Wednesday, November 20, 2013

The Final Test

Although I now work as an Emergency Room doc my initial training was in a Family Practice residency.  I finished that in 1985, but to be officially Board Certified I had to pass an exam.

What a lot of folks probably do not realize is that to stay Certified you have to keep taking the darned thing every seven years.  My lawyer friends cringe at the thought of having to repeat Bar Exams, so I think this is something that the medical profession (Family Practice was first but I think it is general now) can take pride in.

I was a smart monkey back in the day.  I passed Boards with very nice scores and did so without bothering to study.  I think one time my brother and I helped my parents move all day, then went out for well deserved pitchers of day I took the exam and scored in the 85% percentile.

But this time I was worried.  Having spent six years in an intense but somewhat limited scope of practice there were a lot of things I did not know.  New outpatient diabetes drugs.  Changes in guidelines for mammogram screening.  Details of post op care following cardiac bypass surgery.

So I fretted a lot, studied a little, then finally decided to just show up and give it my best shot.  If I flunked it, well, time to retire.  This was not an entirely unappealing concept.

The first couple of times I took the exam in a big hotel ballroom.  A couple of hundred folks scratching away with pencils, filling in circles to answer multiple choice questions.

Now it is all computer based.  And kind of an odd experience.

You show up at a "test center".  Basically a computer lab that runs exams for all kinds of purposes. They take their security very seriously at these places.  You have to show ID to prove you really are who you claim to be.  You have to roll up your pants legs to prove you don't have a smart phone holstered somewhere.  They scan you with a metal detector wand.  You do get (one) pair of glasses allowed but I bet if you put a Google Glasses sticker on them you'd hear about it.

After passing through what approximates airport security you get to go to Dilbertville.  A room full of cubicles each with its own computer terminal.  Cameras watch you all the time.

I expect I did alright on the test.  I signed an agreement not to talk about specific content but there are a few things I can observe for the benefit of other grizzled veterans undertaking this or similar tasks.

1. Working in ER is most excellent preparation for this sort of exam.  On a constant basis I get presented with scraps and bits of information, sometimes conflicting.  I have to quickly consider a range of possible diagnoses and whittle it down fast.  This is very useful when you get a one paragraph scenario and options A through D as answers.  Even when I did not instantly know the right answer I could rattle the decision tree efficiently.  In the real world you often narrow it down to a couple of choices and run tests to confirm your ideas.  In the Unreal world you narrow it down and sometimes just pick the best of two options.

2. After three decades of doing this sort of thing I really have seen almost everything.  I can be fooled, but the Universe has to work at it a bit.  And with 9 hours of sleep and three cups of morning coffee on my side, it has to work pretty hard.

3. Board exams always, always have a few pet diseases.  I am not going to name it but one particular obscure problem appears more than once on any exam you will ever take.  It is a rare bird.  So rare in fact that it is The Great White Whale of diagnoses, the sort of thing that physicians spend an entire career obsessively chasing.  Most of us never find one.

4. I am a probably bit more computer savvy than most physicians of my generation.  Constant use of computers makes an exam of this sort seem familiar.  EKGs still look like scratches and scribbles though, there is something about them that translates poorly to a screen.

I learned some things preparing for this exam so I guess it is a good thing to do.  In the preliminary stages of studying I did a batch of online "modules" from the American Board of Family Medicine. They were very difficult indeed.  I am quite sure that the Knowledge Masters do this on purpose. Rather like swinging a weighted bat in the on deck circle.  If their intent was to scare me into additional study it was a worthy one.  And a successful one as well.

I will be 57 in a few months.  I am not planning on working much after 60.  So this really should be the last time I have to gear up for this experience.  It will be interesting to see if my pervasive fever dreams of being  unprepared for an exam start to fade.  But I wonder, do the things we fear in our own depths ever really change?

Well, time to go hunt whales.

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