History of the ABP

The American Board of Pediatrics (ABP) was founded in 1933 to raise the standards of pediatric care, and it awarded its first certificates in pediatrics in 1934.

Early Medical Care in the United States

In the first few decades of the 20th century, medical specialization did not necessarily involve training. Anyone could say they were a pediatrician without completing any requirements at all. Additionally, the American Medical Association (AMA) listed its members as the member requested, so any of its members could self declare as a surgeon, internist, or pediatrician. Unfortunately at the time, however, some AMA chapters did not accept Black physicians as members (read about the implications below).

However, although there were no legal or medical requirements at the time, medical schools started to organize themselves into departments and offer residency programs. Enough concerns were raised about this self-selection that specialty boards began to emerge.

American Academy of Pediatrics Influence

The American Academy of Pediatrics (AAP) formed in 1931. The founders talked about the need for certification by a specialty board at their very first meeting. After a year and a half of study, the AAP's Committee on Medical Education made a recommendation to the AAP Executive Committee. They envisioned creating the ABP as a separate organization to avoid conflict of interest issues, so the ABP was founded as an organizational member of the American Board of Medical Specialties (ABMS).

Examination Process Begins

Oral examinersThe ABP’s inaugural meeting was in January 1934. The charter set forth three tasks: reviewing accreditation of training programs, developing criteria for those to be certified, and examining applicants. In June 1934, the first ABP examination, an oral exam, was administered.

Prior to administering the exam, the ABP confronted racism because ABMS rules required AMA membership for board certification, but some AMA chapters did not accept Black physicians as members. In disagreement, the ABP’s first president, Borden Veeder, MD, fought to have the AMA membership requirement removed and succeeded. The first class of ABP-certified pediatricians included white men, Black men, and five (likely white) women.

Subspecialties Evolve

Subspecialties in pediatrics began emerging in the 1930s and 1940s, starting as clinics within medical schools. Subspecialty certification at the ABP began with Pediatric Cardiology in 1961, followed by Pediatric Hematology-Oncology, Pediatric Nephrology, and Neonatal-Perinatal Medicine in 1974.

By 2019, the ABP awarded certificates in General Pediatrics and 15 pediatric subspecialties.

Certificates also are awarded in conjunction with other specialty boards.

Examinations Evolve

Through the years, ABP examinations ranged from oral exams at first to paper exams to exams on CDs to computerized exams in proctored testing centers to now an online, longitudinal assessment that can be completed in any location with a computer and internet access.

The frequency of required examinations changed through the years, too. At first, pediatricians were certified for life after they passed their exam. In time, however, the ABP and others in medicine recognized that a single exam at the start of a career did not demonstrate ongoing competence over a lifetime of rapidly changing medical practice. In 1988, the ABP began requiring recertification exams every seven years. In 2006, the timing of recertification exams was extended to every 10 years to coincide with the redesign of the ABMS's Maintenance of Certification (MOC) program. When MOCA-Peds, the ABP's online longitudinal assessment launched in 2019, the ABP's exam/assessment cycle was adjusted to every five years to coincide with the MOC cycle.

Continuing Certification

The MOC program, which emerged in 2003 to ensure certification would be a continuing process, was redesigned in 2006 to add self-assessment and quality improvement activities every five years. While the ABP developed many MOC activities to assist pediatricians with continuing certification, the ABP also continues to work with several external partners to make MOC improvements every year so that pediatricians can earn MOC credit for work they are already doing.

Competency Based Medical Education (CBME)

In the early 2000s, pediatric educators and researchers, with support and leadership from the ABP, developed and evaluated the integration of frameworks for assessing trainee readiness to practice medicine without supervision. These frameworks — core competencies along with their milestones and entrustable professional activities (EPAs) — complement each other and can, as research has shown, fill trainee assessment gaps 

First, the Accreditation Council for Graduate Medical Education (ACGME) and the ABMS developed the six core competency domains used to assess physicians during medical training and throughout their careers. Then ABMS member boards partnered with ACGME in 2009 to author milestones, i.e., descriptive markers of performance levels along a developmental continuum from a novice or early medical student to a master clinician who is years into practice. These milestones were updated in 2021.

Following the milestones, entrustable professional activities (EPAs) were created to describe the essential activities that physicians are entrusted to perform safely and effectively without supervision.

Looking Ahead

Looking ahead, the ABP remains true to its mission by continuing to evaluate the effectiveness of assessing both trainees and practicing pediatricians’ competence in core areas. The ABP also works to improve the standards of certification by examining the current testing model and considering ways to encourage continuous improvement in the quality of pediatric care.

Areas of focus in 2022, in addition to those listed in the ABP's strategic plan, include behavioral and mental health, health equity, and the implementation of EPAs in training programs.

At the ABP, we know that children are some of the most vulnerable patients and deserve the best possible care. We consider a healthier child to be the true measure of our success, treated by outstanding physicians who continue to meet standards of excellence.

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