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Apologies for Thinking Boards Were Logical

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  • Apologies for Thinking Boards Were Logical

    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/p...coring-rubric/
    What is Stage 1 and Stage 2?

    https://www.abos.org/certification/p...rted-outcomes/
    These are mandatory sent at the request of the physician. Don’t do it and you get screened out.

  • #2
    Welcome to the hoops of medicine.

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    • #3
      Originally posted by ACN View Post
      Welcome to the hoops of medicine.
      Rate the six faces on a scale of 1 to 10. Where do you hurt?
      Attached Files

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      • #4

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        • #5
          The only saving grace is if the two examiners take turns asking questions, scroll through the file and check the boxes and play the game. “Dang great work saving the guy’s leg in an impossible situation”. Got to find something to rate this as outstanding. Rationalization and cook the books.
          My daughter’s rant came after a discussion with a mentor that is now doing a turn as an examiner. Don’t sweat this, tie up that etc. Basically, how to play the game.
          What a bargain for only $2325, 90 day turnaround on the test results!
          Silly me. I thought was about the cases. Now I empathize with the MOC and recertification process. I have absolutely no reason to believe and other specialty would be different. Pardon my ignorance.

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          • #6
            At least for EM, I felt like I didn't get my money's worth on the oral boards for several 15 minute awkward encounters in a hotel room with another person (sometimes with another person sitting in the corner watching that person).

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            • #7
              No oral component for me. Just 3 days of 8 hours of computer questions

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              • #8
                Originally posted by CordMcNally View Post
                At least for EM, I felt like I didn't get my money's worth on the oral boards for several 15 minute awkward encounters in a hotel room with another person (sometimes with another person sitting in the corner watching that person).
                I barely passed orals. Strange since I knew the diagnosis of each case, and feel like I can get through a typical work day without (totally) botching everything. Perhaps I got demerits for not stating that I showed up at work sober, in appropriate attire, and put on gloves before performing the rectal exam?

                In other news, I just took the ConCert a few years early. Fingers crossed that I passed; if so, it will be my last renewal.

                It is hard to wrap my mind around where the years have gone.

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                • #9
                  For radiology, it's a computer test now. There were oral boards up until my first year of radiology residency. You'd think there'd be some transparency about percentage of questions answered correctly. Nope. Just a moving percentage of people that fail.

                  There is currently a bill in the CA senate trying to allow NPs to read x-ray, ultrasound and mammo without supervision- the absurdity of that is a different discussion. I've heard nothing from the 3 dominant bodies in our profession, including the ABR regarding this. So, the fees are going somewhere, just not toward better testing, more transparency, and advocacy for the physicians they fleece (rant off).

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                  • #10
                    No idea how C-19 will impact. They have a video of the exact set-up. One big screen controlled by a mouse in your left hand and a portable with another mouse for your right hand. Candidate on left table, two examiners with portables on the right. Examiners and candidate have access to the complete file. A bell rings and it’s go. Good luck to the candidate keeping the case on track.
                    The examiners take turns finding questions to fill in the box. 18 year old comes in after seeing a ready clinic and told to see an orthopedic. Mom explains it keeps bleeding for a week. No OR available in adult, schedule the Peds OR at 7pm.
                    Interrupion, why not 2 months of therapy? Check the box. Back to the case, a question about the medical history, check the box. Back to the case, next question about the literature on alternate techniques, check the box. Next question, 4 week follow up, check the box. Back to the case. They caution that the applicant has not idea how they did. The examiners May have already made up their minds and simply devoted time to filling in boxes. The bell goes off and time for the next.
                    I am sure the examiners really try to accurately assess the competence. Boxes to check and documents to scan. It is unpaid, so it’s probably not completely stimulating either. Might send a bottle to her mentor for the heads up.
                    Depressing. That checks a box too! At least the pass rate is around 95%.

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                    • #11
                      Originally posted by Brains428 View Post
                      There is currently a bill in the CA senate trying to allow NPs to read x-ray, ultrasound and mammo without supervision- the absurdity of that is a different discussion. I've heard nothing from the 3 dominant bodies in our profession, including the ABR regarding this. So, the fees are going somewhere, just not toward better testing, more transparency, and advocacy for the physicians they fleece (rant off).
                      wow, that is a pretty big drop by organized medicine if it truly not being followed (in my specialty, we do a lot of behind the scenes stuff that doesn't make a very good story until things are either done or looking ominous). my knee jerk response was "let them take breast and the associated liability" but I know that misses the point.

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                      • #12
                        Originally posted by G View Post

                        wow, that is a pretty big drop by organized medicine if it truly not being followed (in my specialty, we do a lot of behind the scenes stuff that doesn't make a very good story until things are either done or looking ominous). my knee jerk response was "let them take breast and the associated liability" but I know that misses the point.
                        Don’t think associated liability is included in the bill. Something about immunity, creative isn’t it?

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                        • #13
                          The bill has been around, but it's pushing further every year. Here is the text (imaging is only one of the expansions, but might be the most ridiculous. Most physicians would agree medical school teaches little about imaging, let alone nursing school and associated advanced degrees)
                          https://leginfo.legislature.ca.gov/f...201920200AB890

                          The description about expansion of practice is about 3/4 down the page.

                          I don't know if any of the breast imaging or surgery societies have said anything about it. Nonetheless, I do think that the board has an obligation to protect the public from incompetence, as well as the well being of the physicians they receive dues from. If they would like to simply wipe their hands of any obligation of physician advocacy, reduce fees to simply manage the testing operations and distribution of boards. There shouldn't be a 6 figure wage tied to it.

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                          • #14
                            Hm, I just skimmed the bill, but it looks to me like it is to establish independent practice for NPs, not radiology specific. Medicine (capital M) has already abdicated. I would argue that the fact CA has not is actually a resounding endorsement of physician advocacy.

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                            • #15
                              Originally posted by G View Post
                              Hm, I just skimmed the bill, but it looks to me like it is to establish independent practice for NPs, not radiology specific. Medicine (capital M) has already abdicated. I would argue that the fact CA has not is actually a resounding endorsement of physician advocacy.
                              I know it's not radiology specific. I feel like that's the worst part- it's a line item that probably gets glossed over. I realize this is a common tactic from the state to federal level.

                              Back to the original topic-- I guess we could all join the NBPAS.

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