Advocacy & Health Policy: ACOG Strengthens through Success of the CAFA Initiative

On October 1, 2016, more than 170 Central American physicians will take the ob-gyn certification examination, which has standardized the residency educational objectives in six different countries. The exams will be administered in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama as part of a collaboration between ACOG and the Federation of Central American Associations and Societies of Obstetrics and Gynecology (FECASOG)

CAFA, the Accreditation Committee of the FECASOG-ACOG, develops and administers both the residency and certification examinations every October. After passing the exam, physicians can then become ACOG members.

In addition to the certification exams, more than 270 residency exams will be administered on October 1 to inform Central American medical school administrators and health directors about the quality of pre-service education levels in teaching hospitals and schools throughout their countries.

ACOG’s Central America Section

ACOG’s relationship with Central America began in 1998 with the College’s involvement in the Save the Mothers program initiated by FIGO (the International Federation of Gynecology and Obstetrics). Ralph Hale, MD, then ACOG’s executive vice president, was instrumental in securing ACOG’s participation. The project paired six high-resource countries with six low-resource countries to implement projects to lower maternal mortality.

ACOG, representing the US, was paired with four countries that had the highest maternal mortality rates—El Salvador, Nicaragua, Honduras, and Guatemala. During the course of this project, Central American ob-gyn society leaders expressed an interest in becoming an ACOG section, resulting in the formation of Central America section in 2000 as a part of District VIII.

Several ACOG staff and Fellows were instrumental in the development of this relationship. Key personnel were Tomas Purdon, MD, and Doug Kirkpatrick, MD (ACOG presidents during those early years), Ben Curet, MD (then chair of District VIII), and Sterling Williams, MD (vice president for education and then-director of CREOG), Ralph Hale, MD, Jan Chapin, RN, MPH, and Ruth Moreno (then ACOG staff).

From Central America, Jorge Escobedo, MD, and Cesar Reyes, MD, from Guatemala played key roles, as well as Luis Villatoro, MD, from Honduras and Eduardo Cordova, MD, from El Salvador.

The Creation of CAFA and the Certification Exam

For Central American obstetricians to become Fellows, they—like any other applicant—must have graduated from an accredited program and passed a certification exam. Neither was available prior to 2003, so CAFA, the Accreditation Committee, was formed to fill those two requirements.

The committee was formed by two representatives from each of the countries involved and one ACOG member. The members of the committee received training in examination preparation and residency review from qualified ACOG Fellows. The first training was given by Hal Lawrence, our current executive vice president.

The committee activities have always been based on criteria created by ACOG’s Council on Resident Education in Obstetrics and Gynecology (CREOG) and the Requirements of Residency Programs. Initially, only a certification exam was prepared for final year residents and practicing obstetrician to meet ACOG’s membership requirements. The first exam was offered in 2003. Later, a second exam was created for residents only, following CREOG’s guidelines.

The improvement in residency education and the certification process has been remarkable and has led to an awareness and pride in Central America.


Central America Residency Exam

The residency exam is used for in-training evaluation by residency program directors. The accreditation of residency programs is based on criteria created by CREOG and adapted to each country. Residency reviews are done periodically and include a site visit carried out by CAFA members with the participation of ACOG to analyze and review facilities and programs. On average, there are between six and twelve site visits per year.

The CAFA residency program review requires an incredible amount of dedication from volunteer doctors, who serve on the committee for six years. During this time, they travel to residency programs to accredit them and spend time writing and reviewing exam questions.

Success of the Certification Exam Process

Finishing residents and practicing physicians who wish to become ACOG Fellows take the certification exam. In some countries, the exam is required by the residency program. The obligation to take the exam varies by country. The certification process in Central America has been successful and very well-received. The number of residents and doctors taking these exams has been growing since the first exams were administered in 2003.

In 2015, 116 certification exams were administered, of which 28 examinees passed. In 2014, 133 certification exams were administered, and 23 passed.

Within Central America section, Costa Rica and Panama have consistently achieved the best grades on the exams. Costa Rica and Guatemala have been able to have CAFA requirements accepted by their educational authorities. El Salvador has made the residency exam mandatory, and some of the universities have adopted CAFA requirements. Nicaragua has shown the most relative improvement in genetics, gynecology, and oncology.

The Central American initiative managed through ACOG’s Office of Global Women’s Health has successfully facilitated improved ob-gyn residency programs, regional or country-wide residency accreditation, and individual examination and certification processes in over six countries.

 “We should really be proud of the leadership from the six countries,” said ACOG staff member and Senior Director of Global Women's Health & Special Issues in Women’s Health Carla Eckhardt, “Their commitment to the process, their patience with change and improvement, and their leadership in making the medical education of their students the highest and best it can be is really commendable.”

The CAFA project has served as a model for all Latin American sections. The Dominican Republic, Argentina, Chile, Peru, Colombia and, more recently, Ecuador have formed an Accreditation Committee and are following the same steps as Central America. Uruguay has also expressed a desire to join ACOG and has submitted a formal application.

The work is truly transformative—ACOG should be proud to be a part of it. 

Learn More About Central America Initiatives

For more information about the Central American Initiatives, please visit the Global Women’s Health webpage.



American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188
Mailing Address: PO Box 96920, Washington, DC 20024-9998