{"id":2512,"date":"2016-05-23T13:06:48","date_gmt":"2016-05-23T17:06:48","guid":{"rendered":"http:\/\/allphasepharma.com\/dir\/?p=2512"},"modified":"2025-09-03T22:12:32","modified_gmt":"2025-09-04T04:12:32","slug":"multiple-choice-frustrations","status":"publish","type":"post","link":"https:\/\/allphasepharma.com\/dir\/2016\/05\/23\/2512\/multiple-choice-frustrations\/","title":{"rendered":"Multiple Choice Frustrations"},"content":{"rendered":"<p><a href=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Multiple-Choice-slider-copy.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-2513 aligncenter\" src=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Multiple-Choice-slider-copy.jpg?resize=530%2C149&#038;ssl=1\" alt=\"Multiple Choice - slider copy\" width=\"530\" height=\"149\" srcset=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Multiple-Choice-slider-copy.jpg?w=640&amp;ssl=1 640w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Multiple-Choice-slider-copy.jpg?resize=300%2C84&amp;ssl=1 300w\" sizes=\"auto, (max-width: 530px) 100vw, 530px\" \/><\/a><\/p>\n<p>Periodically \u2013 maybe in preparation for Specialty Board exams \u2013 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\u00a0the 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.<\/p>\n<p>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!<\/p>\n<p><span style=\"color: #993366;\"><span style=\"color: #000000;\"><div class=\"simplePullQuote right\"><p><\/span><span style=\"color: #800080\">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.<\/span> <span style=\"color: #3366ff\">But that\u2019s another issue.<\/span><span style=\"color: #000000\"><\/p>\n<\/div><\/span><\/span><\/p>\n<p>In some cases, the preferred treatment approach may have changed in the last few years but this does not make the new\u00a0action right and the older one\u00a0wrong, 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\u00a0the \u2018no treatment\u2019 choice would have been\u00a0wrong!<\/p>\n<p>Studying a test module 2 years after release may reset your knowledge to the wrong era!\u00a0 Akin to updating a computer running Windows 10 with an older graphics driver\u2026.<\/p>\n<p>Another sample question: Is \u201cEuglycemia at 6:00 AM on postoperative day 1\u201d 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?\u00a0 Is \u201cperioperative temperature management\u201d a correct answer but \u201cperioperative normothermia\u201d incorrect?<\/p>\n<p>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\u00a0<a href=\"#_ftn1\" name=\"_ftnref1\">[1]<\/a>. The one below obviously stumped most readers:<a href=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Medscape2.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-2518 aligncenter\" src=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Medscape2.jpg?resize=530%2C160&#038;ssl=1\" alt=\"Medscape2\" width=\"530\" height=\"160\" srcset=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Medscape2.jpg?w=2648&amp;ssl=1 2648w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Medscape2.jpg?resize=300%2C91&amp;ssl=1 300w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Medscape2.jpg?resize=768%2C232&amp;ssl=1 768w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Medscape2.jpg?resize=1024%2C310&amp;ssl=1 1024w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Medscape2.jpg?w=1590&amp;ssl=1 1590w\" sizes=\"auto, (max-width: 530px) 100vw, 530px\" \/><\/a><\/p>\n<p>It consoles me that so many colleagues got it wrong, but it doesn&#8217;t make me feel good\u00a0to be\u00a01 of the 80% test-takers who did not get it &#8216;right&#8217;.<\/p>\n<p>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.<\/p>\n<p>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 treated as if it were the last word on a particular topic. This over-reliance on &#8216;breaking news&#8217; 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?<\/p>\n<p>In this context, let us support the recent revolt against the arbitrary and time-wasting MOC requirements issued by ABIM.<\/p>\n<p>Here one of my all-time\u00a0favorite multiple choice questions &#8211; I will gladly provide the answer\u00a0(for a nominal fee, just like ABIM) of course.<\/p>\n<p><a href=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/blackboard.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-2515 aligncenter\" src=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/blackboard.jpg?resize=530%2C300&#038;ssl=1\" alt=\"blackboard\" width=\"530\" height=\"300\" srcset=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/blackboard.jpg?w=1089&amp;ssl=1 1089w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/blackboard.jpg?resize=300%2C170&amp;ssl=1 300w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/blackboard.jpg?resize=768%2C435&amp;ssl=1 768w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/blackboard.jpg?resize=1024%2C580&amp;ssl=1 1024w\" sizes=\"auto, (max-width: 530px) 100vw, 530px\" \/><\/a><\/p>\n<p><strong>Reference:<br \/>\n<\/strong><a href=\"#_ftnref1\" name=\"_ftn1\">[1]<\/a> http:\/\/reference.medscape.com\/viewarticle\/860314?src=wnl_edit_tpal&amp;uac=75802SR<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Periodically \u2013 maybe in preparation for Specialty Board exams \u2013 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\u00a0the actual exam. They are produced by specialists in their respective fields; there is <a class=\"more-link\" href=\"https:\/\/allphasepharma.com\/dir\/2016\/05\/23\/2512\/multiple-choice-frustrations\/\">Continue reading <span class=\"screen-reader-text\">  Multiple Choice Frustrations<\/span><span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":2513,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[18],"tags":[1638,1639,1659,403,1583,1644,1641,1643,1640,1642],"class_list":["post-2512","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-the_viewpoint","tag-abim","tag-american-board-examination","tag-american-board-of-internal-medicine","tag-antibiotic-blog","tag-harald-reinhart","tag-maintenance-of-certification","tag-medscape-quiz","tag-moc","tag-multiple-choice-questions","tag-trivial-pursuit"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/05\/Multiple-Choice-slider-copy.jpg?fit=640%2C180&ssl=1","jetpack_shortlink":"https:\/\/wp.me\/p4KWFr-Ew","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":1640,"url":"https:\/\/allphasepharma.com\/dir\/2015\/07\/04\/1640\/plazomicin-a-quick-take-on-a-complex-drug-with-a-complex-development-path\/","url_meta":{"origin":2512,"position":0},"title":"Plazomicin \u2013 A Quick Take On A Complex Drug\u00a0With A Complex Development Path","author":"Harald","date":"July 4, 2015","format":false,"excerpt":"Whenever a new drug is in late stage development, its prospects become the focus\u00a0of intense scrutiny. 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AOM, AECS and AECB were labeled indications for antibiotics in the 80s and 90s but were summarily thrown out from the indication catalogue shortly after the 1998 FDA Guidelines were published. The arguments\u2026","rel":"","context":"In &quot;Recent Literature&quot;","block_context":{"text":"Recent Literature","link":"https:\/\/allphasepharma.com\/dir\/category\/recent_literature\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2017\/01\/AOM-slider.jpg?resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2017\/01\/AOM-slider.jpg?resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2017\/01\/AOM-slider.jpg?resize=525%2C300 1.5x"},"classes":[]},{"id":1314,"url":"https:\/\/allphasepharma.com\/dir\/2015\/03\/25\/1314\/aerosolized-antibiotics-selling-nebulizers\/","url_meta":{"origin":2512,"position":3},"title":"Aerosolized Antibiotics &#038; Selling Nebulizers","author":"Harald","date":"March 25, 2015","format":false,"excerpt":"\u201cThe medicine comes for free, just pay us for the inhaler\u201d should be the marketing slogan for this group of therapeutics.\u00a0 Nebulizers are good business: hard to copy as a delivery system, they are a great opportunity to \u2018evergreen\u2019 off-patent antibiotics. 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