A lot has been written about board recertification requirements. Physicians have grumbled and moaned for years. The objections have caused changes. Some specialty boards have abandoned the tests. And yet — for most specialties, we still find ourselves turning over our credit card numbers, blocking off a day of our incredibly busy lives and heading for a professional testing center.
On the surface, the process is absurd.
Oh, I get that we should keep up to date. In the ’50s, the doubling time of medical knowledge was estimated to be every 50 years. With the current technology, in 2010, the doubling time was estimated to be 3.5 years, with projections that the doubling time will be less than three months in 2020. A physician in the past might be able to be reasonably current by reading their specialty journal and perhaps a conference a year. Now the learning process must be continuous and fluid.
The exam itself has become silly. The test itself takes years in development. Anyone who has been involved with writing high-stakes exams can relate. To take an item, which may seem simple on the surface, to fruition to be exam ready is a labor-intensive process. By the time you sit in front of the computer at the testing center, the exam is out of date. Some items might be a quaint reminder of how we practiced last year.
More than once, I’ve encountered a question, and while I could write a spontaneous essay on the subject being tested, I can’t tell you whether the “correct” answer is A or B. Did the authors follow the guidelines presented last month? No?
Of course, there is also the ridiculous assumption that the facts needed to answer the question are in our heads. In the real world, if you aren’t 100 percent sure of a course of action, you can click on the references embedded in your electronic medical record, or you can pick up your smartphone and get the most current recommendations. Even when you are 100 percent sure of the diagnosis and treatment, you might look to verify that the guidelines didn’t change last month.
But today, I am not adding to the litany of complaints about the stupid examinations themselves. I am here to proclaim my disgust at the indignity of the process of taking the test itself. Here we are, a profession in which trust is paramount. I am a physician. You come to me and trust me to take care of you, to guard your secrets and be reasonable. And then, society asks me to arrive at a testing site and suffer indignities.
Indignity? Yes. Indignity. We are used to the security theater of TSA at the airports. We are accustomed to taking off our shoes and belts. We assume that we must pass through the scanner. Enough public buildings now have metal detectors. No worries. I remember to be thankful that efforts are made to keep us safe.
The indignity of which I speak is the security at the testing site. Even the TSA does not demand that I turn my pockets inside out. The proctors at the center certainly do check our pockets, both at the beginning of the test and again, if you happen to take a potty break.
Actually, it isn’t the pockets that angered me. I find inverting the pockets a bit much, after the scan and with them peering at us throughout the exam, but it doesn’t anger me. They are doing a job.
For the last such test, I had read the instructions carefully. It did say that cough drops in a clear container were allowed. I needed cough drops to sit comfortably for several hours. I carefully brought a snack-sized plastic bag and placed several cough drops inside. I was told they weren’t allowed. I was told I needed to UNWRAP the cough drops. Really? Really!?
I unwrapped my honey-flavored drops and then was made to put them on a testing site provided tissue to have while I took the test. (Note, cough drops placed on tissue stick to the tissue. Nasty.).
Please help me understand. If I were sinister enough and clever enough to predict the answers and write them in teeny-tiny minuscule writing on the inside of a Halls wrapper, wouldn’t I be bright enough to memorize that fact? Are my lozenges a threat to the security and integrity of the exam?
Closed-book exams are archaic. Most in the medical community recognize this reality. Strides are being made to make our recertification processes consistent with the information flow of the times. Regardless of your conviction that standardized testing needs to be revamped, we should all be able to agree that cough drops are an unlikely source of trickery and deceit.
Lisa Masson is a family physician. The opinions expressed are of Dr. Masson’s, and do not necessarily reflect the opinions of her employer.
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