Cognitive Exam

The Maintenance of Certification Part III Examination is an integral part of the MOC process. Unlike some other specialties, an otolaryngology MOC examination is complicated by the fact that many if not most otolaryngologists tend to focus on specific practice areas. An otolaryngologist whose practice focus is head and neck oncology may not see or operate on patients with otologic conditions. American Board of Otolaryngology - Head and Neck Surgery recognizes this situation and has designed some parts of MOC (including the Part III Examination) to address this issue.

The blueprint for the Part III Examination calls for two components for the eighty question examination. One component (Clinical Fundamentals) consists of three questions on topics all otolaryngologists should know regardless of specialty focus. The other seventy-seven questions are specific to otolaryngology specialty areas. Some exams may contain more than 80 questions. The extra questions are field test items (which are indistinguishable from the other questions) and do not count towards the final score. Each person taking the Part III exam will select the specialty focus area of their choice.

The ABOHNS divides the non-Fundamentals question topics into three broad areas:

Data gathering/Interpretation30%
Differential diagnosis/Diagnosis 20%
Management 35%

The questions used on the Part III Examination are drawn from the pool of questions used in the Written Examination. Unlike the Written Examination which includes both basic science and clinical questions, the Part III Examination contains only clinically relevant questions. The passing score of the Part III Examination is the same as the Written Examination meaning that the expected level of knowledge is at the same level as the initial certification examination.

Since the Part III passing score is the same as the passing score of the primary certification examination, passing the Part III examination does not imply any advanced knowledge or skills in any specialty area. Diplomates are prohibited from using passing an examination in a specialty focus area to imply special knowledge or skills in any form of marketing.

Diplomates subcertified in Neurotology and Sleep Medicine will need to pass those specialty focus examinations in order to maintain their subspecialty subcertification. Passing the subcertification Part III Examination will renew both their primary and subspecialty certificates. Since the passing scores on the subspecialty examinations are at a higher level than the primary certification examination, diplomates are not prohibited from indicating their subcertification status.

CLINICAL FUNDAMENTALS includes topics such as emergency airway management, patient safety and anesthesia concepts.

ALLERGY/RHINOLOGY includes questions on the full spectrum of otolaryngic allergy and rhinology including allergy testing, medical management of rhinosinusitis, endoscopic sinus surgery, disorders of smell, headaches, and epistaxis.

HEAD AND NECK includes benign and malignant neoplasms of the head and neck, with a focus on tumors of the upper aerodigestive track, the salivary glands, the thyroid and parathyroid glands, and adult tracheal stenosis.

GENERAL OTOLARYNGOLOGY is comprised of a mix of questions from the various specialty focus examination. The approximate percentage of questions coming from each specialty focus is:

21% Allergy/Rhinology
17% Head and neck
13% Laryngology
17% Otology
17% Pediatric otolaryngology
7% Plastic and reconstructive
8% Sleep medicine

LARYNGOLOGY includes disorders of speech and swallowing, laryngeal trauma, delayed laryngeal speech restoration (e.g., tracheo-esophageal puncture), management of vocal fold paralysis, diagnosis and treatment of early laryngeal cancers, and gastroesophageal reflux disease.

Neurotology is available only for diplomates subcertified in Neurotology. The exam will cover the full spectrum of Neurotology including the diagnosis and treatment of skull base, intracranial, and other related conditions.

OTOLOGY/AUDIOLOGY covers the full spectrum of otologic practice including hearing aids and cochlear implants. Questions about the diagnosis of tumors of the temporal bone are included in this section, but specific management of these lesions is considered Neurotology and is excluded from the Otology/Audiology examination.

PEDIATRIC OTOLARYNGOLOGY questions are limited to patients under the age of eighteen and cover the full spectrum of pediatric otolaryngic conditions.

PLASTIC AND RECONSTRUCTIVE SURGERY includes both cosmetic and reconstructive (including facial fractures) topics in an approximately 50/50 ratio. Major flap reconstruction is included in this section.