American Osteopathic Association Bureau of Osteopathic Specialists

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					National Credentialing Forum 2008
An Overview of Osteopathic
    Board Certification
                   Created by Armando F. Ramirez, CAE
        Secretary, AOA Bureau of Osteopathic Specialists
                Director, Division of Certification, AOA


             American Osteopathic Association
What Is Osteopathic Medicine?
 Osteopathic medicine is a distinctive form of medical care
 founded on the philosophy that all body systems are interrelated
 and dependent upon one another for good health.

 Osteopathic physicians (D.O.’s) use all of the tools available
 through modern medicine including prescription medicine and
 surgery. They also incorporate osteopathic manipulative
 treatment (OMT) into their regimen of patient care when
 appropriate. OMT is a set of manual medicine techniques that
 may be used to relieve pain, restore range of motion, and
 enhance the body's capacity to heal.
The Osteopathic Profession as
 of May 2007 – An Overview

 As of May 2007 there are 61,000 Doctors of Osteopathic
  Medicine (D.O.’s) practicing in the US.

 There are 25 Colleges of Osteopathic Medicine with an
  enrollment of nearly 14,600 students Three of the colleges
  have branch campuses.

 The number of osteopathic graduates is on the rise. In ’06-07,
  the graduating class was approximately 3100.
   Pathways to Certification for
      Osteopathic Physicians
Two pathways to board certification exist for D.O.’s
                                 At completion of osteopathic
                                 medical school, DO’s can:


Enter AOA approved            Enter ACGME-approved
Osteopathic residency         residency Program
Program

                              1.Leads to Certification from
Leads to Certification from
                                  ABMS Certifying Board or
AOA Certifying Boards
through the AOA Bureau of
                              2. AOA Certifying Boards
Osteopathic Specialists
       What is the Bureau of
      Osteopathic Specialists?

The AOA Bureau of Osteopathic Specialists (BOS), established
in 1939, is the official certifying body of the American
Osteopathic Association and oversees and implements all
certification policies
             Mission Statement

The AOA Bureau of Osteopathic Specialists (BOS) is the
certifying body for the approved specialty boards of the
American Osteopathic Association and is dedicated to
establishing and maintaining high standards for certification of
Osteopathic Physicians.

The AOA Bureau of Osteopathic Specialists seeks to ensure that
the Osteopathic Physicians it certifies demonstrate expertise
and competence in their respective areas of specialization.

The AOA Bureau of Osteopathic Specialists is deeply committed
to delivery of quality healthcare to all patients by working with all
its approved specialty boards in the enhancement and
continuous improvement of its certification process.
         Structure – Committees

Committees of the BOS:
•   The Full Bureau – consists of representatives from each of the
    AOA-approved Member Boards
•   The Executive Committee
•   The Standards Review Committee
•   The Recertification Committee
•   The Committee on Basic Documents and Certificates
•   The Jurisdiction Committee
•   The Appeals Committee
      Member Boards - 18
  Osteopathic Certifying Boards
               American Osteopathic Board of:
-Anesthesiology (AOBA)(1956)        -Ophthalmology & Otolaryngology
-Dermatology (AOBD)(1945)                 (AOBOO) (1940)
-Emergency Medicine (AOBEM)(1980)   -Orthopedic Surgery (AOBOS)(1978)
-Family Practice (AOBFP)(1972)      -Pediatrics (AOBPD)(1940)
-Internal Medicine (AOBIM)(1942)    -Pathology (AOBPA)(1945)
-Nuclear Medicine (AOBNM)(1974)     -Preventive Medicine (AOBPM)(1980)
-Neuromusculoskeletal Med           -Physical Medicine & Rehab   (AOBNMM)
  (1977)                            (AOBPMR)(1954)
-Neurology & Psychiatry             -Proctology (AOBPr) (1941)
  (AOBNP)(1941)                     -Radiology (AOBR) (1939)
-Obstetrics & Gynecology            -Surgery (AOBS) (1940)
  (AOBOG)(1942)
    Osteopathic Certification in
             General
    AOA board certification is recognized and accepted by:
•       hospitals,
•       third party payers and
•       federal and state government agencies.

    The AOA’s board certification program is recognized by several
    congressional advisory panels and federal agencies, including:
•        The Council on Graduate Medical Education,
•        The Physician Payment Review Commission, and
•        The Surgeon General of the United States Department of
         Defense and the Department of Veterans’ Affairs.

    AOA-approved osteopathic certification is also recognized for
    participation in Medicaid as reaffirmed by enactment of Public Law 104-
    248 “Medicaid Certification Act of 1995.”
             Certifications Issued

  Since the inception of the osteopathic Board Certification
  program in 1939, approximately:

• 27,000 Primary board certifications issued
• 2800 Subspecialty certifications issued
           Areas of Certification
      Primary areas of certification include:
Anesthesiology                         Neuromusculoskeletal Medicine
Dermatology                            Ophthalmology
Emergency Medicine                     Otolaryngology
Family Practice                        Pathology
Internal Medicine                      Pediatrics
Neurology & Psychiatry                 Physical Medicine &Rehabilitation
Nuclear Medicine                       Preventive Medicine
Obstetrics & Gynecology                Diagnostic Radiology
Orthopedic Surgery                     Surgery (General, Vascular…)
                    (A full listing of Specialty and Subspecialty
                       Areas can be found on AOA web site)
                  Subspecialties
Over 40 Subspecialty certifications are available in areas such as :

        Critical Care            Hand Surgery
        Cardiology               Maternal Fetal Medicine
        Nephrology               Otolaryngic Allergy
        Endocrinology            Pain Management
        Requirements for Initial
             Certification
 Successful completion of an AOA-approved osteopathic or
  ACGME residency

 A valid state license to practice medicine

 Successfully pass board certification
                exam (s)
 Fulfillment of all additional board-specific requirements

 Active Membership in the AOA
      Assessment instruments
The exams given by AOA Certifying Boards vary by specialty and
  by certifying but can include

• Written exams
• Oral Exams
• Clinical Exam
        Commitment to High Standards:
         BOS Standards Review Process-
Psychometric Validation of Assessment Instruments




  To ensure osteopathic board certification processes meet the
  high standards required of the medical profession, the BOS
  instituted a periodic Standards Review Process of all its
  Members Boards to ensure that the Guidelines for AOA
  Certification Examination Standards are met
        Commitment to High Standards –
        Standards Review Process (continued)

Guidelines for AOA Certification Examinations

•   Describe the criteria for psychometric standards for AOA
    examinations (assess validity and reliability)
•   Include job analysis and identifying general and specific
    learning outcomes
•   Identify methods to ensure the security of the examination
    process
    Commitment to High Standards –
   Standards Review Process (continued)

 The Standards Review process is an internal peer-review board
 accreditation process through which osteopathic boards are
 evaluated to ensure psychometric and administrative test
 standards are followed


Periodic five-year review             Quality Improvement in
of adherence to Exam         =        the Certification Process
Standards

 Boards not meeting the standards are deemed not in compliance
 and must take action to correct deficiencies
     Commitment to High Standards –
    Standards Review Process (continued)


Through the implementation of this process, the BOS can “provide
   the public with a dependable mechanism for identifying
   practitioners who have met particular standards.”*




*Standards for Educational and Psychological Testing, American Psychological Association,
    1985
  AOA Recertification Process

The AOA and the BOS believe that initial certification is only the
beginning in the assessment of physician competence

In 1995, the BOS implemented a policy of recertification which is
 mandatory for all initial time-dated certifications.

        The American Osteopathic Board of Internal Medicine (AOBIM)
        began the recertification process as early as 1993 prior to
        recertification being required by the BOS.

Currently all 18 osteopathic certifying boards have a time-dated
certification policy.
    Current AOA Recertification
          Requirements
• Successfully pass a recertification exam(s) at intervals no
  greater than 10 years

• AOA-certified physicians must also complete 120 credit hours of
  Continuing Medical Education for every three-year cycle

• A minimum of 50 credit hours in the specialty is required by the
  BOS, though some specialties do have higher requirements

• Membership in the American Osteopathic Association

• The current model of recertification is evolving into a continuous
  rather than periodic process.
   Evolution of Osteopathic
         Certification
The AOA, its Bureau of Osteopathic Specialists and Members
Certifying Boards believe in the quality movement and the move
to enhance the assessment of physician competence with the
end goal of improving the quality of patient care in the United
States. To that end, it has embarked on several initiatives that
are transforming the traditional recertification process.
   Evolution of Osteopathic
    Certification- Initiatives
1. Commitment to implement an Osteopathic
Continuous Certification Process that addresses
and enhances the assessment of physician
competence.

In November 2007 the BOS approved a resolution to establish
an implementation timeline for all osteopathic boards to have a
continuous certification process by 2012.
The resolution will be presented for approval to the AOA Board
of Trustees in February 2007.
Evolution of Osteopathic Certification:
One Osteopathic Model of Continuous
  Certification already operational


             On January 1, 2004, the American
             Osteopathic Board of Emergency Medicine
             (AOBEM) implemented the Continuous
             Certification in Emergency Medicine
             (CCEM) as an alternative model to
             traditional recertification and assesses
             certified physicians on a continuous rather
             than periodic basis.
            Components of Continuous Certification
           in Emergency Medicine (CCEM):


•   Professional status (state licensure)

•   Completion of the Continuous Osteopathic Learning
    Assessments (COLA) -Eight module assessments to be
    completed over 10 years

•   Formal Re-certification examination– taken 2 years prior to
    expiration of certificate

•   Practice Status (Diplomates must provide evidence of active
    practice at the time of application for Step III)
        Evolution of Osteopathic Certification:
     Continuous Competency Assessment Models
                for Osteopathic Boards

• Osteopathic Boards are presently evaluating the AOBEM and
  other continuous competency assessment models.
   Evolution of Osteopathic Certification:
              Initiatives (continued)

2. Assessing Core Competencies
Beginning with the third cycle of the Standards Review Process
in 2009, each of the Osteopathic Boards will be evaluated on
how the seven core competencies, already being taught by
osteopathic residency programs, are being incorporated into the
certification process
            Assessing Core Competencies (continued)


The Seven Core competencies being implemented by osteopathic
  residency program under mandate of the AOA Council on
  Postdoctoral Training include the following:

 Osteopathic Philosophy and Osteopathic Manipulative
  Medicine
 Medical Knowledge
 Patient Care
 Professionalism
 Interpersonal and Communication Skills
 Practice-based Learning
 Improvement and Systems Based Practice
    Evolution of Osteopathic Certification:
               Initiatives (continued)

3. Evaluation of the use of innovative assessment
   tools to assess physician performance in daily
   practice
  The AOA Clinical Assessment Program (CAP)
  The Clinical Assessment Program (CAP) for Physicians is a web-based
  performance measurement program developed by the American
  Osteopathic Association that analyzes data abstracted directly from
  patient medical records.

  Originally designed to measure clinical practice in residency training
  programs, CAP was extended to the physician’s office in December
  2005. Three measure sets, including Diabetes, Coronary Artery
  Disease and Women’s Health Screening, were developed using
  evidence-based guidelines that represent state-of-the-art professional
  standards of care. These guidelines track patient outcomes in order to
  improve the quality of care and are comparable to other ambulatory
  care measure sets.
      The AOA Clinical Assessment
            Program (CAP)
    The National Standards used for this AOA effort
     include:

•    The NCQA Health Employer Data and Information
     Set (HEDIS) measures
•    Center for Medicare and Medicaid Services (CMS)
•    Doctors Office Quality Initiative (DOQ)

•    Joint Commission core measures.
      CAP and Continuous Board
        Certification Process


Several of the osteopathic boards see the potential CAP could
have in the assessment of physician competence and are
studying the feasibility of incorporating it into the continuous
certification process as it is being developed.
      Board Certification: still a
     relevant force in healthcare
For decades, board certification of physicians has been viewed
by both the public and other interested parties as a mark of
competence and excellence for those holding that designation.

The AOA, its Bureau of Osteopathic Specialists and Member
Certifying Boards believe that in the quality movement taking
place in today’s healthcare environment, board certification
remains, now more than ever, a viable, adaptable and critical
tool in the assessment of physician competence.
          Information Resources
Predoctoral Osteopathic Medical Education
American Association of Colleges of Osteopathic Medicine (AACOM)
          www.aacom.org
AOA Commission on Osteopathic College Accreditation (COCA)
          www.do-online.org Predoctoral Education

Osteopathic Postdoctoral Training
   AOA Council on Osteopathic Postdoctoral Training (COPT)
          www.do-online.org

Osteopathic Board Certification
   AOA Bureau of Osteopathic Specialists (BOS)
          www.do-online.org Board Certification

Osteopathic Credentials Verification Service
          www.do-profiles.org

For Prospective Patients Seeking Verification of Osteopathic Board Certification
          1-800-621-1773, Extension 8266
                         Q&A

The American Osteopathic Association and its Bureau of
    Osteopathic Specialists thank you for your interest.

                 Contact information
          American Osteopathic Association
          Bureau of Osteopathic Specialists
                 www.do-online.org
           1-800-621-1773, extension 8266
              aramirez@osteopathic.org
                                     OSTEOPATHIC MEDICAL EDUCATION
 Larry Wickless, DO1, D Burkhart1, JL Obradovic1, AF Ramirez1                                                                            WHAT IS OSTEOPATHIC MEDICINE?

                                                                                                                                         Osteopathic medicine (formerly known as osteopathy) is "a complete system of medical care with a philosophy that combines the
ABSTRACT                                                                                                                                 needs of the patient with current practice of medicine, surgery and obstetrics. The emphasis is on the interrelationship between
                                                                                                                                         structure and function, and has an appreciation of the body’s ability to heal itself." [2] Outside the United States, "osteopathic
Osteopathic medicine’s principles and practices, which emphasize the relationship between body systems, are integrated                   medicine" is often used interchangeably with "osteopathy".
  throughout the full spectrum provided by the osteopathic medical education continuum.
                                                                                                                                         Doctors of Osteopathic Medicine, or D.O.s, apply the philosophy of treating the whole person (a holistic approach) to the
Students begin osteopathic medical education with a four-year curriculum. The first two years of the osteopathic medical                 prevention, diagnosis and treatment of illness, disease and injury using conventional medical practice such as drugs and
  curriculum focus on basic sciences. The third and fourth years emphasize clinical work, with much of the teaching in                   surgery, along with manual therapy (Osteopathic Manipulative Medicine or OMM).*
  community hospitals and major medical centers.                                                                                         *http://en.wikipedia.org/wiki/Osteopathic_medicine




Following graduation, the new osteopathic physician completes an approved 12-month internship. The internship year
  exposes the physician to core disciplines to include internal medicine, emergency medicine and family practice. Once the
  physician completes the internship year, the physician then chooses an osteopathic residency program in a specialty area of            OSTEOPATHIC MEDICINE IN THE UNITED STATES – SOME FACTS:
  choice, i.e. emergency medicine, family practice, general surgery, internal medicine, obstetrics and gynecology, pediatrics,
  etc., which require two to five years of additional training depending on the discipline. In addition, an osteopathic physician        Number of U.S. Osteopathic Physicians: 61,000 (As of May 2007)
  can further subspecialize through osteopathic fellowship training that requires another one to three years of additional               Number of U.S. Osteopathic Medical Schools: 25
  training after residency.
                                                                                                                                         Number of Students in Osteopathic Medical Schools: 14,600 (As of May 2007)
The knowledge and experiences acquired through the osteopathic medical continuum are assessed through a board
  certification process that requires successful completion of educational components and a rigorous and psychometrically
  valid exam and emphasizes life-long learning through required continuing medical education and recertification. The AOA
  Bureau of Osteopathic Specialists, through eighteen certifying boards, is the primary certifying body for osteopathic
  physicians and provides the certification mechanism.

  1 American Osteopathic Association
                                                                               AN OSTEOPATHIC PHYSICIAN’S JOURNEY THROUGH THE MEDICAL EDUCATION CONTINUUM
                                                                                                                                                                                                                        CONTINUING MEDICAL
                                                                         POSTDOCTORAL                                                    BOARD CERTIFICATION                                                               EDUCATION &
 PREDOCTORAL EDUCATION
                                                                         EDUCATION                                                                                                                                       LIFE-LONG LEARNING


PREPARING FOR ADMISSION                                                 POSTDOCTORAL TRAINING & LICENSURE                           BOARD CERTIFICATION: AN                                                      Continuing Medical Education is a
To be considered for admission to any of the nation's                   Following graduation, D.O.s complete an                     ESSENTIAL CREDENTIAL FOR                                                     lifetime commitment to learning by
osteopathic medical schools, applicants typically have a                approved 12-month internship. Interns rotate                PHYSICIANS                                                                   osteopathic physicians who recognize
bachelor's degree, with undergraduate studies that                      through hospital departments including internal                                                                                          that the study of medicine does not
                                                                                                                                    Although board certification of physicians is
include one year each of English, biological sciences,                  medicine, family practice and surgery. Many may                                                                                          end with completion of medical school
                                                                                                                                    a voluntary process in the United States, the
physics, general chemistry and organic chemistry. Other                 then choose to complete a residency program in a                                                                                         or residency training. The American
                                                                                                                                    majority of hospitals, insurance companies
requirements may include genetics, mathematics, and                     specialty area, requiring two to six years of                                                                                            Osteopathic Association requires its
                                                                                                                                    and health care management organizations
psychology. Most prospective D.O. students major in                     additional training.                                                                                                                     members to earn a specified number of
                                                                                                                                    make it a requirement to have hospital staff
sciences with an emphasis in biology or chemistry;                      D.O.s are licensed for the full practice of medicine                                                                                     continuing medical education credits
                                                                                                                                    privileges and obtained reimbursement for
however, applicants may major in any discipline as long                 and surgery in all 50 states. Each state determines                                                                                      every three years in order to maintain
                                                                                                                                    services rendered. To that end, osteopathic
as they meet the minimum course and grade                               the tests and procedures for licensing its                                                                                               membership and board certification.
                                                                                                                                    physicians begin the board certification
requirements. Applicants must also take the Medical                     physicians. In some states, the same tests are
                                                                                                                                    process immediately after completing their                                   Through this requirement osteopathic
College Admissions Test (MCAT).                                         given to D.O.s and M.D.s; other states administer
                                                                                                                                    residency training or just prior to the                                      physicians not only maintain their
Osteopathic medicine is a people-oriented profession that               separate licensing exams.
                                                                                                                                    completion of their residency training to                                    medical knowledge and skills current
demands dedicated and empathetic individuals.
                                                                                                                                    ensure their ability to practice is not                                      but also remain at the cutting edge of
Prospective osteopathic medical students must exhibit a                 CORE COMPETENCIES EMPHASIZED IN
                                                                                                                                    impaired.                                                                    their respective specialties by learning
genuine concern for people. Applicants may wish to                      POSTDOCTORAL TRAINING
spend some time with a D.O. or do volunteer work in a                                                                               Board certification protects the public by                                   about the latest advances in the
healthcare setting before considering a career in this field.           At the graduate medical education level, all                ensuring that the examinees have completed                                   medical field.
Osteopathic medical colleges require a personal interview               osteopathic internship and residency programs               a program of study or practice in their
to assess an applicant's desire to become an osteopathic                must now incorporate seven core competencies                specialty and have passed a rigorous exam
physician.                                                              developed by the AOA Core Competency Task                   process that has been psychometrically
                                                                        Force and approved by the AOA Board of                      evaluated for validity and reliability.
THE OSTEOPATHIC CURRICULUM                                              Trustees. This is an effort to shift graduate
                                                                        medical education from "experience-based"
The first two years of the osteopathic medical                          education to "competency-based" education                   OSTEOPATHIC CERTIFICATION
curriculum focus on basic sciences. The third and                                                                                   EVOLVING
fourth years emphasize clinical work, with much of the                  The osteopathic core competencies are
teaching in community hospitals, major medical                                                                                      The American Osteopathic Association,
                                                                        osteopathic philosophy and osteopathic
centers and doctors' offices.                                                                                                       through its official certifying body, the
                                                                        manipulative medicine, medical knowledge,
During the clinical years, students study general                                                                                   Bureau of Osteopathic Specialists and its
                                                                        patient care, interpersonal and communication
medicine and are involved in research. They rotate                                                                                  eighteen Member Certifying Boards offers
                                                                        skills, professionalism, practice-based learning
through urban, suburban and rural settings, gaining                                                                                 85 certifications in specialty, subspecialty
                                                                        and improvement, and system-based practice
exposure to all areas of medicine.                                                                                                  and areas of added qualifications ranging
Osteopathic principles and practices, which emphasize                                                                               from Family Practice to Internal Medicine to
                                                                        Number of AOA-approved residency training
the relationship between body systems, are integrated                                                                               Surgery and Cardiology.
                                                                        positions: 5,787
into the four-year curriculum. Students learn                           (2005-2006)                                                 Osteopathic certification is presently
osteopathic manipulative treatment for prevention,                                                                                  evolving into a continuous certification
diagnosis and treatment of disease.                                     Number of approved osteopathic residency                    process rather than a process in which
                                                                        programs:                                                   recertification occurs every several years.
                                                                        (2006-2007)
                                                      Member Boards of the American Osteopathic Association

Anesthesiology                                            Dermatology                                     Emergency Medicine
      Sallie C. Vazzano, Corresponding Secretary                Rick Mansfield                                 Josette Fleming, Administrator
      6500 NW Tower Drive, Suite 13                             Administrator                                  142 E. Ontario Street, 8th Floor
      Kansas City, MO 64151                                     1501 East Illinois                             Chicago, IL 60611
      (816) 584-2622                                            Kirksville, MO 63501-3203                      (312) 335-1065
                                                                (800) 449-2623                                 www.aobem.org

Family Physicians                                         Internal Medicine                               Neurology & Psychiatry
      Carol Thoma, MBA, Executive Director                      Gary L. Slick, D.O., Executive Director        Sandy Elcock, C.M.S.C.
      330 E. Algonquin Rd., Ste. 6                              1111 W 17th Street                             Administrative Assistant
      Arlington Heights, IL 60005                               Tulsa, OK 74107-1898                           2730 S. Val Vista Drive, #146
                                                                                                               Gilbert, AZ 85296
      (847) 640-8477                                            (918) 561-1267
                                                                                                               Phone: (480) 650-3206
       www.aobfp.org                                            www.acoi.org/CertGen.html                      E-mail: aobnp@att.net

Neuromusculoskeletal Medicine                             Nuclear Medicine                                Obstetrics & Gynecology
      Mr. Stephen J. Noone, CAE, Executive Director             AOBNM Staff                                    Barbara Scott
      3500 DePauw Blvd., Ste. 1080                              142 East Ontario Street                        Administrator
      Indianapolis, IN 46268                                    Chicago, Illinois 60611                        (708) 755-2490
      (317) 879-1881                                            (800) 621-1773 ext. 8227                       E-mail: AOBOG@aol.com
www.academyofosteopathy.org/certification.cfm?p                 aobnm@osteopathic.org                           www.aobog.org
     age=neuromusculoskeletal

Ophthalmology and Otolaryngology                          Orthopedic Surgery                              Pathology
      Sandra Hudepohl , Administrative Secretary                Barb Sharp, Executive Director                 AOBPa Staff
      4764 Fishburg Road, Suite F                               1117 Stone Street, Suite 4                     142 East Ontario Street
      Huber Heights, OH 45424                                   Port Huron, MI 48060                           Chicago Illinois 60611
      (800) 575-2145 or (937) 235-9794                          (877) 982 - 6267                               (800) 621-1773 ext 8227
      Fax: (937) 235-9795                                       www.aobos.org/                                 aobpa@osteopathic.org
      Email: aoboo61040@aol.com
      www.aoboo.org/

Pediatrics                                                Physical Medicine and Rehabilitation            Preventive Medicine
      AOBP Staff                                                AOBPMR Staff                                   AOBPM Staff
      142 East Ontario Street                                   142 East Ontario Street                        142 East Ontario Street
      Chicago, Illinois 60611                                   Chicago, Illinois 60611                        Chicago, Illinois 60611
      (800) 621-1773 ext. 8267                                  (800) 621-1773 ext. 8226                       (800) 621-1773 ext. 8229
      aobp@osteopathic.org                                      AOBPMR@osteopathic.org                         aobpm@osteopathic.org
      www.aobp.org                                              www.aobpmr.org/

Proctology                                                Radiology                                       Surgery
      David Harrison, D.O., Secretary                           Pamela A. Smith, Executive Director            Karen Morgan ,Corresponding Secretary
      3520 Guion Road, Suite 307                                119 E. 2nd St.                                 4764 Fishburg Road, Suite F
      Indianapolis, IN 46222                                    Milan, MO 63556                                Huber Heights, OH 45424
      (317) 923-1033                                            (660) 265-4011                                 (800) 782-5355
                                                                www.aocr.org/certification/index.asp           www.aobs.org/

               Boards without standalone websites have requirements posted on the AOA website
               at www.do-online.org under Certification