The undersigned hereby makes application to The American Board of Obstetrics & Gynecology, Inc. (ABOG or Board) for admission to take the [Maintenance of Certification; Qualifying; Certifying; Subspecialty Qualifying; Subspecialty Certifying] examination in [Obstetrics and Gynecology] of the ABOG, all in accordance with, and subject to, the requirements of the ABOG for such examination, pursuant to the Articles of Incorporation, By-Laws, Rules, Regulations, and other qualifications from time to time required by the ABOG. Funds are being submitted simultaneously with this Application in payment of the application fee and I agree that if this Application has been accepted by the Credentials Committee of the ABOG, to immediately forward the examination fee upon my receipt of notification that this Application has been accepted by the ABOG. I further agree that neither the application fee nor the examination fee shall be returnable to me in any event and that in either case the cost of processing my Application, and examination, respectively, whether I am permitted to take the examination or not, are of greater value than the fees themselves. I am aware that the ABOG is a Delaware not for profit corporation whose principal place of business is located in Dallas, Texas. I understand that the ABOG is not affiliated with and is not an agency of the U.S. or any state, and that it is a private medical certification board.
2. Representations of Applicant.
2.1 Applicant hereby represents and warrants that the information and answers to the questions provided on this Application are true, correct, and complete to the best of my knowledge and I agree that any information that is false, misleading or otherwise misrepresents the true state of facts, or any significant omissions made by me, regardless of whether such information was provided by me in ignorance or in good faith or because of misunderstanding, may disqualify me from having my Application accepted and/or from allowing me to take the examination, and may disqualify me from any entitlement I may have had to previously take such examination.
2.2 Furthermore, if I am permitted to take the Examination, and it is subsequently learned by the ABOG that any information that I furnished in my Application or otherwise which resulted in my being allowed to take the examination proves to be false, misleading, a misrepresentation, or contains significant or material omissions, regardless of whether such information was furnished in ignorance of the true facts, in good faith, or because of any misunderstanding I may have had, then, and in that event:
1) I hereby agree that in addition to being disqualified from the taking of any examination, (if I have not already taken the examination), then, and in that event, I agree that I shall be disqualified from taking the examination (if not already taken); or,
2) If I have received a Diploma of Qualification, I hereby agree to the revocation and forfeiture of such Diploma at any time and agree to return said diploma upon demand, at any time, and from time to time by the ABOG, and at my sole cost and expense.
3. Conditions for Examination.
I understand that the decision as to whether or not I am given permission to take the Examination for which I am applying, and as to whether my examination qualifies me for, and any entitlement I may have to continue to qualify for, a Certificate or Diploma is based solely and exclusively on the decision of the ABOG and its members and examiners and that such decision is final. I hereby agree to hold the ABOG and its members, examiners, directors, and officers harmless of and from any and all claims, demands or causes of action of whatever kind, nature or character, that I may now or hereafter have by reason of the conduct of and results of any such examination, and any entitlement I may have to continue to qualify for any certification that may be issued to me. I further agree to indemnify, release and hold the ABOG and its members, officers, agents, directors, examiners and any persons with which it is affiliated harmless from any and all travel and other related expenses incurred by me as a result of any examination or the cancellation of any examination by me, or the ABOG.
4. Understandings, Agreements, Covenants, and Warranties of Applicant.
4.1 I understand and agree that the decision as to whether my grades and other performances on the ABOG's examination qualify me for, and any entitlement I may have to continue to qualify for, a certification of qualification rests solely and exclusively in the ABOG, and that its decision is final.
4.2 I further acknowledge, represent, warrant, and agree that membership in the ABOG is not necessary for me to practice medicine in any jurisdiction in which I am or may become licensed to practice medicine and that any such membership or qualification in or by the ABOG is an honor or privilege, not a right. I further agree, represent, and acknowledge that membership or non-membership in the ABOG generally, or in any specialty or subspecialty group of the ABOG, does not affect my ability to engage in the practice of medicine or interfere with or affect my ability to earn a living and engage in my profession although membership in the ABOG generally or in any specialty or subspecialty group of the ABOG would enhance my standing in the medical community.
4.3 After completing or nearing completion of an ACGME-approved residency program in Obstetrics and Gynecology and meeting all of the requirements of the ABOG for such program, I agree to complete an application to begin the certification process. Upon those conditions I understand, consent to, and irrevocably agree that the results of my examinations may be made available to the Program Director of any residency program in which I have participated or I am currently involved and/or the Accreditation Council for Graduate Medical Education (ACGME) for any and all purposes. Furthermore, I hereby release and agree to indemnify and hold the ABOG and its officers, directors, and employees harmless of and from any and all claims I may have with regard to the effect or impact upon me of the release of my examination results to my Program Director or the ACGME and waive any rights I may have, if any, to have the examination results maintained in confidence.
5. Release and Exoneration of ABOG.
I hereby waive, release, exonerate and agree to indemnify and hold harmless the ABOG and its directors, officers, members, committees, committee members, employees, examiners, and agents from, against, and with respect to, any and all demands, claims, losses, costs, expenses, damages, of any kind, including for reasonable or other attorney's fees, and judgments, of any kind or character, alleged to have arisen from, arising from, resulting from, out of, with respect to, or in connection with, any action which they, or any of them, take or fail to take, as a result of or in connection with this Application, any examination conducted by, the ABOG, any examination which the ABOG determines, in its sole and exclusive discretion that I have failed to qualify for, and if applicable, the failure of the ABOG to issue me a certificate, diploma, or other emblem of qualification, or the ABOG's revocation of any certificate, diploma or emblem of qualification previously issued to me. I further agree to release, exonerate, indemnify and hold the ABOG and its directors, employees, members, examiners, officers, agents, free from any claims for liability or damages or complaint of whatever kind or character whatsoever, by reason of any action, they, or any of them, may take in connection with this Application, such examination, the grade or grades given in respect to any such examination, and/or the failure of said Board to issue me a Diploma of Qualification, or by reason of the forfeiture or revocation thereof because of my failure to comply with the Articles, Bylaws, Resolutions, Rules and Regulations of the ABOG, as may from time to time exist or be revised.
6. Venue and Jurisdiction.
I agree that if any dispute arises between myself and the ABOG with regard to my qualification for or my taking of the examination, the results of the examination, and/or any decision made by the ABOG with regard to my qualification for, and any entitlement I may have to continue to qualify for, a Certificate or Diploma, that dispute shall be had, held, and adjudicated in an appropriate court in Dallas County, Texas. I hereby consent to the jurisdiction and the laws of the State of Texas and exclusive venue in Dallas County, Texas with regard to any dispute that may arise with regard to the conduct of the examination or my qualification for, and any entitlement I may have to continue to qualify for, a Certificate or Diploma or in connection with the manner of conducting any examination or the results thereof, or my rights to membership in the ABOG or to any privileges of such membership. I further agree that if, and to the extent, I may have any legitimate claims concerning my qualification for, and any entitlement I may have to continue to qualify for, or the conduct of any such examination, I will first exhaust all administrative remedies available to me under the Guidelines of the ABOG, and after first doing so, if, and to the extent, I may have any claims that can be heard in a court of law under the terms hereof, such claims shall thereafter be addressed exclusively to the attention of an appropriate court in Dallas County, Texas where the ABOG maintains its principal place of business. I acknowledge that the application and examination fees that the ABOG charges and that I have agreed to pay would be higher if I, and other applicants, did not agree to these venue provisions. I further agree that in any such court proceeding Texas substantive law shall be applied and be applicable.
7. Adjudication of Disputes, Forum: Waiver of Right to Jury Trial.
In the event that any dispute arises between me and the ABOG whether under the terms hereof or as a result of any action taken by the ABOG or me as a result or consequence of my submitting this Application, my right or privilege to become or remain a member of the ABOG, my use of the ABOG website or any documents or materials I downloaded, viewed or referred to on the ABOG's website, or by reason of any Application, request for information or other contact between me or a representative of mine and the ABOG or any representative of the ABOG, I and the ABOG expressly agree to waive and hereby waive any rights we each may have to a trial by jury of any and all issues arising in any action or proceeding between me and the ABOG or our respective successors, representatives, assigns, or heirs. In addition, any claim, dispute, or controversy ("claim") by me or the ABOG against the other shall be resolved in an appropriate court of law located in Dallas County, Texas, as described above.
8. Continuing Requirements upon Receipt of Diploma.
In the event I successfully complete the examination requirements, meet all of the requirements and conditions for, and receive a Diploma, I hereby agree to comply with all of the provisions of the Articles of Incorporation, Bylaws, Bulletins, Rules and Regulations of the ABOG, including all of the requirements for Maintenance of Certification, and the qualifications for, and any entitlement I may have to continue to qualify for, the receipt and retention of that Diploma, as they currently exist or may hereafter be revised, and further agree that in the event I ever violate any of the terms and provisions of the Articles, Bylaws, Bulletins, Rules and Regulations of the ABOG, as they may exist from time to time, that any Diploma issued to me may be revoked or forfeited in accordance with the terms and provisions of such Articles, Bylaws, Bulletins, and Rules and Regulations of the ABOG.
9. Authorizations for Release of Information and Release.
I hereby authorize the ABOG or any employee, agent, director, officer, representative, member, examiner, or any other person with whom the ABOG may have dealings to obtain any and all information from schools, current or former employers, criminal justice agencies, individuals, medical institutions, hospitals, medical associations, medical organizations, or other organizations or persons, concerning my history, my history in the medical profession, and relating to any and all of my activities. I hereby authorize and direct the medical organizations and associations, hospitals, and other medical professionals named in this Application and the responsible officials thereof to furnish the ABOG such information as it may request to verify the accuracy of the information contained in this Application and of my medical professional history, and hereby agree to release and hold all such organizations harmless from any liability or damages for providing such information to the ABOG. This information may include, but is not limited to, academic, employment, achievement, performance, personal history, arrest and conviction records, as well as any other information pertaining to my professional credentials or history in the medical profession or my history, generally. I hereby authorize and direct such third parties to release such information upon request of the bearer of this Authorization or a counterpart thereof. I understand that the information released is for official use by the ABOG and may be disclosed to such third parties as may be necessary in the ABOG's sole discretion in the fulfillment of the responsibilities of the ABOG. I hereby release and agree to indemnify and hold harmless any individual, person, organization, association or other entity including records custodians, as well as any corporation, partnership or other legal entity, from any and all liability for damages of whatever kind, character or nature whatsoever which may at any time result to me or I may incur on account of compliance or any attempts to comply with this Authorization. Any third party furnishing information to the ABOG may rely upon a signed copy of this document as if it were an original. I specifically authorize the ABOG and its employees, officers, directors, agents and representatives, to the extent required by any federal, state or local law, ordinance or regulation, or by any lawful subpoena or other legal process served upon it or them, to reveal the facts of this or any other application I have submitted to it, the nature and results of any examination I have taken, and any other information regarding my professional standing, knowledge, qualifications and/or competence.
I understand that the ABOG is relying upon the accuracy of all of the information that I have supplied in this Application, although the ABOG is free to, and I expect that it will, independently attempt to verify the information contained in this Application. Nevertheless, I warrant that all of the information contained in this Application is true and correct and that no material omission has been made in the content of this Application. I understand that I do not have any right to submit this Application or take any examination for which I am applying and that this privilege has been afforded to me by the ABOG to submit such Application and to take such examination subject to the Articles, Bylaws, Resolutions, Rules and Regulations of the ABOG. I further acknowledge that nothing done by the ABOG in granting or denying this Application, allowing or disallowing me to take the examination, or the results of any such examination which I may take, prevent me from practicing medicine in the states in which I am so licensed.
I have read the contents of this Application and all of the terms, conditions and provisions contained herein. Further, I understand these terms, conditions and provisions and agree to be bound by them in consideration of the willingness of the ABOG to receive this Application and I hereby acknowledge that such consideration is sufficient and valid. I understand that in the absence of my agreement to these terms, conditions and provisions, the ABOG would not have received my Application nor, if my Application is accepted, allow me to take the examination for which I am applying.
The terms, provisions, covenants and remedies contained in this Application shall be enforceable to the fullest extent permitted by law. If any such term, provision, covenant, or remedy of this Application or the application thereof to any person, association, entity, or circumstances shall, to any extent, be construed to be invalid or unenforceable in whole or in part, then such term, provision, covenant, or remedy shall be construed in a manner so as to permit its enforceability under the applicable law to the fullest extent permitted by law. In any case, the remaining provisions of this Application or the application thereof to any person, association, entity, or circumstances other than those to which they have been held invalid or unenforceable, shall remain in full force and effect.
To request special examination assistance or a test modification during the examination due to a disability, documentation of the disability and specific accommodations requested will be required. Please mail/fax this documentation to the Board office no later than 90 days prior to the examination. The Board reserves the right to verify your disability. The Board will attempt to make accommodations for applicants with verified disabilities. The Board supports the intent of the "Americans with Disabilities Act (ADA)". You are reminded, however, that "auxiliary aids (and services) can only be offered that do not fundamentally alter the measurement of skills or knowledge that the examination is intended to test". (Americans with Disabilities Act, Public Law 101-334§309(b)(3)
14. Use of Third-Party Study Aids during MOC.
It has come to the attention of the ABOG that certain companies are offering a service which allows you to pay a fee to receive summaries to the articles that are the basis of the ABOG's MOC program. The articles assigned and test questions given are Lifelong Learning and Self-Assessment MOC components.
The purpose of this provision is to put you on notice that if you are or continue to utilize such services such as the ones listed above to answer the test questions, you will be in violation of the MOC's Professional Standing requirement. The ABOG will require you to sign an on-line attestation which provides in principal that you certify to the ABOG that you have read each assigned article in its entirety and have not relied on or used any third party service to aid in answering the test questions.
The Board of the ABOG has determined that using these or similar services to answer the test questions or by falsely certifying to the ABOG that you have read the entire article without the aid of third party services is a violation of the Professional Standing requirement and ethical standards of the ABOG and will result in the loss of your Diplomate status.
If you are also a member of the American College of Obstetrics and Gynecology ("ACOG"), subscribing to these services can jeopardize your standing. The College has recently released the following statement to its members:
ACOG is aware that commercial companies offer summaries of the Articles in the Lifelong Learning and Self-Assessment exam of the ABOG for a fee. The purpose of the Lifelong Learning and Self-Assessment is to fulfill the requirement of ABOG's MOC and to assure that the physicians are keeping up to date in our specialty and related areas. To accomplish these two goals, the physician is expected to read the entire article and complete the examinations. When this is accomplished, ACOG will award cognate (CME) credits. If the physician does not read the entire article and complete the exam personally, no CME credit can be given. When this process is not followed, any physician requesting credit will be in violation of ACOG's Code of Ethics and may be subject to disciplinary action by ACOG's grievance procedures. Penalties could include a range from warning to expulsion based on the findings of ACOG.
It is our mission to provide the public with the expertise it expects when hiring a board certified physician. Using any service which allows you to circumvent reading the assigned articles hurts your patients and the integrity of this Board.
All Examination materials are copyrighted by the American Board of Obstetrics and Gynecology, Inc. Any disclosure of the questions or answers or their substance, in whole or in part, to any person, organization or entity, public or private, orally, in writing, or by other form of communication is strictly prohibited. In the event that the ABOG determines that any unauthorized disclosure has been made by any person granted access to this examination, it reserves the right to refuse participation credit to such person or revoke its participation credit, if already granted, and, in addition, to seek monetary and injunctive relief in court, submitting to the exclusive personal jurisdiction and venue of a State District Court of Dallas County, Texas, and the United States District Court for the Northern District of Texas.
Policy approved on 7/6/2018