Periodically – maybe in preparation for Specialty Board exams – we all work through some test modules graciously provided at the ABIM website. These test questions are in multiple choice format just as one would find in the actual exam. They are produced by specialists in their respective fields; there is an emphasis on recent publications from the main literature sources. This makes good sense: it keeps us reading the relevant literature, studying a chapter or two in the textbooks. However, in this drive to maintain up-to-date knowledge , there is a lot that reminds me of Trivial Pursuit.
For instance, it is bothering me when I think I know about a particular subject but still cant answer a question. Too often I find myself confronted with choices of which supposedly only one is right. And I am stumped!
It also bothers me when there is a page-long case description, chock-full with data, where just reading the background information takes you a minute, leaving precious little time to reflect on the answers provided. But that’s another issue.
In some cases, the preferred treatment approach may have changed in the last few years but this does not make the new action right and the older one wrong, in my opinion.Take the treatment approach to acute (presumably bacterial) sinusitis: the new up-to-date recommendation leans towards watchful waiting, esp. in patients with good follow-up. The same case (presented in the 2013 ABIM module) is treated with amoxicillin/clavulanate, no ifs, ands or buts. Marking the ‘no treatment’ choice would have been wrong!
Studying a test module 2 years after release may reset your knowledge to the wrong era! Akin to updating a computer running Windows 10 with an older graphics driver….
Another sample question: Is “Euglycemia at 6:00 AM on postoperative day 1” a component of the Surgical Care Improvement Project (SCIP) core measure set? Why is it the correct answer when the actual SCIP criterium specifically applies to cardiac patients only? Is “perioperative temperature management” a correct answer but “perioperative normothermia” incorrect?
Here a recent example from another source, Medscape. The Quiz: What Do You Know About Cystitis? was a well designed instructional module, and it came sprinkled with knowledge test questions [1]. The one below obviously stumped most readers:
It consoles me that so many colleagues got it wrong, but it doesn’t make me feel good to be 1 of the 80% test-takers who did not get it ‘right’.
Multiple choice exams are here to stay. When everyone is in the same boat there is a level of justice and evenhandedness which no verbal exam can ever provide. I get that.
I have no suggestions how the process could be improved except to say that sometimes less is more, and that the latest news should not be be treated as if it were the last word on a particular topic. This over-reliance on ‘breaking news’ in lieu of essentials, this total disregard for individualized medicine and medical judgement is driving a robotic behavior in which guidelines rule and patients become mere objects. Why is there no place for an individualized approach, for perspective?
In this context, let us support the recent revolt against the arbitrary and time-wasting MOC requirements issued by ABIM.
Here one of my all-time favorite multiple choice questions – I will gladly provide the answer (for a nominal fee, just like ABIM) of course.
Reference:
[1] http://reference.medscape.com/viewarticle/860314?src=wnl_edit_tpal&uac=75802SR
