Apologies for Thinking Boards Were Logical

[endo4jc]

I have read many comments from physicians basically trashing some pieces of the specialty boards. Most characterize it as an administrative money making machine. As a non-physician, my exposure is limited. BEFORE my daughter’s board collections were done, I was introduced to the negative sentiment. Similar to the Press Ganey patient surveys. Foolish me, I thought competence was based on the oral exam of 12 cases selected. Just a rant. Feel free to rant. Very disappointed in certification.

1) The oral exams scoring system seems not to determine the physician skills are above, expected, below, or unacceptable. It seems to focus on attributes without weighting.
2) Patient Reported Outcomes- required emails of patients with undefined questions.
Short version:
The oral exam of 12 cases seems legitimate, the scoring system seems a crock. A mechanical metric to assign a number to purely an opinion.
Check all the boxes is seems worthless. I would rather see scoring of the cases.
Is my impression that the certification process falls way short, wrong?
Situational, cases are for patients 12 and over. There are orthopedic pediatric physicians. I guess under 12 doesn’t matter.


Basically, the scoring metrics seem to be structured very generically and procedurally.
The resulting output is a convenient score, using a Scoring Rubric for Part II (the oral exams). Attached:

https://www.abos.org/certification/part-ii/scoring-rubric/

What is Stage 1 and Stage 2?

https://www.abos.org/certification/part-ii/patient-reported-outcomes/

These are mandatory sent at the request of the physician. Don’t do it and you get screened out.

You have mentioned in other posts that your daughter is an orthopod. Did she recently sit for the 2020 part II boards? Or is she collecting for July 2021?

[Lithium]

If NCAA football were run like our specialty boards, Lincoln Riley, Jim Harbaugh, Ryan Day, and Dabo Swinney would have to hunker down every ten years to read through banks of multiple choice questions about the implementation of the West Coast offense, the evolution of the forward pass, who set the rushing records of the Sun Belt conference, and the design of the Cover 2. They would pay thousands of dollars (chump change, since they make plenty of money) and fly to one of four cities in the country, where they would go through airport-level security screening before they completed a computerized multiple choice exam to prove their competence in their profession. If their certification were run like some specialties, they would then stay in town for another day, where some practice squad players would suit up, and the examiners (possibly consisting of active, or retired, or recently released peers) would ask the coaches being examined to call several practice games, in order to judge how well they have drawn up plays and motivated the players.

Meanwhile, coaches who have been practicing their craft for many decades, such as Nick Saban, Les Miles, and Mack Brown would be grandfathered an exemption from these requirements. They would be free to recruit and continue with their work while their peers worked to meet their profession's standard of excellence.
Also exempted would be all assistant coaches. So at least if Harbaugh or Swinney failed their coaching boards, they could trust their head assistant to take the reins while they remediate. It might be inconceivable that a previously successful coach could fail the test, but some failures would be necessary to demonstrate that the test is legitimate and not just a rubber stamp.

I mean... as long as the head coach can pass the test, aren't the assistant coaches doing most of the recruiting and heavy lifting anyway?

[Zaphod]

Every passing is a good thing. We all learn the same anatomy and treatment. It isn’t like Harvard has some secret way of teaching their medical school versus state medical school X.

Again, I would argue that it is a good thing to have a certain standard we all must pass. If not you can’t justify charging so much money. So they take a few thousands dollars. Big deal. We make plenty of money. Do you want just anyone to say, they can practice medicine? Or treat you? Should simply getting into medical school be enough? And having to take boards, force you to learn and study a lot. If not people would simply do the bare minimum to get the residency years over with.

Me personally, I studied knowing that I didn’t want to fail the boards the first time. And if there was no big pressure to study hard, I may not have the knowledge I have now. Most of the day to day stuff we do can be learn from a few years of residency. What separate the physicians from the nurses and students and other ‘health care providers’ is the board.

This is the purpose of usmle, residency and in service exams. We have already screen people to be the cream of the crop, there is zero extra incentive necessary. In fact, drs unquestioning loyalty to any test put before us is most of the problem. The rest is unfortunately sorted in practice, theres no real way to do what you describe as you'd be making it so doctors cant practice which comes at a massive cost to all parties.

Most of the questions on boards written section arent applicable to real life and great scores come from knowing which era answer to give. Orals are very unrealistic and given that terrible docs and great docs alike pass them, again, they do not serve their purpose as a mark of distinction. This is testing/certification theater, nothing more.

I dont think its wise to allow a private company to have the power over your ability to practice and make a living.

LOL at thinking boards separates us from nurses and students. Its the depth of knowledge and practice, which is a massive gulf. And yet they can practice medicine solo in many states and growing, without these hassles.

Boards do not represent real life in any way. We constantly learn, read articles, prepare for cases, etc...and we dont need boards for that, because we care about our patients and want good outcomes. You shouldnt need boards to learn your field, seems obvious, and non emergent or day to day minutiae doesnt need to be on instant recall to be good either.

The fact is boards do not actually do the service most prescribe to them, and are better suited to other avenues where you have more contact, time and knowledge of your skills. There is zero reason why this type of function shouldnt be done in residency.

If it were in any way geared towards real practice and results older docs would be the ones having to prove their competency and new graduates would be the ones with automatic granting of certification. This has been shown in actual studies, unlike anything related to boards.

And yet unethical, not so great docs are around and treating people, and they are most often board certified as well, delineating nothing.

[Tim]

“If it were in any way geared towards real practice and results older docs would be the ones having to prove their competency and new graduates would be the ones with automatic granting of certification. This has been shown in actual studies, unlike anything related to boards.”

Now I understand why the advice was “keep it extremely brief and simple.” You are talking about some things that are way over the heads of most examiners. Your job is not to train them in 10 minutes. Don’t think cases aren’t picked because they might be interesting or intriguing. The skills developed in fellowship can lead to responses that one tries to show off skills greater than the residency training. Poor tactic.

[Zaphod]

“If it were in any way geared towards real practice and results older docs would be the ones having to prove their competency and new graduates would be the ones with automatic granting of certification. This has been shown in actual studies, unlike anything related to boards.”

Now I understand why the advice was “keep it extremely brief and simple.” You are talking about some things that are way over the heads of most examiners. Your job is not to train them in 10 minutes. Don’t think cases aren’t picked because they might be interesting or intriguing. The skills developed in fellowship can lead to responses that one tries to show off skills greater than the residency training. Poor tactic.

Not sure what this is meant to say. I dont know how many people try to show off during board collections, seems a very low lunatic fringe. In reality the norm is to highly limit your cases and style of practice to be very controlled during board collection periods, anything else is insanity.

All that comment meant was that studies show recently graduated physicians are more likely to be following guidelines in surgery and treatment and be up to date than older near retirees. And those are the ones grandfathered into the system.

Boards, and tests in general are just a game. Know the rules, beat the game. Simple, but doesnt make it useful or meaningful. People often confuse effort and cost with meaning.