Does This Exam Really Measure Physicians' Knowledge?
The 10-year recertification exam has drawn stinging criticism from physicians who feel that it's unfair, irrelevant to practice, and not a reliable gauge of physicians' knowledge. Indeed, although numbers of exam-takers are increasing, pass rates are dropping.[3] In 2009, 90% of 4526 first-time internal medicine recertification exam-takers passed. In 2013, of 5772 internal medicine first-time exam-takers, only 78% passed. Many physicians feel that this points to serious flaws in the exam.
Jonathan Weiss, MD, a Monticello, New York-based physician who is board-certified in internal medicine, pulmonary medicine, and critical care medicine, is one of them. He describes the exams as a "useless waste of precious time" because they tested material that was irrelevant to his practice and siphoned off time he could have spent with patients.
Additionally, he says, "in this day and age, when physicians are encouraged to look things up rather than to rely on memory, a closed-book 'cognitive' exam is even more absurd and potentially harmful to patients. And there's no real evidence that these exams have improved the quality of patient care."
Lesley Fein, MD, a West Caldwell, New Jersey-based rheumatologist, is similarly indignant. "Imagine if lawyers had to pass the bar exam every 10 years. They wouldn't stand for it," she observes.
Dr. Nora defends the necessity and fairness of the exam, which "is intended to be an assessment of a physician's knowledge, judgment, skills, and familiarity with new standards." She says the exams "are subjected to rigorous psychometric evaluation to make sure questions are reliable and valid."
She also commiserates with exam-takers. "I know the time before the exam involves stress for many physicians, and I just want to cry for them. But it comes back to serving the public trust, making sure physicians are as competent and up-to-date as they need to be."
How MOC Came to Exist
Board certification dates back over 75 years and "grew out of the need to ensure that physicians claiming to be specialists did, in fact, have the appropriate training and knowledge," Dr. Nora recounts.
Although certification was originally conceived as a once-in-a-lifetime event, "patients became concerned because medicine has evolved dramatically," Dr. Nora explains. So by the 1990s, specialty boards had instituted a recertification process, consisting of an exam taken every 10 years by anyone who completed training after 1990. Those who completed training earlier were "grandfathered" into the system. But, "now we understand that every 10 years is no longer appropriate because medical science is changing so rapidly, so more frequent activities are necessary."
Each specialty board has its own set of MOC requirements and timetable in which these requirements must be met. But all boards require four components:
• Licensure and good professional standing;
• Cognitive expertise, measured through a formal closed-book examination;
• Lifelong learning and self-assessment; and
• Practice performance assessment.
These are specific to each board but include a combination of educational activities (including CME), patient safety modules, open-book tests, self-assessment of some practice metric, and patient/colleague surveys.
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Cite this: Do Recertification Demands Waste Doctors' Time and Money? - Medscape - Jun 04, 2014.
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