperative Management
Complications
General Medical

5% of Foot Surgery questions.

0% of RRA Surgery questions.

Definition: The technique, the pertinent elements, and the interpretation of the history and physical exam.

Sample topics:

  • Ask for a diagnosis from a particular examination element.
  • Ask for the pertinence of a particular examination.
  • May involve non-lower extremity pathology.
  • List multiple findings of a history and physical examination and ask for a diagnosis.
  • Pertain to pathoanatomy, pathomechanics, and/or pathophysiology.

15% of Foot Surgery questions.

15% of RRA Surgery questions.

Definition Interpretation of specific studies of diseases, disorders, and conditions of the lower extremity. RRA subject areas may be tested on the Foot assessment.

Sample topics:

  • Diagnosis or differential based on laboratory studies, imaging, or other diagnostic studies.
  • Diagnosis based on a specific imaging study.

10% of Foot Surgery questions.

10% of RRA Surgery questions.

Definition: A differential diagnosis based on multiple elements, including history and physical, and diagnostic studies.

Sample topics:

  • Ask for a diagnosis based on multiple elements.
  • List findings of a study or studies with no imaging study shown and ask for a diagnosis.

20% of Foot Surgery questions.

20% of RRA Surgery questions.

Definition: General principles standard to all surgical disciplines and applicable to podiatric surgery. RRA subject areas may be tested on the Foot assessment.

Sample topics:

  • Preoperative, intraoperative, or postoperative decision-making or management.
  • Not procedure-specific.

20% of Foot Surgery questions.

25% of RRA Surgery questions.

Definition: Intraoperative aspects of specific surgical procedures.

Sample topics:

  • Relevant (normal or abnormal) anatomy encountered and surgically altered during the performance of a surgical procedure.
  • Anatomy that is encountered and surgically altered.
  • Incision placement and dissection technique.
  • The orientation of bone cuts.
  • Selection and application of fixation devices and bioimplants.
  • Placement and fixation of tissue transfers.
  • Selection and application of closure materials, drains, and surgical dressings.
  • Complications that are assessed and/or managed intraoperatively.

10% of Foot Surgery questions.

15% of RRA Surgery questions.

Definition: Procedure-specific and preoperative or postoperative in nature (not intraoperative). RRA subject areas may be tested on Foot assessment.

Sample topics:

  • Selection of a specific procedure based on findings.
  • Diagnosis that requires a surgical management decision.
  • Postoperative management of a specific procedure.

15% of Foot Surgery questions.

15% of RRA Surgery questions.

Definition: Procedure- or injury-specific postoperative or post-traumatic conditions. RRA subject areas may be tested on Foot assessment.

Sample topics:

  • Identification and/or management of lower extremity procedure-specific postoperative complications.
  • All-inclusive subject categories dealing with diagnosis and/or treatment.

5% of Foot Surgery questions.

0% of RRA Surgery questions.

Definition: All general medical diagnostics and treatments exclusive of lower-extremity pathology.

Sample topics:

  • Systemic complications.
  • Diagnosis that requires a medical management decision.
  • Medical management: diagnosis and treatment of diseases, disorders, and conditions exclusive of the lower extremity.
  • Interpretation of history and physical examination and diagnostic studies relating to non-lower extremity pathology.
  • Anesthesia: local, regional, spinal, epidural, IV sedation, and general anesthesia topics, including related peri-anesthesia assessment and pharmacologic management.
  • Emergency medicine: diagnosis and treatment of urgent or emergent diseases, disorders, and conditions exclusive of lower extremity.

Foot Surgery Subcategories

Deformities
Infections
Neoplasms/tumors/masses (primary benign, primary malignant, metastatic)
Other Conditions
Acute Trauma
Nonspecific
  • Acquired digital deformities
  • Hallux abductovalgus
  • Hallux limitus
  • Central metatarsal deformities
  • Fifth metatarsal deformities
  • Other common forefoot deformities
  • Congenital digital deformities (polydactyly, syndactyly, marcrodactyly, overlapping digits)
  • Congenital forefoot deformities (brachymetatarsia, clawfoot, hallux varus)
  • Metatarsus adductus

The following subcategories are covered in all Subject Areas except “Surgical Procedures/Techniques”:

  • Metatarsus adductus
  • Soft tissue
  • Bone/joint
  • Systemic
  • Soft tissue
  • Bone
  • Vascular disorders
  • Focal neuropathies (entrapments, neuroma, TTS) and RSD
  • Neuropathic bone, joint, or soft-tissue derangements
  • Neuromuscular disorders
  • Arthritic disorders
  • Metabolic bone disease
  • Tendinopathies
  • Other soft-tissue disorders (plantar fasciitis)
  • Nail and dermatologic disorders
  • Chronic post-traumatic disorders
  • Osteochondroses/AVN
  • Digital and sesamoidal fractures/dislocations
  • Metatarsophalangeal joint dislocations
  • Metatarsal fractures
  • Tarsometatarsal fractures/dislocations
  • Acute tendon ruptures/lacerations
  • Acute nerve/vascular injury (including compartment syndrome)
  • Miscellaneous acute trauma (degloving injury, foreign body, gunshot wounds, crush injury, contusions, burns)
  • Pediatric fractures/growth-plate injuries
  • Joint implants
  • Fixation devices
  • Bone grafts/bone substitutes/bone healing
  • Suture materials
  • Soft tissue/anchor/skin graft/healing
  • Anatomy
  • Medicine (illnesses/therapeutics)
  • Anesthesia
  • Other

RRA Surgery Subcategories

Deformities
Infections
Neoplasms/tumors/masses (primary benign, primary malignant, metastatic)
Other Conditions
Acute Trauma
Nonspecific
  • Metatarsus adductus/skewfoot
  • Pes planus
  • Pes cavus
  • Clubfoot
  • Tarsal coalition
  • Vertical talus
  • Calcaneovalgusli>
  • Equinus deformities
  • Complex leg/ankle deformities

The following subcategories are covered in all Subject Areas except “Surgical Procedures/Techniques”:

  • Skewfoot
  • Pes planus
  • Pes cavus
  • Clubfoot
  • Tarsal coalition
  • Vertical talus
  • Calcaneovalgus
  • Equinus deformities
  • Complex leg/ankle deformities
  • Soft tissue
  • Bone/joint
  • Systemic
  • Soft tissue
  • Bone
  • Vascular disorders
  • Focal neuropathies (entrapments, neuroma, TTS) and RSD
  • Neuropathic bone, joint, or soft-tissue derangements
  • Neuromuscular disorders
  • Arthritic disorders
  • Metabolic bone disease
  • Tendinopathies
  • Other soft-tissue disorders (plantar fasciitis)
  • Nail and dermatologic disorders
  • Chronic post-traumatic disorders
  • Osteochondroses/AVN
  • Digital and sesamoidal fractures/dislocations
  • Metatarsophalangeal joint dislocations
  • Metatarsal fractures
  • Tarsometatarsal fractures/dislocations
  • Acute tendon ruptures/lacerations
  • Acute nerve/vascular injury (including compartment syndrome)
  • Miscellaneous acute trauma (degloving injury, foreign body, gunshot wounds, crush injury, contusions, burns)
  • Pediatric fractures/growth-plate injuries

The following subcategories are covered in all Subject Areas except “Surgical Procedures/Techniques”:

  • Midfoot fractures/dislocations
  • Rearfoot fractures/dislocations
  • Ankle fractures
  • Acute soft-tissue ankle injuries
  • Acute tendon ruptures/lacerations
  • Acute nerve/vascular injury (including compartment syndrome)
  • Miscellaneous acute trauma (degloving injury, foreign body, gunshot wounds, crush injury, contusions, burns)
  • Pediatric fractures/growth-plate injuries
  • Joint implants
  • Fixation devices
  • Bone grafts/bone substitutes/bone healing
  • Suture materials
  • Soft tissue/anchor/skin graft/healing
  • Anatomy
  • Medicine (illnesses/therapeutics)
  • Anesthesia
  • Other

Assessment Performance

The LEAD program is not a pass/fail examination. Instead, ABFAS uses the science of Measurement Decision Theory (MDT) to analyze the probability that you are keeping up with topics relevant to the practice of foot and ankle surgery. See the LEAD Program MDT Requirement webpage for the LEAD performance requirement and standard.