Pediatric Maintenance of Certification

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 

 

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.