Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Saturday, March 22, 2014

S.A., It Aint So

In the hilarious and highly underrated movie, Moving, starring Richard Pryor, the main character (Pryor) loses his engineering job of 15 years. Before he storms out of his boss's office, he gives him the finger, only it's his index finger. He then ruminates for days over his humiliation in using, "The wrong finger!" Ultimately, it becomes a family joke.

You Tube Link

Somehow I was reminded of this scene when I was pondering what to do about my self assessment (SA) MOC credits.

I've been dutifully filling out my CME credit details on the American Board of Psychiatry and Neurology (ABPN) site, and I have more than enough credits to take my recertification exam in 2015.


But I'm short 1 SA credit.

You may recall from my Alphabet Soup post, or you may not but feel free to link to it, that if you were board certified in 2005, you need 40 SA credits.

I got all 39 of my SA credits from The Carlat Report (TCR). And until a couple months ago, I planned to continue using TCR to complete my SA credits. It was simple. Instead of just taking a post-test for CME credit, I would take a pre-test that asked the same questions. Then I'd read the material, and then take the post-test and get my certificate. That way, I had assessed myself, and I could tell that I had learned something.

That's the idea, anyway. In reality, I could have simply taken the pre-test, which gave me all the correct answers, skipped reading the material, and filled in the answers on the post-test.  And then I would have learned nothing.

The SA requirement was really well thought out, don't you think?

Then TCR changed it's SA policy, and now they have a separate, yearly package:

We are now offering a NEW self-assessment CME product that consists of 12 monthly issues of The Carlat Psychiatry Report, plus a bonus 120+ pageMedication Fact Book. This inclusive product is $377 and is worth 18 Category 1 CME credits and 8 ABPN SA credits.
The subscription can be purchased at any time in 2014, but all tests must be taken by December 31, 2014, at which time SA credit will be awarded. 

This happened when I was one credit short, can you believe? And even if I were to switch over to the new product, it's not clear to me from the description if I can get a credit or two at a time, or if I have to take the whole test and get 8 SA credits at the end of the year (I've asked them about it, but the answer was slightly vague, and seemed to corroborate my suspicions). Since I'm taking my exam in 2015, I would like to have my credits out of the way earlier than the end of this year.

What to do?

I checked the ABPN site, and they have a page with a list of all their approved SA products, most of which are day or weekend seminars that cost more than I care to spend.

The one I decided to do was a Mass General Academy online module in general psychiatry. 50 questions, 4 SA credits, 35 bucks.

I was, of course, expecting the same deal: pretest, read, post-test. But there's nothing to read. Just 50 questions to answer. They don't report your score to the ABPN, but they give you feedback on how you did.

This was convenient for me, but the questions were not great. Here's an example:

48. Which one of the following hypnotics is free of daytime sedation and significant memory impairment:

a) diazepam.
b) flurazepam.
c) triazolam.
d) zolpidem.

Now, clearly, they want you to answer "d) zolpidem", which I did. But honestly, if you were prescribing Ambien for someone who'd never taken it before, would you feel okay telling them they'd be free of daytime sedation and significant memory impairment?  Does a period of time when you don't know where you were or what you were doing and later found out you rammed your car into a truck not qualify as "significant memory impairment"? Tell that to Kerry Kennedy.

Point being, MOC is a racket that costs time and money, and takes time away from patient care and from actual learning. Maybe a board recertification exam MIGHT be worthwhile if it asked questions that were accurate, up to date, and relevant to real world practice.

What questions, you ask?

Let's make some up.

With which of the following would you choose Brintellix as first line treatment for depression?

a) United Healthcare
b) Blue Cross/Blue Shield
c) Aetna
d) Medicare

Okay, enough with the sarcasm. What I'm really thinking is that it would be great if every practicing clinician would submit one or two questions to a giant question bank, and then self-assessment CME, or even board exams, could be generated from that bank.

The questions could reflect, for example, practices that are bread and butter for someone working in one specialty, and more obscure and likely forgotten, or never learned, for someone else. Like, I could come up with a Psychoanalysis question, and Jim Amos from The Practical Psychosomaticist could come up with a C/L question, and George Dawson over at Real Psychiatry could come up with an Addiction question.

Alternatively, the questions could be ones that don't have clear answers, and would require a little looking into, and maybe some discussion with colleagues. For instance, I have this theory that when it comes to antidepressants, there are SSRI people, and there are non-SSRI people. Is there a way to tell, a priori, who's who? I think this is a question that David Healy is interested in researching. But without clear research, it would be nice to have that discussion with other psychiatrists who are dealing with the same dilemma. When faced with a new patient, I kind of know how I go about deciding, but it's more of a hunch than anything else, and of course, there's always the business of trial and error.

All I'm saying is that there are so many better and cheaper ways to generate lifelong learning than stupid APA endorsed SA CME. Like POLL (Psychiatry Online Lifelong Learning), our free online journal club. Please check it out.

Tomorrow, I'll be joining a free MOC Update Webinar sponsored by AAPS, We'll see if they have anything to say about the SA business.

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