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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.

If at First you Don’t succeed Try Try ….Something New ( Part 3 )

Written by Stuart Silverstein on Wednesday, 06 March 2013. Posted in failed pediatrics board exam, pediatrics board review, pediatric board certification review, Pediatric Maintenance of Certification

Of Course a Course?

Even if you are an auditory learner, attending a pediatric board review course is often not enough.  Live board review courses are primarily a good way to preview what you should be studying and/or serve as a review to reinforce the material you have already studied in board review books and questions. Even within a board review course one will find wide variation in the lectures. Some lecturers are very good at providing high yield pearls and focus their lecture on the board exam. Other lecturers just give their standard lecture on their area that includes clinical information and research that is not helpful to those of us who are only interested in passing the exam at this point in your career. 

Less is More

Often out of desperation, after failing the boards there is a tendency to buy every book written and attend every course you “ heard” was good.  It is better to focus in on a limited number or resources and really work with them than to surround yourself with a forest of books and material. 20% of the material out there will give you 80% of the results. Focus on the 20% that will work for you. There is nothing wrong with using the same resources as before or updated editions, as long as you take a new approach.

Pediatric Studying

Content Specifications

The American Academy of Pediatrics publishes the Content Specifications of topics you need to focus on in preparing for the pediatric board exam, which is similar to the content specifications for the Pediatric Maintenance of Certification/ Recertification exam published by the American Board of Pediatrics. It can be found here

 

Included in the content specifications are important images and illustrations you must be familiar with. Therefore you will need a good access and/or material that will help you distinguish between similar looking illustrations, tables and photos.

 

There is very little variation from year to year regarding the topics emphasized in the content specifications. The core material needed to pass the boards is fairly static.

Reinforce with Review

Remember to review the material you studied the previous study session. With each progressive week the sections you have reviewed more than 3 times will become less and less time consuming. At the end you will be studying the areas you were stronger in to begin with.

In fact each study session you should begin my answering board review questions from the material you studied the previous week to gauge how well you actually mastered the material and to identify any gaps.

Missed it by That Much

Of course most pediatricians who failed the exam tell us they failed by only a few points. In the past the curve has been set up so that everyone who fails the exam misses it by a small margin, which often comes down to 10-15 questions. We have heard that the grading system has changed somewhat and that instead of a curve, passing is based on answering a minimum number or percentage of questions correctly.  This will be the subject of a future blog.  In the meantime we still suspect that passing and failing will still come down to 10 -15 questions making the difference between passing and failing the boards.

We have outlined some important steps you can take that will help you answer the 10-15 that make the difference between failing and passing the boards successfully.

We have heard from some of you who are taking the exam again and wish to hear from more of you. This will enable us to help share, anonymously of course, the experience of others. This pooled information can further help repeat board takers finally get it done.

Finally, we know you may feel like this now:

You may feel like this

But once you outline a study schedule and strategy you should and need to feel like this:

You need to feel like this 

 

If at First You Don't Succeed Try...Something New (part 2)

Written by Stuart Silverstein on Friday, 15 February 2013. Posted in failed pediatrics board exam, pediatrics board review, pediatric board certification review

pediatric board review (night before)

Above image: Night before the board exam

The 7 Year Itch

In Part 1 of our blog for those taking the pediatric board exam for the 2nd or nth, we left off by noting the importance of a fresh start and a new approach. We have heard from many readers in other specialties since publishing Part 1, noting that we seem to be focusing on the pediatric board exam.  We want to point out that the same exact principles apply to the Neurology Board Exam as well as other medical specialty exams.

This becomes particularly important now that you must take the exam within 7 years of completing residency. That means you get 7 tries before being sent to the penalty box. The penalty box is having to complete another year of Internship.  Not to offend anyone who has had to do this[1], but this cannot be pleasant.

Know What you Know

When we are stressed the first thing we do is reach for comfort food, but the comfort is of course only temporary and empty of any nutritional value. Many of us after failing the boards feel empty and need validation and we reach for the equivalent of comfort food. That is we study the areas that we know well, to make ourselves feel good.  While this might help in the very short run, it should be done only to help you get back in the saddle

Part of doing something new must consist of studying and working on the areas you are weakest and sections you have done poorly on. The challenging part is working on areas that you are not only weak in but areas you find mind numbingly boring. For me, remembering and studying developmental milestones was particularly challenging. You must identify those areas for yourself. Start your road back to passing the pediatric boards (or any boards), with the material you are weak in and find most boring while your energy level is up and you are eager to get it right this time.

You might consider differentiating the material you know well from those you do not know well with a color-coded spreadsheet. For example material you know well can be highlighted in green, the material you know fairly well, but needs additional work can be yellow, and the material you find most boring and need to work on a lot can be highlighted in red. As you learn the material and become more comfortable with it, you move it to the yellow column and finally the green column. Once you have honestly moved all of the material to the green side, you can see visually that you are on your way to passing the pediatric board exam. As an aside, you may pick your own colors from the rainbow for your spreadsheet.

Know Your Own Way

An often-overlooked step is recognizing how you study best. Different approaches work for different people and you must determine what will work for you. You can begin by determining if you are primarily an auditory or visual learner. As a general rule, most of us are better visual learners.  If you are primarily a visual learner, and find that you get very little out of live lectures, why would you now consider attending a live board review course?  Your focus should remain visual learning through books, but focusing on different books than before.

If you are primarily an auditory learner, you don’t necessarily have to attend a live board review course. Another alternative might be dictating and playing back the file in your car, while you are working out at the gym, or even during sex if that works for you [2]

If have any artistic talent, drawing a picture to help remember the characteristics of a disorder might help, for example drawing a child on a motorcycle might help you remember the characteristics associated with Kawasaki Disease.

In the final section of this blog we will go through some of the pros and cons of courses and putting together a study plan and outline to better streamline your next attempt to pass the exam.

 pediatrics board exam prep

Above image: When you block out time to study, it's important to actually study 

 


[1] Feel free to contact us if you had. We would like to know what this process was like/ Clearly you are not the only one your experience can be helpful to others.

[2]  and the person you are having sex with assuming there is an actual partner involved

 

If at First you Don’t succeed Try….Something New (Part 1)

Written by Stuart Silverstein on Friday, 01 February 2013. Posted in failed pediatrics board exam, pediatrics board review, pediatric board certification review

If at First you Don’t succeed Try….Something New (Part 1)

The failure rate for those taking the General Pediatric Board Exam administered by the American Board of Pediatrics is surprisingly high. The overall failure rate is approximately 40%. However, this includes everyone taking the Pediatric Board exam, including those taking the exam for the first time and those taking it for the 2nd, 3rd and Nth time

 

Sadly, if you have taken the exam before, which would mean you failed at it at least once your chance of failing is higher. The failure rate is only ~25% for first time takers. Therefore, a large proportion of those taking the Pediatric Board Exam have failed it in the past.

 

I have a confession to make. I didn’t pass the pediatric certification exam the first time I took it either. But please don’t tell anyone, I would like to keep this a secret between myself, pediatric residents, pediatricians, and those who are following us here, here, and here. Shh let’s keep this between us only.

 

Misery enjoys Miserable Company

If you have taken the board exam before you know who you are… You are the ones going to the same pediatric board review courses and avoiding eye contact with each other. 

 

This is unfortunate since making contact and comparing notes would go a long way to avoiding making this into an annual ritual. Instead of attending another board review course it’s time to become a board certified pediatrician and attend one of those vacation pediatric conferences in the Caribbean.

Life in the Skinner Box Taking a New Approach

Do you remember those rats in the Skinner box you learned about in Psych 101 during your glorious college days? Those rats often understood something that even the brightest doctors sometimes miss: The rates learn that if pressing the same bar over and over gets you a tazer shot they need to try a new approach. Yet most pediatricians who get that tazer in the form of that failure notice from the American Board Of Pediatrics continue to take the same approach year after year thinking eventually it will work and they will get the “pediatric board certification“ pellet they desire. They attend the same pediatric board review courses, order the same pediatric board review DVD’s, access the same Board Review Questions and Answers, and the same editions of the Board Review Books that didn’t work for them. By no means am I telling you that those won’t help. However, it is the study method that must be tweaked.

 

It is unlikely that the pediatric board certification will suddenly appear unless you change your approach.  We will go through a systematic approach here for those of you who will be preparing for the boards a 2nd time. I once had to go through that process myself, but as I said that will be a secret between us.

 

Zen and the Art of Pediatric MOCcycle

Written by Stuart Silverstein on Tuesday, 15 January 2013. Posted in Pediatric recertification, Pediatric Maintenance of Certification

I recently heard about a pediatrician, who procrastinated as long as he could to put his toe into the uncertain waters of the “MOC” process until the deadline for “enrolling” in the MOC process was less than a month away. That pediatrician was me!  

 I not only had to  put together the book used by so many of our colleagues, but I also have to go through the process myself.  I can tell you the latter is much more difficult.  It is much easier to teach and preach than to perform.

I invite those of you who are and/or will be going through the MOC process in the coming weeks to join me on what I hope will be a humor-laden description of this confusing process which will cover more than merely preparing for an exam.  That isn’t to say that preparing for and taking a proctored exam is an easy task for us working stiffs who spend all day helping patients and then answering to the needs of a family when we get home. Many of us have not taken an exam since Bill Clinton was actually the president, and not a hired gun giving speeches at the DNC.  

 

For most of you, this process will begin with a good news/bad news letter.  The good news is you have been given 2 more years to prepare for the proctored exam.

The bad news is you will have to enroll in the MOC process, and go through MOC cycles” to maintain your certification.  The proctored exam is just one part of the on the MOC–cycle trip.  The MOC process is not a cheap one and proportionately higher for us pediatricians who cannot compete with our more fortunate procedure reimbursed colleagues. We will cover that in future blogs.

 

Circling the Cycle:

Part 1: Professional Standing – Also known as having a valid medical license.

Part 2: Knowledge Assessment:  Differentiated into 2 subcategories[1]

  • Knowledge Self Assessment- 200 online questions, which you don’t even have to pass to get credit.
  • Decision Self Assessment – 50 multiple choice questions based on patient cases , this time you have to get a passing grade

Part 3:  Cognitive Expertise:  Also known as the proctored exam, or the big test, the one you had to take every 7 years and now have to take every 10 years while MOC cycling.

Part 4: Performance in Practice:  This is the part that had and still has me as confused as an octogenarian staring at iPod®.   As of this writing I am still not clear on what the heck we are expected to do.  This is not a simple matter of answering questions online or even preparing for and taking an exam. This involves something along the lines or doing a quality improvement study in your practice. 

I began reading this, and flies began landing on my eyes without my noticing while I reviewed the 2 choices for fulfilling this requirement which were:

  • Established Quality Improvement Projects:  Where you collaborate with other groups and practices.  Lots and lots of moving wheels.
  • Web Based Improvement Activities: These seem to be off the shelf activities conducted within your practice and presumes you will want to do this with in conjunction with the other physicians in your practice.

 

The other day I tried to make sense of this part of the MOC process.  I stared and read it over and over until my mind went blank.  The next thing I remember was sitting at Brazilian Steakhouse  and some guy named Raul was serving me sliced Turkey from a cutting  board at my table.  I guess I was so traumatized that I must have suffered retrograde amnesia. [2]  Therefore I will have to cover this in greater detail when I return to this part of the MOC requirement as I tackle it myself.

 

Coming Attractions

 

In the future, patient surveys will be added to the mix. Yes!  Patient surveys handed out to parents who will provide their opinion of communication style and availability.  It is not yet clear if you will have to hand this out randomly, or cherry pick your favorite patients for their input.  As if there aren’t enough challenges, practicing medicine will become American Idol where you will have to perform for a panel of judges. What’s next?  Patients commenting on your doctoring skills on your Facebook® wall and hitting “Like” buttons?

 

We will keep you posted when and if you will have to face such a tribunal!

 

For me the process began with what seemed like a bombardment of some 300 email and snail mail letters that I ignored until I realized those ignored letters is not good for my professional standing with the board.  I was also thankful that the ABP has not discovered Facebook® or Twitter® where I would sure to face the electronic equivalent of being placed in the public stocks.

 

Qualify to Enroll

 

I had until December last year to “qualify” to enroll in the MOC process, s I finally took the first steps to “qualify” for the enrollment process.  Up until that moment, as the author of “Surfing your Way to Recertification”, I have been receiving calls, emails and, yes, Facebook messages from friends asking about the process.  Much to my shock, when replying to my friends, I found myself stammering and changing the topic to the weather or local traffic reports. Until then I couldn’t give first hand advice and guidance.

 

In order to qualify I had to get through Parts 2 and 4.  Part 1, providing proof that I had a medical license which was easy enough.  Then again, if you don’t have a medical license why would you be going through all of this torture?

 

Over the coming weeks, we will muck through the MOC process together.  Unlike the ABP, we actually are familiar with Facebook ® and Twitter®, and I invite you to “like” us on Facebook and “follow our Tweets” on Twitter®.  We also want to note that this blog and our materials will help you get through and demystify the process.[3]



[1] Which makes this all even more convoluted and confusing, since they are 2 activities why not just assign them each an independent number. ?

[2] Folks, this was inserted the sake of humor,  it didn’t really happen so please do not write us to let us know that you had the same experience, as you might be better served seeking psychiatric assistance if that is the case.  

[3] We are not here to provide inside information on questions asked on the exam, answers to the questions, or otherwise reveal any other part of the MOC process, or the exact areas of knowledge that will be tested. We do welcome general feedback and shared experiences going through the process, but are not looking for nor will we be accepting such exam specific information.