COMMENTARY

Taking the Boards: A Frisking, Then a Mugging

John L. Marshall, MD

Disclosures

March 20, 2014

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I'm 52 years old -- a terrible age. If I were a little bit older, this wouldn't have happened. What happened? I had to take the oncology certification board examination for the third time, and what a painful experience it was.

I did all my modules and got my 100 points, and then it was time to take the test. I'm a specialist, so I don't take care of leukemias and lymphomas and breast cancer -- and frankly, over the past 10-12 years, there have been dramatic changes in all of those disease areas, so I had to go to school.

I completed a board review class. I got books. I did practice questions. I went to journal clubs and to our fellows lectures. I tried my best to essentially learn from scratch all of these diseases that used to be simple because we gave the same treatment to all patients, but now we have incredible molecular data and profiles.

So, I get all ready for the test. It was a big deal -- a big hassle -- because I still had my day job.

I studied hard, and then I went to the test center. Have you ever been to a test center? This is unbelievable. You take the test on a computer -- no number 2 pencils anymore. Sitting next to me are a bunch of high school kids taking their SATs. A few insurance salesmen are taking their licensing exam, and a few other oncologists were there to take their board exams. We knew each other.

You have to be basically naked to enter this room. They make remove your wallet and your watch -- everything from your body -- and you sit down and face a computer screen. No one has thought about glasses. I'm an old guy, and I need them to see the computer screen, so I had to keep my head up the whole time. I probably have a bad neck now from a whole day of staring at the computer screen and reading these questions.

The exam had 3 sets of 60 questions each. It was really hard. I am an expert in gastrointestinal (GI) oncology. In fact, a few years ago I wrote questions for the board exam, and fortunately a couple of those were on the test, so I hope I got those right. However, I encountered several questions in the GI section for which no right answers were in front of me. I'm pretty sure that there were no right answers, and if I'm struggling with those kinds of questions in my area of expertise, what must it be like on the questions that are not in my area of expertise?

I was taking the boards with a colleague who is a breast cancer expert, and she expressed the same thing. I started to think about whether this test actually measures my skill and knowledge base for taking care of cancer patients at 52 years of age.

I understand the whole idea of requiring board exams, and I considered it a good idea to go through this process. It brought me up to date, but I thought that the test was not a fair judge of my abilities as an oncologist to care for patients day in and day out. The test had a lot of tricky and badly worded questions, so we need to reach back out to the board that administers the test and make sure that they have our feedback about the quality of this test.

I'm still bitter. Here it is a month later, and I still don't know whether I passed this test. I feel a little bit like my daughter, who is waiting on college applications to find out whether she was accepted. Fingers crossed that I won't have to do this again until I'm 62 years old.

This is John Marshall, signing off for Medscape.

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