Generally, board cert. consists of written & oral tests before a board (several members) of the discipline (surgery, cardiology, gyn., etc., etc.). If you pass written, you go to oral and then you select a number of patients during a time period (maybe a year, whatever the discipline requires) whom you treat and you write-up in detail all things that you did having to do with the patients. You present it to the board and must defend what you did & didn't do on the case. They judge and you may or may not obtain approval. It takes months & months of work. No small thing, and this is done while you are practicing medicine -- so some patients of docs are not being seen by a board-cert MD. That's how it works in the areas with which I am familiar.