Recertification- we all hate it the way it is

[andersenpa]

From the NYT:

http://www.nytimes.com/2014/12/16/opinion/board-certification-has-gone-too-far.html?_r=0

 

I agree almost 100%

Primarily with the idea that mass regurgitation of memorized facts is perhaps one of the worst ways to assess how well someone will practice

 

I don't think that recert HAS to go, but it needs to be done MUCH better, and in the case of PAs more applicable to our respective fields of practice

[EMEDPA]

a generalist exam (pance) passed once followed by a CAQ every few years + cme should be enough. Develop a primary care CAQ and let folks who want to practice exclusively primary care (about 1/3 of PAs) take that. the rest of us can take CAQs in our respective fields.

[gbrothers98]

I think the important point the NYT article made was that the Recert or MOC process needs to improve. 

It likely will, given enough attention. A broad statement that physicians dont like or believe MOC is worthwhile is erroneous. There are plenty that think worthwhile continuing education is a necessity to maintain competence and also to provide the public with plenty of evidence their welfare is protected. As I get older, I hate different entities telling me what I have to do. A heavy hand makes it worse. Seems like some specialties are suffering from overbearing leadership rather than a more collaborative environment.

 

While an open resource exam is a great idea, PAs have seen how that has gone in the past with Pathway 2. For every proponent there were multiple detractors. An open resource exam is a great idea in theory but difficult to reliably put in practice. There will always be the question of exam integrity, whether it be sharing of exam items or having a proxy take the exam. One may state this would be rare and infrequent but once that horse is out of the barn, it is out and the whole process is brought into question.

 

For the PA recert, I think most PAs would like 2 things.

 

One is to have something applicable to what they do on a daily basis be tested. I have sat for one PANCE, 2 PANRE and one CAQ. The PANCE to my recollection was a reasonable exam. The CAQ was also a reasonable exam. The 2 PANRE were not. This was due to the quality of questions that were posed and their association with what I do on a regular basis (very little).

 

2nd is that feeling of failure that seems to be more commonplace as the testing site is left. Plenty of posts on this forum after PANRE of WTF. While in the end statistics are usually your friend, only 2% of PAs fail and the cutoff seems to be a very low threshold, those 2 weeks of waiting for results really suck. But why should I leave that cubicle and wonder if I have a job or not?

 

The idea of an initial cert followed by CAQ is reasonable for those whom happen into a specialty they like and continue to work within the specialty. I dont have data to refer to but I think that pipeline does not exist for many PAs when they start. There are also plenty of mid career PAs whom switch from general practice to a specialty and vice versa along with some whom switch to a nonclinical role. I have pointed out in the past that much can change in 10 years. Something more rigid like this would place a damper on that lateral mobility that PAs still enjoy to a certain extent.

 

I wonder in the future if we will see more changes than what we have seen now, with the institution of SA and PI CME and a 10 year cycle. If truly wanted to establish ongoing competence, better to identify areas desired and provide articles or direction in those areas, make people responsible for them and test on the content. Much clearer direction and likely more applicable than cramming for general medicine at the end of a decade. For example, to maintain board certification in EM, candidate has to maintain licensure, has to take a test every couple years on articles or topics chosen for that cycle that a consensus has chosen. Then there is the 10 year exam on the whole enchilada of EM. Interspersed is PI CME but I look at the ACEP topics such as handing off pts or pt education aftercare and I think that is all very worthwhile. I think much push back on PI right now is the dearth of it, the fact that while it seems like a good idea, it may not translate into improvements for patients. But it likely will ensure that a certain standard is met, less practice of medicine and more science of medicine.

 

Last, there is that perception that we are being used to make money off of for various organizations and agencies. For many professionals, this has become the norm. I live in a state that overall is not very wealthy. Surprisingly, I find myself in the top 10% of income earners in the state. I pay quite a bit in taxes yearly that go to support entities that I in turn interact with professionally. I don’t see at times that I am getting the value I should. But whatareyagonnado?

 

I would also ask those whom are concerned about money leaving their pockets to support these added CME costs among other things, how they have come to be on the hook for the cost? Many companies send their workers for training on a regular basis and pay for it, pay for their professional licenses and other costs associated. It is a fact of business. I think CME reimbursement and also professional fees should be the third rail of our profession. Losing this is short sighted and a major detriment professionally in the long term.

 

G Brothers PA-C

[andersenpa]

If it comes down to open book vs the standard computer based exam format, I choose open book any day of the week. Studying and reading the material in my office at my own pace gives a greater yield than cramming for a test center.

 

As the author alludes to, the mass regurgitation model does not reflect day to day practice. The recert SHOULD be modeled to reflect or practice. The great majority of us use digital and web based resources on a daily basis. The volume and turnover of medical literature is so great that it is unreasonable to expect memorization of it all. We all look things up as we go along. I would go so far as to say that any provider depending on their memory to manage every detail is not meeting the patient need and practicing poorly. Yes, for much of what we do we have routine care that we know like the back of our hand....but nature created rare cases, zebras, diagnostic criteria and multipage antibiograms (to name a few), and we can't pretend they don't exist.

 

Obviously the only true test of competency is one that applies to the field we practice in. I get zero gain from testing PANRE in adult medicine (which I took last time around) when I practice in a surgical specialty. Even the surgery exam is not applicable. That test does NOTHING to "provide the public with plenty of evidence their welfare is protected"!

 

The low fail rate for the PANRE, particularly when it applies so poorly to so many diverse PAs, only shows what a poor tool it is. If a cardiac surgery PA can pass it only by studying practice questions for 2 weeks, then it has lost all credibility as protection for the public.

 

When the SA/PI programs get more robust and diverse it will mean more. Certainly more than a perfunctory sit-down exam with 90% of the content removed from my daily practice.

 

And I wouldn't assume that most or even many docs think the current MOC is adequate (http://www.changeboardrecert.com/index.php).

Most PAs that I have spoken to feel that way about ours. 

[andersenpa]

An interview with the physician leading the opposition to the ABIM MOC process

THIS WILL EFFECT US!

 

http://www.medscape.com/viewarticle/837012?src=wnl_edit_specol&uac=65818DK