You're welcome to reprint these articles on your website and in your e-newsletters free of charge, provided that you don't change the article in any way and you include the byline (including a link to our pediatric board review website). 

In doing so you agree to indemnify www.laughingyourway.com and its directors, officers, employees, and agents from and against all losses, claims, damages, and liabilities that arise out of their use.

 

New and Improved Pediatric MOC: Part 4 Improvement in Practice

Written by Stuart Silverstein on Tuesday, 26 January 2016. Posted in Maintenance of Certification (MOC)

The MOC process continues to be abuzz with change with the ABP keeping an eye on other specialty groups that are part of the American Board of Subspecialties parent group. 

Due to this, the American Board of Internal Medicine (ABIM) has already temporarily suspended the Quality in Practice requirement through the end of 2018, while the process is under review.

Similarly, the American Board of Pediatrics (ABP) is also reviewing the Part 4 requirement. However, they have not suspended the requirements. Sorry!  

However, in the June 30th ABP Blog they concede that this is still a work in progress and offered up, what they consider to be, a more user friendly and relevant options that are outlined on their website. These seem to be variations on the same options that have been in place already.  Therefore, we are still recommending that you use the Practice Improvement Modules (PIMs).

There is, however good news for some of you. The good news is you may have fulfilled the Part 4 MOC with work you have already completed. 

Home is where the MOC is!

If you are lucky enough to be part of a practice that has taken on the onerous task of qualifying as a “Patient Centered Medical Home” (PCMH), you have already engaged in Quality Improvement (QI) activities. These activities are approved by the National Committee for Quality Assurance (NCQA) and as they say, “what’s good for the NCQA goose is good for the ABP gander”. This is similar to graduating residents killing 2 birds with one MOC stone for QI projects done during residency [i].

The gruesome details on applying to the QI activities for Part 4: Improvement in Professional Practice Credit can be found here. Or you can use this video link. 

Create You Own QI

One of the more relevant ways to obtain Part 4 credit is by creating your own QI project. Personally, I do not see how this is easier or even a step-up from using one of the predesigned PIM’s but this is considered to be one of the more “intuitive” models offered by the ABP. This is also one of the paths to applying the PCMH projects for MOC Part 4 Credit. 

Institution MOC

Another avenue to explore is if you are fortunate or unfortunate enough to be a department chairman, chief quality officer or a director of public health. You may have an opportunity to get MOC credit for work already done if you have lead “substantial health care quality initiatives” in your organization. When you look in the ceiling to floor mirror and see such a person, this link applies to you.

Overall it seems that for now you have to do the busy work with the good news being that you can double-dip for the busy work you have already done. The ABP promises more changes to come as they study the issues further. Hopefully, "what’s good for the ABIM goose will be good for the ABP gander."

 

 

 

 



[i] This is called, Practice Assessment, Patient Voice and Patient Safety Requirements on the Internal Medicine MOC process. 

 

Kill ACGME and MOC Bird with 1 Stone

on Monday, 07 December 2015. Posted in Maintenance of Certification (MOC), Pediatric Maintenance of Certification

As of Spring 2015, residents can dip their toes into the MOC pool with the rest of us.  If you are currently a resident, you are asking yourself, "why would I want to take on something I can thankfully postpone for 5 more years?". There are more important thing's to do like, I don't know? Passing the Boards in the first place!? 

That is all true but consider this:

While you are in residency you may very well be participating in quality improvement activities to meet your ACGME requirements. Wouldn't it be nice to be able to double dip and get MOC credit that you can bank and use later when you will need it?  It's not very often that you can double dip or kill an ACGME and MOC bird with one stone.  

As a resident you are allowed to participate in Part 2 activities as well (see our MOC blog for more information on Part 2 Activities). However, your deposit into the “Bank of MOC” won't count for the future. Yet, we still encourage you to participate anyway since this will help you prepare for the Pediatric Board Certification exam. Additionally, it will also help you shine the Pediatric In-Training Examination (ITE).  

Before you qualify you have to take your first ITE and then you can start banking Part 4 MOC points when partaking in appropriate quality improvement activities during residency.  

Say No To Despair and Fear and Yes to Steps to Just Persevere

on Tuesday, 01 December 2015. Posted in failed pediatrics board exam, pediatrics board review

In past years you had to wait until the most wonderful time of year was done before you

received that letter from the American Board of Pediatrics either congratulating you on

successfully passing the exam or a letter regretting to inform you that you unfortunately, didn't

pass the Boards. Well, it seems like now that the exam is electronically graded those letters

come before the holidays even have a chance to get rolling. We have heard those whoo hoo

celebratory shouts and those sighs of despair which means the results were sent out just before

the most wonderful time of the year.

For those of you who were congratulated we would like to second that. We want to especially

congratulate those who didn't pass the first time around, how much sweeter it must be to get

that letter.

For those of you who didn't pass, this is certainly not the time of the year to despair. It's the

most wonderful time of the year to persevere. However, persevere doesn't mean studying the

same way you did the first time. You must do something different.

If you are one of those who passed after taking the exam the second time around, you very

likely tried a new approach. Feel free to share your experience with those who are in the

position you were a year ago.

In fact, the 6th edition of Laughing Your Way to Passing the Pediatric Boards released last

October not only contains completely updated material, but we've also included a chapter

devoted to those of you taking the exam for the 2nd time. If you want to get started right now

you can start the most wonderful time of the year and not despair. Use the code persevere2015

to get an 20% discount to take the sting out.

Before the Ball Drops

on Friday, 20 November 2015. Posted in Pediatrics Recertification

For those of you with certificates that expire in 2015, hopefully you've already completed the requirements for the current MOC cycle.  If one of your requirements is completing Part 3, the cognitive expertise “secure exam”, this is one ball you don't want to drop.

You might have circled December 31st on your calendar as the day the ball is dropped from the roof of One Time Square .  But, if you wait until the 31st you will have dropped the ball on getting your certificate renewed.  You needed to circle November 30th at 3PM as the deadline for registering to take the exam at one of the prometric test sites.  That's 3PM Eastern Standard time for those of you living in Arizona refusing to set your clocks forward.  The deadline for taking the exam is actually December 15th. After that your ball turns into a pumpkin and you'll be searching for the lost glass slipper of recertification.

If you are one of those adrenaline junkies who are still watching the clock tick there is still time left to prepare.

For those of you wishing to use our material the bad news is we will not have a new edition of Surfing Your Way to Pediatric Recertification until early 2016. However, the good news is we have already released the brand new 6th edition of Laughing Your Way to Passing the Pediatric Boards this fall.  The updated material is the same material included in the soon to be released Surfing Your Way to Pediatric Recertification. The only difference is the first section that is focused on the initial certification exam.  

You may order the Laughing Your Way to Passing the Pediatric Boards 6th edition and we will include our Down to the Wire Guide to Passing the MOC e-book, which includes our guide and recommended step-by-step pathway for fulfilling the MOC requirement.  The e-book includes a pre-test diagnostic quiz to help you identify areas of weakness to focus on as the clock ticks towards December 15th.

Simply order the main text using the code DROPTHEBALL2015 to get the PDF download.  No need to drop the ball now.  Prepare for the secured exam so you can actually look forward to the ball dropping on new year's eve while looking forward to a fresh start in 2016 with your MOC in place. All without worrying about dropped balls and missing glass slipper.

MOC and Moca Just Take Me to Boca

on Wednesday, 18 November 2015.

If you've managed to navigate the MOC cycle, you're about to get ready for the “rinse and repeat as necessary” cycle. If you have actually read the emails from the ABP about the possible changes to the MOC process you are probably alone. 

I know that I for one stopped following the dizzying back and forth proposals, which is ironic since I'm actually in the business of helping you navigate the process.

I have also been ignoring the letters letting me know that in order to keep my MOC status current I must cross the bridge to the next cycle. But first, I must pay the $1,300 toll. That's a hefty toll and an easy one to postpone for more immediate needs like my home mortgage, car loan and food.

With the December deadline looming I'm finally getting ready to pay the hefty $1,300 MOC reenrollment entrance fee for the next cycle.  To prepare for this I finally began reading all the updates out there and apparently there is more changes coming and controversy with it in the forecast. The latest broo-ha-ha started with the American Board of Internal Medicine (ABIM) recent decision to transition to a more relevant system. Yeah, I know many of you are asking, “What could be more relevant than tabulating a hand washing survey your patients fill out?”  Of course there are lots of ways to measure the quality of our work!   However, for now the ABP is sticking to the tried and irrelevant?

However, the American Board of Pediatrics has conceded that their ABIM brethren may be onto something and they are “studying“ other options. In fact, they are considering changing the MOC process to the more friendly MOCA process. Similar to the Starbucks moca latte, which comes in a more neutered red cup without distracting holiday / winter symbols. We will explore the extra A in MOCA in our next blog; as well as the changes implemented by the ABIM and other speciality boards and what you might expect in the future. In the meantime order yourself a moca latte in the inoffensive to some offensive to others neutral red cup and mumble to yourself, “I don’t care about MOCA, just take me to BOCA“ 

 

Because the Mets are Really SOCKING the Ball Hitting those Home Runs Over the WALL

on Sunday, 25 October 2015. Posted in pediatrics board review

We want to apologize to our readers who are avid New York Mets Fans apologizing for an egregious error on P 828 that unfortunately was not noted or corrected in our original printing of the 6th edition of Laughing Your Way to Passing the Pediatric boards.

This is especially embarrassing since author, Dr. Stu Silverstein has been a Mets fan dating back to 1969 and has the saved headlines to prove it. 

Specifically, footnote number 6 on that page (shown below) incorrectly states in reference to the criteria for meta analysis., “Or it can be discussing the New York Mets rapid decline and subsequent elimination from the playoffs prior to the start of the season for the next 200 years.”

We are correcting this mistake effective today for all future printings to now read “ Or it can be discussing the New York Mets rapid success in 2015 following their being prematurely written off by Yankee fans and other scientists who prematurely wrote them off before the season even started”

We do not know where this will go from her, but the Mets ARE in the World Series and clearly did not miss the playoffs this year as predicted by so many before the season started. Had they used proper Meta-analysis techniques or shall we say “Mets” analysis techniques they would not have made this error and we would not have included this.

Please except our apologies and “ Let’s go Mets” 

The Countdown to Pediatric MOC Certification 2014

Written by Stuart Silverstein on Wednesday, 29 January 2014. Posted in Maintenance of Certification (MOC), Pediatrics Recertification

We have received countless calls and emails from pediatricians who are faced with an expiring board certificate and the specter of sitting for a proctored exam for the first time in over 10 years. 

At least this is a task that most of us have a successful track record with or we wouldn’t be Board Certified Pediatricians in need of recertification

However, getting through Parts 2 and Parts 4 are even more daunting since it is not clear what exactly needs to be done to get credit.

I know I personally had no idea of the details until I went through the process myself last year. I even wrote about it.

Even once the process began to make sense, and you roll up your gingham patterned sleeves another curve ball hits the outside corner. Last year the scoring system changed. This year the expiration date for your pediatric board certification expires on December 18th rather than December 31st.

However don’t despair we are here to help you get through the MOC process.

In order to get through it last year I had to go through several trials and errors. These included glitches in:

  • Registering for the exam 
  • What I should have brought to the exam
  • What I shouldn’t have brought to the exam
  • What I forgot to bring to the exam

(The security in the exam center felt like I was in an airport surrounded by marginally dressed TSA agents)

Prometrics exam meme

I spent days and weeks trying to determine which were the least confusing, most useful and cost effective (cheaper) modules to go through. The explanations on the websites were not always easy to follow. There were no arrows pointing to the best and least time consuming modules.

I found myself so confused and bored flies were landing on my bloodshot eyes and it took me 3 hours to notice. That is when I decided to get on the phone with both the American Board of Pediatrics and the American Academy of Pediatrics.

bored at the moc process

I remember wishing for a simple monograph I could use to supplement the study materials I had used. A monograph that would walk me through the process and provide me with a general idea of what material I needed to focus on.  Believe me I searched for such a concise booklet but was stuck with the outlines on the American Board of Pediatrics and American Academy of Pediatrics Websites, which were anything but concise.  Without the numerous phone calls I would probably be scrambling to get my MOC recertification completed along with the class of 2014.

After I successfully completed the cycle I decided to put together a monograph so that my colleagues could benefit from the legwork I did to simplify the process for myself.

We also included a MOC Nuggets ™ section which will help you gauge how prepared you are regarding fund of knowledge for the pediatric recertification process. Like all of our material, this is based on the content specifications of the American Board of Pediatrics.

The sample questions and answers include tips on how to break down questions. This will be especially valuable to those of you have not studied nor sat for an exam in more than a decade.

This guide will help you get through the process in the spirit in which it is intended.  Your focus should be on learning the material in the modules, and improving the quality of your practice rather than trying to figure out the process itself. 

 

pediatric recertification meme

Keeping Score of the Pediatric Recertification (MOC) Grading Changes

on Friday, 13 September 2013. Posted in Maintenance of Certification (MOC), Pediatrics Recertification

We just released our blog with suggestions on taking the MOC 3 Pediatric Recertification Exam. Within a day we received a notice from the ABP which was also posted on their website that they are changing the way the exam will be scored and how the results will be provided.

I didn’t mention in the previous blog that I did indeed score high enough to pass my Part 3 MOC (hold the applause please) and boy am I glad since I do not like any change.

(For those of you like this information straight up on the rocks, this is the link to the American Board of Pediatrics announcement: http://bit.ly/15o4bot)

Here is the TL:DR (too long didn’t read) version:

1)    What percentage correct do you now need to pass the exam?

You still need to get around 75% correct to pass the exam, and yes that means you need to get approximately 75% to get a raw score of 180.

2) What was wrong with the old way of scoring…back in the good old days of June 2013, when life was simple and sweet?

Well that is a good question and the answer is back in those days there was essentially only one exam that everyone took. Today in the era of September 2013, there is more than 1 exam and that leads to a greater variation in the amount and type of questions (note: there may be some overlap with what questions are asked on each specific exam). Therefore, there is much more “examic diversity” and all of the exams are not created equally. Some questions are easier than others.  Therefore, the percentage correct will not necessarily be the same for each exam. Some, for example, might allow a passing grade for a score below 75%. However the scaled score for that passing grade will be 180.

3)    Will I still know how I did in each specialty?

In the past you were told what percentage correct you got broken down by specialty. Now, you are going to be told, your raw score for each of the 17-specialty areas.

**They are going to a standardized score**

Up until now it was pretty straightforward: you got around 75% correct (not 80%) and you passed. There was essentially ONE test given

Bottom line is you need a scaled score of 180 to pass, but the percentage correct you need for that raw score will now vary depending on which version of the exam you are taking.

If you have not taken the exam yet and your certification expires December 31st, 2013 we suggest you sign up now since you can take twice and you want to leave yourself a margin of error.

 

pediatrics_recertification_changes 

ON Your MOC Get Set GO: A guide through the pediatrics MOC part 3

on Tuesday, 27 August 2013. Posted in Maintenance of Certification (MOC), Pediatric recertification

For those of you who need to take the MOC part 3 or “secured exam” you probably have realized that you cannot take it over the summer. This may be concerning if your certification is set to expire in December 2013. You now only have 4 months left to take the exam. Since you have only 2 shots at it, you should consider taking the exam in September.  

When I realized there was only 2 shots at it, I began to panic since I wanted plenty of time to prepare in case I didn’t pass. I chose to take the exam in early June.

So I went through the registration process and the day of the exam approached, It is good advice when they say allow a lot of time to find the Prometric Center. The test center was located in an unmarked building in an industrial park. The GPS on my android kept informing me that I had arrived at my location, which was an intersection between 2 dump trucks and a disco bowling alley.

When you finally arrive you are given a locker and informed that you have to empty your pockets. I suggest you bring some ibuprofen with you in case you get a headache. I sure wish I had. If you take other medication remember to take that with you as well.

prexam_feelings

How I felt when sitting for the exam

When you finally sit for the exam, you are in a room full of cubicles and while it is theoretically quiet, those who are easily distracted by a symphony of gum smacking keystroke click clack,in B Minor will need to find a way to filter out the noise. If you fit that description definitely bring earplugs. While they DO provide you with over the ear headphones, they are the kind that seems to have been made in the 1970’s. It has plastic edges that leave permanent scars behind your ears.  They did filter out some noise if you don’t mind the painful distraction of the hard edges cutting grooves into your outer ear.  I also suggest you bring light clothing with a zip up sweatshirt. You never know if it will be too hot or too cold there.

You won’t need a calculator because there is an on screen calculator there for you to summon up during the exam.

Exam layout

The exam is set up as follows:

You have to answer 2 sets of questions with 100 questions in each set. You have around 2 hours to answer each set and once you close out 1 set you cannot go back to it. During each question set you are given a warning when you have an hour remaining and 30 minutes remaining. In addition, there is a hold button for questions you are not sure of or just want to come back to. I suggest that you answer all the questions you are sure of first and place the ones you are not sure of on hold to come back to later. You need to make sure you release the hold button when you come back to answer the question!

I made the mistake of not realizing this. I went back and entered answers to these questions and thought I was done. However, when I looked at the main menu the questions were still listed as incomplete. Fortunately, I had time to spare

After I finished the first question set and reviewed my questions, I still had over a half hour left. It is tempting to use that time rather than move on to the next set. However, this is a test of stamina as much as it is a test of knowledge. Most of us have not taken standardized exams in years and are not used to this

I viewed myself as being on borrowed time regarding attention span, so I closed out this set, took a break and went onto the next set.  At that point I wished somebody had suggested I take along a light snack as I am suggesting you do. At that point I realized that I was also on borrowed time regarding my blood sugar levels dropping.

After the exam they informed me that it rang during the exam with various sounds and ring tones indicating I had texts coming in. In reality they could have told me this when I went for a bathroom break.  But I was very relieved that I was done with the exam and immediately changed my ring tone to Alice Cooper’s “School’s out for Summer“  .. at least I was done with this exam for the summer.

recertification_gif

How I felt after the exam

TL:DR (Too long, didn’t read):

 

  • Get there early to make sure you can find the Promtric ® center  
  • Bring ibuprofen  and any medication you might need with you.
  • Let folks know you will not be responding to phone calls or text messages since all your belongings will be placed in a locker (sort of like going to prison except they let you keep your belt and shoes)[1]
  • Bring earplugs
  • The computer has a calculator
  • Answer all the questions you know first and hold the ones you are unsure of for later and come back to them.
  • Unhold questions that were held after you answer them.


[1] In a future blog we will discuss some smart phone apps that auto respond to texts 

Is the 2013 Pediatrics board exam going to be harder than the 2012 board exam?

Written by Stuart Silverstein on Monday, 15 July 2013. Posted in pediatrics board review

180 is the New 410

Up until this past October you were graded strictly on a curve. That means, if you looked around the room and you sensed the group was smarter than usual you were in trouble. Theoretically at least, the same raw score one year could have been a passing grade and a failing grade the following year.

That is because the previous passing grade was 410 (based on a 0-800 scale ). This 410 benchmark was based on a raw score that was 0.9 standard deviations below the mean.  This meant that in practical terms that you needed to answer 70-75% of the questions correctly to pass the exam.  As a result 75-85 % of first time test takers pass the exam. The American Board of Pediatrics does not make available the pass rate for those taking the exam for the 2nd , or nth time, but it is believed that the passing rate for this group is lower. (see our blog for 2nd time test takers)

Therefore, by definition a set number of first time test takers (and probably a higher number overall when factoring in repeat test takers) will be failing the exam.

A lot changed in October 2012.  One change, is 180 is the new 410.  The passing grade for the American Board of Pediatrics Certification exam is now 180 (on scale of 0-300). The big change is your score is not curved. Your fellow test takers can be whiz kids from prep school or cyanotic mouth breathers from Brooklyn like myself, and it will have no bearing on your ability to pass.

This past year, according to the American Board of Pediatrics, more than 85% passed. However, they maintain that the same number of test takers would have passed even under the old system. Yet, still more people passed percentage wise than in previous years.

We do know that, whereas in the past the percentage that passed was controlled via a set curve. Now, the only way to control this is via the difficulty of the questions themselves. Again, if they are looking to return to the 80-85% pass rate that they have in the past, it is likely that the questions for October 2013 might be more challenging.

pediatrics_board_review_studyhard

Therefore, it will become more important to be very prepared for this exam.  In addition to using pediatric board study guides and books, the American Board of Pediatrics suggests you review the pediatric in house training exams available to residency programs. The board notes that these consist of retired board questions that are reflective of what you might encounter on the exam regarding degree of difficulty. Knowing how to approach questions methodically and being familiar with the material so that it is impossible to forget will likely become more crucial now. 

Just answer the questions, you’ll get the points

Written by Stuart Silverstein on Friday, 21 June 2013. Posted in Maintenance of Certification (MOC), Pediatric recertification, pediatrics board review

As of the previous blog, I obtained a total of 30 Part 2 points.  These were achieved relatively painlessly

10 Points: General Knowledge 2013 General Pediatrics Comprehensive Knowledge Self-assessment 

For this activity there was no minimum score required and was very painless 

20 Points: 2013 General Pediatrics Decision Skills Self-assessment 

In this activity there was a minimum number of points that WAS required. However, this activity contained sections that were relevant to clinical practice AND appears to be helpful in preparing for the Part 3 Prometric Exam. I would go ahead an classify this as relatively painless, especially since as noted in our previous blog you can take your time to search the interweb for the answers. I will note here that after going through this process the ABP really designed this portion to help you out.

A minimum of 40 Part 2 points is needed to meet the requirement and completing these activities brought me to 30 points. So, I needed 10 more points. Be careful though, many of the Part 2 activities are not so painless since you are required to get a minimal number correct to get your points. 

You are permitted to retake any one of these tests but be warned, you only get one shot at retaking it. And for these activities, you have to actually know the subject well or be willing to read the material that accompanies these activities. Most of the self-assessment topics are subspecialty based, and quite esoteric for those who are not in that field, and possibly esoteric and boring even to those in that subspecialty. This wasn't going to work for me! I don't mind earning my points and learning but I want it to be material that is relevant to the work I do as a General Pediatrician. 

So there I was in search of user friendly and hopefully relevant activities where I could either get the answers based on my current fund of knowledge and/or would find it easy to read up on the correct answers (which of course is the goal of the Pediatric MOC / recertification process anyway).  

So I decided to check out the American Academy of Pediatrics PREP Self Assessment Questions that are also approved for MOC as well as CME credit.   

First you have to get there though the following link http://pedialink.aap.org/ and assuming you are a member of the American Academy of Pediatrics and registered with the PREP program, you log in under your username and password. 

You should click onto the "CME tab" rather than the "MOC tab".

Now you will be faced with 2 radio button "Mode" options 

1) Learning

2) Exam

Fortunately, the correct mode is the one that is also the default mode: LEARNING

This is the mode that must be selected and submitted in order to get the MOC Credit

Sometimes it pays to be paranoid. I did call and confirm that "learning mode" was the correct mode. I also wanted to confirm that the minimal score required was 80%.

While they did confirm that 80% correct was required to be eligible for MOC Credit this requirement did not apply to the 2011 PREP Self-Assessment.

Therefore, completion of the 2011 AAP: Prep Self Assessment Questions does not require a minimal number correct to get MOC or CME credit. 

You can get 0% correct or 100% correct and this is not reported to the ABP. The AAP only reports that you have completed the activity. (Of course this means anyone can fulfill this obligation, even Hodor from HBO's "Game of Thrones" could complete this activity if placed in front of the keyboard.) 

Hodor_pediatrics_MOC

I would like to point out that this is not consistent with the spirit of this MOC activity and we are in no way encouraging it. Such a casual and meaningless approach is not the intended goal of the ABP.  However, it is refreshing and less stressful to know that you can go through this exercise and actually learn without worrying if you will get the MOC / CME points. 

Since there is no minimum, this was an excellent painless method to obtain 20 Part 2 Points 

Although, as they say on TV, this offer is for a limited time only. This gift, (20 Part 2 points, regardless of the number you answer correctly) must be completed before December 31, 2013. 

Choice c pediatrics

I personally recommend the 2011 PREP Pediatric Self Assessment as one of the activities for your 20 points and that is exactly what I did, and am now the proud owner of 20 additional points.. 

My total Part 2 Points is now : 50  

10 Points : General Knowledge : 2013 General Pediatrics Comprehensive Knowledge Self-assessment 

20 Points : 2013 General Pediatrics Decision Skills Self-assessment 

plus 

20 Points 2011 PREP Self-Assessment

Thankfully, I have fulfilled my Part 2 Point requirement with 10 points to spare. Now, the 20 additional points out of the 100 total can come from Part 2. So I have 10 points toward this flexible requirement. 

My new search is to find an additional painless way to obtain 10 more Part 2 Credits.  At this point I have decided to go with Part 2 points since Part 4 Performance in Practice is still an unknown process.  So my search for continues. 

I also have to enroll and register for my Cognitive Expertise - Secure Exam (Part 3) exam at a local Prometics (R) center . I wish to take this exam before July 1, since you cannot take the exam during the months of July and August and I wish to have a margin of error in case I have to take the exam again, in the fall i.e. I don't pass the first time. 

Next blog I will have an update on my search for 10 more Part 2 points. Also, I will update all of you on the process of registering for the Prometrics test and the real rate limiting step which is actually committing to an exam date. I hope you find this blog series helpful. Feel free to contact me with any questions via email or commenting below.

Be Decisive With Pediatric Decision Making Self Assessment Part 2

Written by Stuart Silverstein on Monday, 10 June 2013. Posted in Pediatrics MOC , Pediatrics Recertification, Pediatric recertification, pediatrics board review

I am happy to report that I did reach the 80% mark and am now the proud owner of 20 more Part 2 Pediatric MOC points. This brings my total up to 30 Part 2 Pediatric MOC points.

How did I approach it differently this time? 

1)    For one thing I made sure I was very certain I had the correct answer (should be obvious).

2)    If it seemed to be challenging I held off on answering it.

3)    Free throws  - I went through the ones that to me were pretty easy to figure out fairly quickly.

4)    Challenging Layups - If I still wasn’t sure I went back and made notes on the information that was being presented and often this was enough to make the answer apparent.

5)    Needs some time - In some cases this was not enough and the obvious answers didn’t seem to be correct.

6)    All along the way I kept track of the percentage correct, with each correct answer I got closer and closer to the 80% number.

7)    I also tracked the number of incorrect answers I was getting and yes even despite this approach I still answered questions incorrectly.

8)    Since this is an open book, which is now an outdated term; more like an open google test. I used google for the “ needs some time” category. The way I did it was by simply searching for the clinical descriptions and lab findings .

9)    More often than not this helped me discover the correct answer and I actually found myself learning along the process.

10)  Once I reached the magical number 0f 80% I still had a couple more questions to go but the pressure was off.

11)  But I and you should still want to get as high a score as possible. After all, this is a really good opportunity to learn. Although the process is challenging the American Board of Pediatrics (ABP) really set it up so you review a lot of material.

12)  So I took a different approach this time and reached 84% and now am the proud owner of 20 points toward fulfilling my Part 2 Pediatric MOC requirement.

13) Yes that means I got 8 wrong, which is quite close to comfort, in missing out on an opportunity to get 20 points on what I believe is one of the more useful, and least painful ways to get your Part 2 Pediatric MOC points.

Be decisive with Pediatrics Certification Review

 

Recall that I already got 10 points on the dashboard for completing 2013 General Pediatrics Comprehensive Knowledge Self- Assessment and now have 30 Points.

Therefore, I suggest you go through this process the way you would approach anything that required concentration. If this means putting on your thinking caps and playing ocean sounds then do it. (see previous blog)

Remember to be methodical; they are presenting material in broad strokes. The question consisted of a history, physical and lab / imaging studies.  I made a list of all the pertinent positive findings and pertinent negative findings. This allowed me to filter out irrelevant negatives.

I noted when something had “quotes” around it, it meant that things weren’t necessarily what the patient was describing, and I made a “beware” notation on my notes.

One of the benefits of this section is once you have “committed to an answer” you can print out the case summary which helps outline fine points of difference in differential diagnosis which is sure to be helpful in preparing for the secured Part 3: Pediatric MOC exam.

So my scorecard so far is

Part 2 Points:

2013 General Pediatrics Comprehensive Knowledge Self-Assessment: 10

2013 General Pediatrics Decision Skills Self-Assessment:  20

Still need 10 more to meet the minimum of 40 Part 2 points. I will need 30 more points if I want to use Part 2 points for the 20 “either Part 2 or Part 4 “ category toward the total 100 points needed for Parts 2 and Parts 4. Wow, I think I just confused myself.

I will let you know in the next blog where my search for the most useful and least difficult to pass MOC Part 2 activities 

Be Decisive With Pediatric Decision Making Self Assessment Part 1

Written by Stuart Silverstein on Friday, 31 May 2013. Posted in Maintenance of Certification (MOC), Pediatrics MOC , Pediatrics Recertification, Pediatric recertification, Pediatric Maintenance of Certification

Pediatrics MOC 

When we last left off, I had only receive 10 Points toward my total of 20 Part 2 Lifelong Learning and Self Assessment points:

I was previously going through the Pediatric Decision Making Self Assessment activity. Which when completed would yield me 20 more points on the Big Board, half of the 40 points required for Part 2: Pediatric Maintenance of Certification (MOC).

However, this was not a softball toss since a minimum score of 80% was required to grab this 20-point brass ring. Simple enough?

Pediatrics MOC decision skills self assessment  

How I felt when I found out I needed 80% correct answers on the pediatrics decision skills self assessment test

 

Not really! You are given 50 case scenarios, and a score of 80% means you cannot miss more than 10 of these (you might want to check the math). It is all or none, you might understand much of what you are reading but if you choose the wrong answer there is no going back. This is not one of those CME tests you answer until you get the right answer which by the way, is my favorite type of CME test since the creation of the internet by Al Gore.

It really isn’t a “self assessment” since you are being assessed by the American Board of Pediatrics based on the decisions you “commit to”. I would call it more of an assessment by the ABP of whether you can keep your Pediatric certification. But lets not get caught up in semantics.

Pediatrics MOC correct answer

How I feel when I get a pediatrics MOC question correct

I was handled a nice big slice of humble pie when I did not hit the decision making hammer hard enough to hit the 80% bell. It seems I missed the 80% by taking this activity too lightly. I did it in several sittings. Often when I was tired at the end of a long day or while listening to the theme song from Law and Order on iTunes rather than ocean sounds as recommended in a previous blog. 

Honestly, I did not follow my own advice of going through the answers in detail.  I just wanted to get through them and get my 20 points so I can continue working as a pediatrician.

I now faced just one more chance to ring the bell, there would not be a 3rd chance to get my ticket punched on this relatively easy and useful activity.

This is a very useful activity since it really has value clinically and for preparing for the MOC Pediatric Recertification “secured“ exam.  

In several instances you are presented with very similar patients, i.e. 12 year old with leg pain, but the clinical presentation are quite different.  This is a great exercise in teaching and demonstrating why and how reading the question is so important and is really hitting at differential diagnosis.  

In my next blog, I will tell you how my second attempt went. Stay tuned!

Jumping into the Part 2 MOC Pool

on Wednesday, 01 May 2013. Posted in Maintenance of Certification (MOC), Pediatrics MOC , Pediatrics Recertification, Pediatric recertification, pediatrics board review, Pediatric Maintenance of Certification

Well it is now May and more than ¼ into the calendar year. The deadline for completing the Pediatrics MOC (Maintenance of Certification) cycle including the exam is looming. Since I do need to leave a margin of error, I have decided now is the time to get through Part 2 of the MOC cycle and begin thinking about Part 4. Recall, I already completed Part 1 by having a medical license.

Pediatrics Recertification

I discovered that Parts 2 and Parts 4 are intimately linked like Heckle and Jeckle

Between Parts 2 and Parts 4, I must complete 100 points divided as follows:

  -Part 2 – Lifelong Learning Cognitive Expertise: 40 Points

  -Part 4 - Performance in Practice: 40 Points

 

Therefore, I must get at least 40 points through Part 2 Activities.  There is an additional 20 points that I can decide between Part 2 and Part 4 Activities.  At this point I am not sure which way I will go with this.  This is because Part 4 Performance in Practice is a large unknown. 

 

This still begs the question, if Parts 2 and 4 are activities done in concert with each other, why aren’t these PARTs 2 and 3 with the exam being Part 4.  As if the process isn’t convoluted enough.

 

This is like Billy Crystal inAnalyze This asking ”How can we talk about the first thing without discussing the 2nd thing first???”

 

Part 2 is primarily questions and answers on relatively known territory. In a previous blog I noted that there are 3 options for Part 2.

At the time of that writing I didn’t pay any particular attention to the details of these 3 options. That was because I wasn’t personally going through the process.  I now have learned more and will share that with you now..  Boy this has more subplots and number patterns than an episode of Touch.

The components are as follows with my analysis of each:

 

            Knowledge Self Assessment- While there are a variety of options which you can search for the one I suggest as a no–brainer is the “American Board of Pediatrics General Pediatrics Comprehensive Knowledge Self- assessment, 2013” which consists of 200 multiple choice questions selected from the secure exam (aka Part 3) pool. You get to kill 2 MOC birds with 1 stone. You get 10 “Part 2 points” while practicing for the test and assessing your areas of strength and weaknesses.

You are also told that your chances of passing the secure exam can be predicted based on how you do on this set of questions as follows:

 

Your score

Likelihood of passing the Secure Part 3 Exam

80% or greater

Likely

66% -79%

“Uncertain

65% or less

 FUGGETABOUTIT [1]

 

Pediatric Recertification

 

The best part of all is there is no minimal number correct to pass.  You can also take this as many times as you want and essentially know these questions cold.  You get “immediate feedback“ which simply means you will be told either you answered the question correctly or you answered it incorrectly. In addition, you will be told which answer was correct.

However, you will not be provided with detailed answers. This is where a good review book will come in handy. You can take notes or study in real time regarding the details of the topic being questioned and learn it for the next time the concept is tested or when you come across it clinically, which is supposedly the point of all this.

I was so excited about this that I re-enrolled for another set of questions. After answering the questions again, I got a confirmation of completion email from the ABP which stated that I can check my dashboard to see how it was applied. I assumed I would be getting 10 more points. WRONG! You only get credit for this set of questions once and once only.

 

I really do suggest you take the time to write down the specific topics you do not do well on and START with those topics when reviewing for the Part 3 recertification exam requirement. There are also a limited number of images you have to click on for some of the questions, much like you will have to do on the actual exam.

There are other sets of questions you can choose from.  To my own peril I thought the same rules applied that no passing grade was required.  At this point it appears, that for the other options you need to get 80% correct. Unlike other CME question sets, you do NOT get to answer them over and over until you get them right. Here you only get ONE more opportunity to answer the questions you got wrong.  If you still don’t reach the 80% threshold, that module is not available for you this year.

So I decided to try my hand at the next  option which are:

Subspecialty Questions

Well here again, you have to get at least 80% correct and do not have unlimited attempts to answer the questions you got wrong. After a humiliating attempt to answer subspecialty questions I decided to try my hand at the 3rd Part 2 activity, which is:

Decision Self Assessment Skills

This is worth 20 Part 2 points and is more in line with General Pediatrics. Interestingly, it actually is fun.

Here you are given a patient brief history and are provided with a medical history , physical findings and diagnostic studies. There are 50 such questions.

You then have to either pick a diagnosis, or decide what study to do next etc. There are more than 4 choices here. After going through all this, you are either right or wrong.

Here you also have to get 80% correct which means you can only get 10 wrong in order to hit the bell and get your 20 points.

If you do not get 80% you get to take it again. However if you still get less than 80% on your second chance, you are done and will have to find other activities to get your Part 2 card punched.

In this case you ARE given detailed explanation and summary but only after you have committed to an answer.

I am currently in the middle of this and will update my status with the next blog. If I successfully complete this activity I will have 30 total points (20 here and 10 from the General Pediatric Knowledge Self Assessment)

I will still have to choose another activity worth 10 points to get my 40 Part 2 points.

I will need another 20 Part 2 points if I choose my combination points to be Part 2 rather than Part 4.

Once I complete the Decision Skills section… hopefully successfully I will write about my next steps on the road to MOC.

By the way we invite you to discuss your experiences and if you found any relatively painless approved activities for completing the Part 2 requirement.



[1] Outside of Brooklyn the phrasing is different. 

 

The Sounds of Studying for the Board Review Thinking Cap!

Written by Stuart Silverstein on Wednesday, 20 March 2013. Posted in USMLE review, Neonatology review, board review, Pediatric recertification, Neurology Board Review, pediatrics board review, Pediatric Maintenance of Certification

One of the most important steps in setting aside time to study is to actually set aside the time to study.

It can be challenging to separate regular (aka more enjoyable comfort zone time) from the time you must set aside to study for whichever board exam you are preparing for.

We suggest studying in a specific place or even engaging in a certain action that puts you in the mindset that this is the time I will be reviewing for the pediatrics, neurology or neonatology boards.  This was probably the origin of the “thinking cap” where one put on a special cap when one had to do serious thinking. I know of someone that does not need to wear glasses but puts on plain glass frames when they sit down to study (sounds crazy, but works for him!)

Pediatrics Board Review Thinking Cap

Consider this a reset button, which puts the brain and body on notice that this is time to get down to business and do some serious board review studying. Call it “board review conditioning”.

Well, once you have put your brain on notice, where will you do the studying? We suggest picking a place that is specifically designated as “the” board review location.  This can be a room in your home, a conference room in your office, or perhaps a conference room in the public library. This should be a place that has as few physical distractions as possible.

Now that you have separated the time and space, how do you filter out the distraction of sound and in some cases the distraction of silence?

neurology board review too quiet

Everyone is different.  Some people study better with total silence, some like white noise, and some even like a lot of noise.  Any of these sounds is difficult to reproduce in the setting you have selected as the ideal location to focus on pediatrics board review questions, for example:

While we usually recommend resisting temptation to be distracted by the Internet in general when blocking out time to study, one important exception could be logging into one of the many websites that provides ambient sound.

One of the websites we have found most useful is nature sounds for me which is a free online tool to play nature sounds on your headphones to help provide the ambient sounds you work best with. There are 4 channels that allow for 4 separate sounds to be played at once (i.e. birds, river etc.)

We have found this to be an excellent tool to filter out or even filter IN noise. For example, let’s say you study best with ambient background conversations, the kind you would get at a local café. However, you prefer a location where you won’t meet anyone who might start talking to you and pull you away from the important pediatrics board review material you wish to focus on? This tool will provide you with “ambient conversations“ so you can have your café cake and eat board review questions in an environment without actual people.

The sounds range from ambient ocean waves to kitchen sounds, seagulls, owls, and even wolves. If you find sustained sounds distracting you can even vary the sounds so the conversations come and go, the same for the seagulls and rain.

We suggest you try this wonderful and free tool, and consider the headphone to be the noise cancelling thinking cap you need to put on when you have set aside time to do serious board review thinking.

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