Good evening. I'm Paul Whittem. I am the chair of the AOBOG board, and I'd like to welcome everyone to the AOBOG's first ever webinar for residents, and thank you for your attendance. And I'm Mary Cameron Tolman. I'm AOBOG's administrative director. We know certification is a huge step in your career, and we know it can seem daunting, and so we are here tonight to kind of try to demystify the process a little bit and provide you with some practical steps and expectations for pursuing certification with AOBOG. So here's a quick roadmap of where we are headed this evening. We're going to talk about what AOBOG does as a certifying board and who we are. We're going to talk about what you need to do and when, if you choose to certify with AOBOG, and that will include what we do not require in the process. And all of that will hopefully help you understand why you would want to choose AOBOG certification. We'll talk a little bit about what to expect on exam day, and then when it comes to questions and answers, please feel free to post your questions as you have them. We will try to address them as they come up, but we will definitely leave some time towards the end for some dedicated question and answer as well. Our special guest this evening is running just a few minutes late, so we'll bring her back towards the end of the call, and I'll give it back to Dr. Whittem. At a summit of leaders in OB-GYN GME this past summer, we created this Venn model to visualize the different roles taken on by the certifying boards. The ACGME and Review Committee and societies like ACOOG, ACOG, and the various subspecialty groups. ACGME sets the standards for training residents and fellows and ensures its accredited programs meet those standards. ACOOG and ACOG and the various subspecialty societies are membership organizations. They provide educational materials based on evidence to support the workforce and practice management. So what does AOBOG and ABOG do? AOBOG is operating under the authority of the American Osteopathic Association, is a certifying body. We do not create educational materials or curriculum. We set standards for professionalism and eligibility requirements for our exams based on evidence and grounded in psychometric rigor. We develop blueprints to establish criteria for the minimally qualified candidate, and we advise the ACGME Review Committee when they set their training standards. Who are we? On the screen are photos of myself and the other members of the AOBOG board, but the board is much more than the eight of us. There are also over 120 volunteer physicians who serve as item writers, examiners, subject matter experts. We're practicing physicians, specialists, subspecialists, hospitalists, program directors, educators, private practitioners, all working to maintain a certification and continuous certification process for practicing physicians. All right, so let's talk about the basics to qualify for AOBOG certification, starting with our primary specialty, OBGYN. So in order to qualify to take our exams, candidates must be a graduate of one of the three types of medical schools listed on the screen here. So a graduate of a COCA-accredited College of Osteopathic Medicine in the U.S., or a graduate of an LCME-accredited medical school in the U.S. or Canada, or a graduate of a medical school outside the U.S. or Canada with the appropriate ECFMG documentation. So for as long as we have been certifying physicians, which has been over 80 years with AOBOG, we've always accepted graduates of the comms, but those last two are relatively new. And, you know, with the finalization of the single GME accreditation system, the AOA changed its requirements so that all the osteopathic specialty boards now accept MDs and foreign medical graduates into our certification process. And we think that's important, you know, as more and more MDs are training alongside DOs, even in the legacy DO programs, those MDs should have options and certification just like our DO counterparts do. So really the important thing is that middle one, ACGME-accredited residency. Has to be ACGME-accredited, period. There are still a few physicians who fall into kind of that spot between when the single GME accreditation system was still ongoing, and so their programs were AOA-accredited because they graduated in 2020 or earlier, but now it is ACGME-accredited training that is the only option. Now, by the time candidates, you know, sit for exams, you do have to adhere to the AOA code of ethics. By the time you get to the oral exam process, you do also need an active license to practice in the U.S., its territories, or Canada. We just had our special guest, Paul Kim. Let's back up, Mary. So before we get any farther, Dr. Teresa Hubka is with us this evening. She is the 128th president of the American Osteopathic Association. Dr. Hubka is the first OBGYN to serve as the president of the AOA. She's a clinical professor, clerkship director, former residency director, mentor, and passionate advocate for women's health and osteopathic medicine. She also runs her own private practice in Chicago and manages to squeeze in time to serve as an examiner and item writer for AOBOG. Dr. Hubka, welcome. Thank you both, and I'm really, really excited to be here. I just came in from the hospital, so yes, active practice. That being said, I'm really excited that you're here to learn about the osteopathic board certification, and I want you to know that what I think is so amazing about this is, is that number one, our boards are very available in your, how do I say, your third year before you're actually out there in practice, so you can take them in your third year and be practice ready by your fourth year. We've been working really hard to make sure that these, that the board certification is really clinically based, and so it makes you, I call it, practice ready. So this is great for the fact that employers want to see individuals that can be, that are board certified, and they're really looking for that. That shows a kind of a excellence in your specialty or excellence in what you do as osteopathic physicians. So I think that our boards are definitely very doable, very easy to obtain. When I say easy, you know, you still have to work hard and study and really be part of it, but it's really much more user-friendly, and I think about it that, you know, when you can take it in your third year, you know, the start of the board certification or enter into that process, then in your fourth year, you can start functioning and working and looking towards practice. So it makes you practice ready, so that when you get out, the employers are saying, you know, gosh, I'd like to get that person, you know, as a member of our team so that they can, you know, start doing what they're doing. So anyway, I think that there's so many good things about our board certification, and then I will say this, I love being a part of the board examining process. It's great to, you know, see everyone that comes through, and we've got, you know, great people, you work hard, you're, you know, wonderful in the profession. So I really also enjoy the fact that it does have the osteopathic philosophy components within there, so that we're really, how do I say, proving or showing our profession and who we are as osteopathic physicians. So I'll give it back to Mary and Dr. Witham, but anyway, we're here for you. The AOA really, you know, wants to make sure that you have a proud profession to be part of. Thank you. So what does the timeline look like? Board eligibility for AOBOG begins when you graduate and ends on December 31st on the sixth year following graduation. Regardless of when you graduate during the calendar year, it always ends on December 31st. Our process for OBGYN certification is two exams, a written and an oral. As you can see from this timeline, the journey to certification starts before you graduate with a written exam, usually taking place during residency. So candidates start with that written exam, and I think Dr. Hupko is alluding to a few special things with this. So the written exam we do once a year. It's usually in the spring, mid-April to maybe early May. And we feel by testing prior to graduation, it's just one less thing you have to worry about. Like Dr. Hupko said, practice ready, right? You can focus on finding that job. You can focus on the move that you have to make if that's the case. And residents can take the written exam as early as your third year. We find about 10% of our candidates opt to test during their third year, and a lot of them do come from residencies that plan the curriculum in such a way that they feel like they are ready to test in the third year. But any candidate who's interested has that option to test during their third year residency. You don't need special permission from your program director or anything like that. So the exam is computer-based. It's remotely proctored. It's a three-day testing window. We'll talk a little bit more about some of that later. Applications open six months prior to the exam. In fact, the application for the 2025 written exam literally opened today. So we encourage you to hop right off the webinar and right off to registration. But they do close one month prior to the exam. With the application, we do have an exam fee of $1,175. And I always encourage candidates to apply by our first deadline, which is usually about two months prior to the exam to avoid the late fee. Always avoid late fees if you can. After passing that written exam and graduating from residency, then you can move on to the final step in OB-GYN certification, which is our oral exam. And that one we do offer twice per year, both spring and fall. And we think that gives you more options to test during your board eligibility window, gives you some flexibility in testing in a time that works well for you. Each administration is a two-day window. And you do have to have AOA recognition of your training before you can take the oral exam. And we'll talk a little bit more about how to get that recognition shortly. It's a pretty streamlined process, but we'll cover that. Now, after doing our oral exams remotely for about four years, starting in the COVID period, we are planning on return to in-person oral exams starting next spring, so spring of 2025. And those are going to take place in Chicago. We are considering continuing offering a remote option for kind of extenuating circumstances candidates. We found things like our military candidates stationed abroad, that was a really good feature for them. And so we're looking at maintaining that option for candidates in that situation as well. Applications for the oral exam, just like written, open up about six months prior. But because there's extra time in building the schedule for those, we do close the exam applications three months prior to the exam date. And the fee for that test is $3,275. So I want to take a few moments and point out some things we do not require for OBGYN certification. There is no requirement for a minimum amount of time in practice before you can sit for the oral exam after graduating from residency. This can be important if you're really motivated. While it's not super common, we do have candidates who take the written in April, graduate in June, and take our orals in October. It seems this is most common for candidates to pursue if they're military candidates as they have orders coming and don't know when or where they'll be in the world or when they'll have time to study or come back for the exam. AOBOG does not require the residents to complete FLS or EMIGS or any other laparoscopic simulation course, nor do we require case logs, which can be really helpful if you go into fellowship or limited scopes of practice very quickly. Like if you take a labor's position and don't have GYN cases, that's fine. Or if you go into a fellowship and don't have you don't have to moonlight to collect cases, you can focus on your fellowship. The oral exam consists of predetermined clinical case scenarios, so you'll be tested on that knowledge and skills whether you practice it or not. So we just had a question pop in about what are the chances EMIGS will be added to the requirements in the future? It is not on the radar at all. The board has felt very strongly for a long time that your competence as a surgeon, and particularly a gynecologic surgeon, is better assessed by your program director and how you're training, and that especially with FLS being kind of more for towards general surgery, that it's not necessarily a great indicator of your skills as a surgeon. And so it seems like another hoop to jump through, and we don't think that's an important hoop for you to have. So and another thing to think about, and I'm just throwing some points in here, but the reality is is that what you learn in your residency as far as your surgical skills, you're going to actually need to do more in your active practice. So to test it means not as much or it's not as valuable as actually doing the day-to-day, and you will be mentored by your senior level faculty member, or I should say practice partners, and so forth. So that's where you get your real skills. It's not from an examination of that. What the exams are doing as far as the oral exams is letting us know that you are capable of making clinical decisions on behalf of your patients, and so that's why this is not in the near future something that we're looking at, as well as collecting case logs truly again doesn't help us in any way. So not having to collect those case logs and not having these fundamentals of laparoscopic surgery or emigs is actually a benefit in that you're now able to look at how you practice clinically and the decision-making process, and are you practice safe and practice ready. But keep in mind if those are required by your program for graduation, you must complete those to finish your residency. Good question. That was a good question. Keep them coming. All right, so something new-ish that we do accept that you might not be aware of. AOBOG will accept a passing grade on the AOBOG qualifying exam as equivalent to a pass on our own written exam for the purposes of sitting for our oral, and you might wonder why we were willing to do that, and the short answer was candidates asked. We found that there were candidates who trained at historically ACGME residents who just didn't even know that they had options in certification, and they said, well, I feel very strongly connected to the osteopathic profession and I would like to return to that, and so we didn't want them to jump through that extra hoop. Some were in fellowship and realized that our subspecialty process is also quite streamlined, and so they saw that as attractive, or they were having issues completing those case log requirements, right, because they didn't have any, you know, GYN cases anymore as an MFM fellow, and there was also some confusion during that single accreditation system period where some programs thought, oh, well, we're ACGME accredited now, so we have to take the ABOG exam, and that just wasn't the case, and then AOBOG has felt really strongly for a very long time that, you know, our exams are very equivalent in their rigor and what they test out of your expertise and how they evaluate your knowledge. Our test blueprints and our pass rates are very similar, and we were really lucky that we have a good relationship with ABOG, and so we were able to partner with them to find a way to primary source verify that passing grade to create this pathway for physicians who wanted to take it, and it's been available for about two years now. So, just thinking a little bit about actual exam day, right, we talked about the process, but, you know, what to expect when you get to exam day. So, like we said, the written exam is computer-based. It's currently remotely proctored, and with remote proctoring, we have that three-day window in the spring, but with remote proctoring, the exam is available 24 hours a day during that three-day window. We highly recommend with our current vendor that you test from a personal computer, preferably on a personal internet network, just because hospital devices and networks can have firewalls that can cause issues on exam day. That exam is given again once a year during the spring. It's four hours long, not including the breaks, and it is 225 single best answer multiple choice questions. The content is set up to test kind of the spectrum across OB and GYN. You can see our current test blueprints posted both on the slide and it's on our website. In terms of preparing for the exam, we can't in our position endorse or recommend any board prep courses, but we do want to give you a little bit of a leg up, and so we do post the common references used for the exam construction on our website and have that available to all candidates. And then once you've taken the exam, you can expect results to be posted within about eight weeks, usually less, but eight weeks is always what we shoot for. As we mentioned earlier, the oral exam is returning to an in-person format in the spring of 2025. The exam will take place at the AOA headquarters in downtown Chicago, so come to Chicago, plan to spend the weekend, enjoy the venues, the restaurants, the theaters, make it a time after the exam is over to kind of relax and unwind and enjoy the hard work you put into getting here. The exam is offered twice per year, spring and fall. The two-day exam windows are usually on Friday and Saturday, with candidates assigned to a morning or afternoon session on one of those days. The exam is approximately four hours long. It consists of predetermined clinical case scenarios based on the care of the female patient. Candidates rotate through three stations with a break between each station. Each station has two examiners and covers three topics from the posted topic list. Images and video clips may be part of any station. So taking a break from OBGYN for a moment, so let's say you're interested in fellowship. What does AOBOG have to offer you in terms of subspecialty certification? So we currently offer four subspecialties under the OBGYN heading, so GYN oncology, MFM, REI, urogyne. We do not currently have a certification in complex family planning, and that is not really on the radar for development for us, so keep that in mind if that's something you're interested in. However, we are currently in the process of petitioning the AOA for jurisdiction in two new subspecialty areas. We are looking at pursuing creating a certification in both pediatric and adolescent gynecology and one in minimally invasive gynecologic surgery, so those may be available in the coming years as we work on that. The eligibility requirements for subspecialty certification are listed on the screen. You do have to have an active OBGYN certification with AOBOG. At that time, you do need to be a graduate of an ACGME accredited fellowship, so again ACGME accreditation is key, but at this point you do have to be a graduate. Board eligibility in the subspecialties is separate from primary certification. It also begins on successful completion of your training and expires on December 31st of that sixth year following, so essentially you have two clocks, right? So if you graduate from your residency in 2025 here, then your OBGYN board eligibility window ends in 2031. You go off to fellowship, graduate that in 2028. Your subspecialty eligibility window then goes until 2034. So part of the reason you have to be a graduate of a fellowship in order to take our subspecialty certifications is because all of our subspecialty certifications are a one-step process. They are oral exam only, so let me just repeat that. One step, only an oral exam. There is no written for any of our current subspecialty exams. GYN oncology and MFM are offered twice per year, GYN oncology and MFM are offered twice per year, both spring and fall. REI and Urogyne are offered spring only. So in addition to having that AOA recognition of your fellowship training, again we're still going to talk about how to get that, okay? All of our subspecialty candidates are required to submit a research thesis. Only GYN oncology, MFM, and Urogyne also submit case logs as subspecialists. REI does not. REI does more of a precept clinical scenario like the primary OBGYN or OVCM. And then one big thing I'd like to highlight, put it in bigger text, is that AOA and AOBOG do not require maintenance of primary OBGYN certification after you become subspecialty certified. Now I always tell people, check with anybody who cares about your certification, right? Your employers, the hospitals you have privileges at, the insurance companies, to make sure that they are okay with you dropping the specialty. But as far as AOBOG is concerned, once you are subspecialty certified in anything we have right now, you do not have to maintain primary OBGYN certification. Now we have made our osteopathic continuous certification or OCC process a little easier to maintain both along the way, but we don't require it. So that's something to think about as well. So exam day for the subspecialties. They also are going to be returning to in-person exams in Chicago in 2025. These exams are also four hours long with two examiners for GYN oncology, MFM, and Urogyne. Candidates are tested on their general knowledge of the subspecialty, cases they submitted as part of their log of clinical activity, and defense of their research thesis. REI candidates are tested on preset clinical case scenarios, similar to the OBGYN oral exam, as well as their thesis defects. Specific information regarding topics for cases and general knowledge can be found on the corresponding subspecialty page on our website. All right, and we had another question come in, so I want to take a moment to address that. Someone asked, will extenuating circumstances for remote oral exams be case-by-case, or how can we inquire about this when it's time to register if we think we may qualify, i.e. active military stationed overseas? We're still kind of refining what that process is going to be, so absolutely at the time of registration let us know that this is your situation, that you're interested in understanding, you know, finding out that are, and really even before you register, right? There's never a bad time to reach out and ask questions. So as we focus on the transition to, you know, returning to in person, we want to finalize what that process will be as well, and we'll have that information available on our website once we have a process, but if you don't see anything on the website, call us, email us, I would much rather we chat, and you feel comfortable about the process, and we'll work through it with you if we have to, okay? Okay, there we go. So this might be something you don't know. The AOA also has nine what we call conjoint subspecialties, where multiple boards work together on the exam content, and so those are available to any AOA diplomate who has the appropriate training. The nine conjoints are listed on the screen here, but so that means if you as an OBGYN wind up taking a correctional medicine fellowship, there is an opportunity for you to get certified in that through the AOA. Currently AOBOG has diplomates who are certified in addiction medicine, and the one that might surprise you is we have sleep medicine as well, so that's kind of interesting. So as we get to these last few slides, I want to highlight a couple of ways you can really help yourself in the process. All right, so first and foremost, update contact information. Get it to us. Help us make sure that you are getting the information you need. You can send your reminders about applications opening or deadlines coming up if we've got a good email address on file for you. Now you can update your profile on the AOA database directly on the osteopathic.org website. We pull all of our information from that core database, but you can also just email us, right? Reach out to us at AOBOG. Send us an email at AOBOG at osteopathic.org. Tell us what that preferred contact information is, and we'll get the database updated for you, but please make it, you know, something that you do check regularly. If that is your residency email for now, when you graduate, make sure you update it at that time as well. Keep yourself informed. Check the website regularly. That's where we post dates and deadlines, when applications are going to go live, what the deadline is to apply for. A lot of the exam-specific information can be found there. We kept kind of teasing about the get your training AOA recognized, so ask your program to send your training information into the AOA. All training information has to be primary source verified, so it's got to come directly from your program. The picture on the screen is just a sample template that our postdoctoral education team put together to send out to people and say, well, it should look something like this. But really, programs can send what's easiest. You can, you know, they can include everyone in one letter, all the trainees in the program. They can put you all on the spreadsheet. That would be fine. Really, the key pieces of information are the program's name, your ACG&E ID number, your name as the trainee, your AOA number, if you know it. If not, we can help you figure that out. Your training dates, both the ones you've actually completed and your anticipated end date. And we're really looking for, you know, your verification information at a couple of different points. So first would be when you apply for the written exam. We're going to check to make sure that you've been verified as a third or fourth year resident. The second is after you successfully complete your residency before you sit for that oral exam. And then if you go up to fellowship, you don't get it again at that point. But again, that information needs to come directly from your program. It can go to this postdoc at osteopathic.org email address. There are a couple of ways through the AOA website where you can submit requests that would go to your program director to update that information. Like you can pre-populate it and then we verify directly with them as well. Some programs are very proactive. You know, towards the beginning of the academic year, I get emails, you know, and say, okay, these are all of, you know, here's my new PGY1s. Everybody has moved on up. And if we have that before you apply, I mean literally application processing can take, you know, minutes. And it's quite simple because we've streamlined that process so much. I want to emphasize that the AOBOG exams are accepted by ACGME for accreditation purposes and our pass rates are reported to ACGME and each program annually. So there's no penalty to your program if you want to take AOBOG exams. And it's also important if you want to go into fellowship. There are no specific guidelines regarding leave during training. Your program directors determine if and when residence fellows or training is complete within the ACGME requirements. And generally speaking, if you want to keep your options open, follow ABOG's leave policy. We do also have a re-entry pathway for candidates who are beyond the traditional six-year board eligibility window. I won't go into the details today, but it is a three-year window during which they can request to re-enter the process. So let's chat a little bit. First things, if we do have what we call our board's certification speaker request form, the QR code that is on the screen will direct you to that. If you or your program would like somebody to do, you know, a presentation like this and come and talk to you more directly, sit in dialogue, answer all of your questions, and we'll be happy to do that ourself, Dr. Whittem, another member of the board. So we've made that available. If you have other specialties also at your hospital, this is available to all of the specialties. It's just one form for anyone, but we're happy to come talk to you about it. And let's take a minute to open up the floor and see if we have other questions. All right. What is the average length of time to receive results from the board? So we make every effort to have them out in eight weeks or less. Average, I'd say it's closer to the six-week mark. So with those exams happening usually in late April or early May, you should have your results before you graduate, if you take it during your fourth year. Can we go over what CME looks like and board recertification? Sure. Okay. So once you become actively... So once you become board certified, you enter into what we call our OCC process, osteopathic continuous certification. And so there are four components to that. Component one is to maintain an active license to practice in the United States, its territories, or Canada. You don't actually have to turn anything in for that. We have all of the state licensing boards reported to a central database that we can pull for you. So we check that periodically throughout your certification. Component two is the CME component. And so the certification CME cycle is a three-year cycle. Like right now, we are at the end of the 2022 to 2024 cycle. So it is the same cycle for all diplomates, regardless of when you become certified. When you first become certified, you do have a prorated requirement for that first cycle, just because some people come in right at the beginning, others at the end. But when you're looking at a full year requirement, our current requirement is 60 total CME credits. Of those, 25 need to be specialty specific. Although I will say we have a pretty broad definition of what is OBGYN specific, right? I mean, you are primary care providers for a lot of your patients. And so if you have to do domestic violence training as part of your licensure requirements, well, that's really relevant to what you do. And so that's specialty credit. You do want to point out, we have wonderful partners in CME within the osteopathic world, but you do not necessarily have to take osteopathic CME credits. You can do online credits. If you are really, especially if you go into fellowship and you become part of maybe the Society of MFM, that's a good place to get your CME credits. It's really pretty open, but we're looking for those 60 total credits, again, 25 specialty specific in a three-year period. And really compared to most licensing boards requirements, that tends to be lower than those requirements. Component three is the assessment component. And we do something now we call longitudinal assessment, which is kind of a fancy way of saying small batches of questions over long periods of time. And so when you first become certified, you're going to get one full calendar year off. So for example, the physicians who get certified we're doing oral exams later this week here in October. So they get certified in October. They will not start longitudinal assessment until 2026. So they get 2025 off. You did the hard work. You got through the oral. We're going to give you a little bit of break on the assessment. But once you do roll into longitudinal assessment, questions are pushed out in its quarterly batches. You get 10 questions per quarter for the first three quarters of the year. The questions are open book. We even post on our website what the references used for each quarter are. We still primarily use the ACOG practice bulletins and clinical guidelines and committee opinions as kind of a good accessible resource that a lot of physicians use and for keeping up with kind of current practice in OBGYN. So we tell you which ones we use. You can go online anytime during that three-month period. And what's nice about it is you can answer two questions today. You can answer three next week and keep coming back as long as you get them done within that window. Because it is open book, we do require a pretty high threshold to pass. You do need an 85% to pass for any given year. But here's what's nice. Quarter four is built in remediation. So any questions you get wrong or let's say life happens and you missed some along the way, you get those questions back in quarter four. And that is kind of a second chance to get them right. So some of the ideas, you know, this is what you do in practice, right? You get an interesting case. You don't know it, you look it up, right? So that's why it's open book. Or you talk to a colleague. And if you show that you learned something along the way, well that's just as good as knowing it in the first place. So I think that's good. The other, the final component is what we call practice performance assessment. And so the requirement there, also it follows with the certification CME cycle. And so you have to do one of these activities each three-year cycle. But there is so much that OBGYNs do all the time that fall under this umbrella of practice assessment, quality improvement, that it's really not a terribly difficult, a terribly difficult thing to, it's required to be, sorry, the internet on one computer went down, but I think you can still hear me on this one. Anyway, but the, so the requirement there, like I always think about, we have this quality improvement activity attestation option, and it's an online form where you can attest to things you already do in practice. Think about things like those labor and delivery drills that most hospitals have you do every year or every other. They qualify, right? Meaningful use through your electronic medical records, participation in a national data registry like an opioid prescribing registry, participation in a hospital committee that's focused on patient safety or patient care, all of those things qualify. And bear with me while I reshare my screen here so you can actually see that slideshow. But all of those things qualify, all of those things, you know, are pretty easily worked in. And if for some reason you don't have an activity like that, we have some other options as well, like a cultural competency module that the Office of Minority Health puts on where you can get some CME and do your PPA all at the same time. So those are the steps to recertification, and we guide you through that whole process. We love to send out reminders to make sure we're keeping you on track because it's easier for all of us. Okay, so have we seen a difference in pass rates between those who take oral boards in October after graduation versus later on? So I wouldn't necessarily say like right away in that October over graduation. I find most of our candidates tend to sit for the oral exam within three years of graduation. And our pass rate on the oral exam for first-time test takers ranges between 90 and 92 percent. I do find once you get beyond that three or maybe four-year mark, like if you wait right until the end to try to take it, those candidates I think struggle a little bit more. Just because you are a little bit further up in practice, it's more likely that maybe you're starting to specialize a little bit, right? Maybe you're doing more GYN surgery, you're not doing as much obstetrics, those kinds of things. But like I said, I'd say probably a good 80 to 90 percent of our candidates sit within three years of graduating. Right, some residents are being advised to consider taking AOBOG and ABOG exams to open up more job prospects in certain geographic areas. Have we noticed this? We've noticed this and we're constantly working on this. It seems like every day we get more and more verification that the doors are opening up to people that took just the AOBOG exams. I won't say that we're 100 percent, but we're definitely better today than we were as far as being accepted five years ago. I think the pendulum is swinging. And I haven't read the article, but I got an email today that there's an article in JAMA basically stating that a study that was done between GYN surgeons, between allopathic and osteopathic, and they found no difference in outcomes, results, or any differences. So I think as as time goes on, you're going to see more and more that we're trained the same, we practice very similar, and our outcomes are very much the same. So the differences are very locally based, very regional, and when we notice those, if you hear of any of those, please let us know because we're working to rectify that situation. The one thing that I will say is once you start taking two board examinations, you will have to continue the cost factor of two board examinations. So I would just say take the osteopathic board examination as your primary board examination and follow within that path. Because as Dr. Whitham just said, if outcomes are the same and everything, why would you want to have to take two and have to continue with two cost factors here? We have excellent board certification, board examinations. We, you know, the osteopathic profession and AOBOG, I love our AOBOG because we've worked so hard to make these exams available, accessible, and to really make them top line. And as I said, you know, making them practice ready. So it's great that they open them up. And why do they open them up? Because, you know, it's another resource of income for them. It doesn't change your perspective or your outcome as far as your patient care. And it really doesn't make more opportunities and jobs because these are accepted, our board certification is accepted, both state and hospital based and insurance companies. So again, I just say to you, once you start, there will be questions if you then have to drop out of the AOBOG and, you know, keep with one or the other. So you don't want to have to make that choice. If you have started with the AOBOG, which is an excellent exam, and it really is something that is available, accessible, we try to make it, you know, user friendly, cost effective, and practice ready, then continue with that. And one, support the profession that supported you, but also, you know, again, know that, feel confident in what we have here at AOBOG. And it looks like it might be the same person who asked that question, but they just made a comment that they were advised to do AOBOG and EMIGS on its own, and then the field feels more even for people who are familiar with those. Interesting, interesting feedback. Thank you. Okay. Are there any osteopathic manipulative treatment questions for written or oral boards? That's a fun one too. So there are some. So we do have a goal to keep about 5% of the process in what we call osteopathic principles in practice. And so some of those might be specific OMT type questions. Some of those might be more the osteopathic approach to medicine. But there is an osteopathic component to the exam. We don't have a practical exam, so you will not be asked to demonstrate. Although, something else I guess we could point out, if you are a physician who's very interested in OMT and including that in your OBGYN practice, the AOA did also just literally last year created something they call the Distinct Osteopathic Exam Committee, but it's an OMT designation that physicians from any specialty can apply for. So they take an additional short written exam and do a practical test as well. And then you get this additional OMT designation that you can add to your certification to show that you can achieve that level of excellence in OMT. So wonderful. Let's take just a quick minute. No more questions? Not coming in, but if they do, we'll get them. Well, we'd like to take a minute and thank our colleagues at the American College of Osteopathic Obstetricians and Gynecologists for their assistance in tonight's webinar. After becoming certified, you are eligible to receive fellow of ACOOG status. As a reminder, residents receive free membership in ACOOG. So take advantage of it now and see all that ACOOG membership has to offer and can do for you. Free monthly webinars on board relevant topics, networking opportunities, advocacy for women's health and the profession, discounts on conferences, and personal service from a dedicated staff to help you throughout your career. One last thing I'd like to say is there will be a survey coming to each of you that registered for this very shortly after we're done here. We would appreciate your feedback in filling that survey out. And again, from all of us, thank you and good night. Thank you so much. Thank you and good luck. And again, we'll leave the contact information up. But like I said, call us, email us. We are happy to talk to you through this process, answer any other questions you may have along the way. Good night.

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oral exam

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