TO: American Board of Internal Medicine
Philadelphia, PA
FROM: Mikkael A. Sekeres, MD, MS
Leukemia Program, Cleveland Clinic Taussig Cancer Institute
Cleveland, Ohio
Dear ABIM,
Has it been a year already since I last wrote? [3/10/13 issue]
Wow-time flies! You remember how these letters are in the spirit of Henry David Thoreau and Martin Luther King, Jr., both of whom penned essays while they were serving jail time, right? Well, I got paroled from the emotional jail of post-traumatic stress disorder from having studied to recertify my medical oncology boards, but emblematic of the well-described theory of recidivism, landed right back in the slammer of righteous indignation. As before, my comments are intended to be constructive, to offer suggestions moving forward.
So, how can I catch you up on the goings-on of the past year? Let's see, some highlights from 2013[horizontal ellipsis]the roll-out of the Affordable Care Act was a bit of a mess. Then there was the transition of the Pope, Nelson Mandela's death, the birth of Prince George Alexander Louis of Cambridge, the Syrian civil war[horizontal ellipsis]busy year! How about for you?
Not so good? I heard about the April 2013 ABIM medical oncology test-where there was a delay in getting the medical oncology exam to test centers, so all of those oncologists who had studied for months for the exam, canceled their clinics for the test day, and made it to the testing center by 7:30 am had to wait in cramped hallways for five hours before being let into the testing center. Could this have affected the candidates' test performance? I bet-this is a high-pressure event, and it doesn't take much to get "psyched-out," which could result in a poor performance on the test. To be fair, you recognized this, and in compensation you offered those bedraggled, defeated oncologists the opportunity to take the test again, for free.
Really?
A person has to put his or her life on hold for months to study for the test, cancel their clinics, wake up early to take the test, etc., etc. I mean, I understand there are only so many ways to deal with this type of situation, and maybe Pearson VUE had some degree of responsibility (though, ultimately, it is your exam). But isn't this compensation akin to offering a free second colonoscopy because during the first one you forgot to turn the light on the scope? Maybe you could have adjusted the passing rate a bit instead, or offered those who failed within a certain range the chance to make it up through additional maintenance of certification (MOC) points.
Fast forward to the November 2013 ABIM medical oncology exam. The test arrived at Pearson VUE right on time, which was ***AWESOME!!!*** But then I talked to a friend of mine who took the test, and unfortunately he failed-only by a point or two. He was really depressed about it and mystified, as he had studied hard, and in the past has done extremely well on standardized tests-and as we know, standardized tests are great at predicting success on standardized tests. So he did the unthinkable-he called you, and you looked into whether there were any irregularities with his exam. Lo and behold, two of his sections had not been scored, and he was thus given a point total of zero for those two sections.
What?
Did the test pages stick together or something? No, it was on the computer, so that doesn't make sense. Did this affect other people? Who knows-few would be brave enough to call you and ask. You told him you didn't know how it happened, but to be fair, you recognized your role in this, and in compensation you offered this bedraggled, defeated oncologist the opportunity to take the test again, for free.
Is anyone else noticing a pattern here?
By chance alone, throwing a dart at a big target with the possible test answers to those two sections depicted on it, he would have gotten enough points to crest the line between pass and fail. Why didn't you just let him pass? Instead, you told him it would take months to determine what happened, so he had better just take the exam the next time it was offered. He has to-his employer has a policy that if a person does not pass his or her specialty boards, that person is fired. He can't afford to risk it.
You know, these are funny times in which we live. You may have heard, the SATs are being completely revamped. David Coleman, who took over as president of the College Board in October 2012, recognized that the test has inherent socio-demographic biases, favors students coming from greater family wealth who could afford prep courses, and asks questions rarely encountered in high school that do not reflect innate intelligence, nor college preparedness. So he's changing the test, focusing it on evidence-based reading and writing instead of on esoteric words (like esoteric), on defining words in the context of how they are used, and on real-world math problems.
Do you think that the ABIM medical oncology exam suffers from some of the same issues? The biases, the favoring of people who have more resources (such as time not treating cancer patients or conducting cancer research) to study for them, the questions about strange and rare cancers, or for sub-specialists questions about cancers outside your specialty?
One other issue raised about the time spent studying for the SATs is the opportunity cost of how that time could have been used devoted to schoolwork and extracurricular activities that could better prepare students for college. This was identified by Derek Briggs, at University of Colorado.
In Oncology, that opportunity cost involves curing cancer.
As I mentioned a year ago, doctors who continue to regularly see patients should be required to demonstrate that we have kept up on current diagnoses and therapies. I also fully support the maintenance of certification requirements as a method of doing so. But in the year 2014, to have us sit in isolation for six to eight hours taking a test (when it eventually arrives to the testing center) answering questions in a vacuum (if the computer is even capable of registering or scoring our answers) makes little sense. Let's revamp this exam or, better yet, do away with it entirely.
Yours Very Truly,
Mikkael A. Sekeres
Medical Oncology Board Certified through 2022
More 'Second Thoughts'!
Check out all the previous articles in Mikkael Sekeres' award-winning 'Second Thoughts from Sekeres' column in this collection on the OT website: http://bit.ly/OT-SekeresCollection