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.

Thursday, February 12, 2015


I took my MOC exam today. I probably passed, but I'd forgotten what it's like to take an exam and really not have a sense of how it went.  I certainly didn't bomb it, but I didn't crush it, either. (It seems like those verbs should be interchangeable).

Was it like the practice questions? Somewhat. But the content didn't seem to be represented in the same proportions. There were no questions involving drug interactions and CYP 450 stuff. Only one MAO-I question. And a much smaller percentage of mood disorder questions than I expected and prepared for. At the same time, there were more questions involving somatic symptoms than seems representative of what one might see in practice, relative to MDD and bipolar, or schizophrenia, for that matter.

I found the medication questions fairly straightforward. But there weren't that many. There were a LOT of personality disorder questions, with what felt like a disproportionate number where the answer was Narcissistic PD. At least I hope it was.  In a way, the PD questions were easy-I don't have difficulty identifying diagnostic criteria. But when it comes to the statistics of the various PDs, I don't know that much.

The friend with whom I studied for the exam took hers a couple days ago. She felt like the questions were easier than the ones we had reviewed, which is probably true, when they covered the same topics the review questions had. She said she had a lot of child questions she didn't feel that prepared for. I had almost no child questions, but quite a few GeroPsych ones, for which I felt moderately prepared. I also had more forensic questions than I expected, and those covered topics I wasn't that familiar with.

The one area I felt was represented in the way I expected, both proportion and content, was substance. I think Beat the Boards did a good job preparing me for those. And there was one question that came straight out of the practice exams-about trichotillomania and habit reversal training as treatment.

My friend and I had a long study session last weekend. She brought along a problem book that a friend of hers from work had given her, and we used that to supplement the Beat the Boards problems, The book is, Study Guide to Psychiatry: A Companion to the American Psychiatric Publishing Textbook of Psychiatry, Sixth Edition, by Philip Muskin. I'd say the questions were a little harder than the beat the boards ones, and there were occasional inconsistencies between the two sources, but the explanations were mostly helpful. I think it's probably worth looking at, if you're in the process of preparing for the exam, and it does include the DSM IV to DSM 5 transition material.

The exam took me a total of 2 hours, including the tutorial at the beginning, a bathroom break in the middle, and the survey at the end. I should have, but didn't bother to write in the survey that not all the meds referenced in questions were listed in the drug guide, which is a screen you can pull up to find the brand name that goes with the generic in the question. There is an allotted 5 hours for the exam, which is 220 questions long. As a gauge, I'm not a fast test-taker. I just either knew the answer or didn't. If I didn't, I either guessed completely randomly-and there were fortunately very few of those questions-or I made an educated guess after narrowing it down, but I didn't spend long deliberating (in New York medical circles, they say "davening", but I don't know if that's a regional thing).

The testing site reminded me, both from a visual and olfactory perspective, of the 1980s suburban industrial building in which I worked as a programmer during one summer in high school. It had the same mix of small to middling companies looking for reasonably priced infrastructure and willing to situate themselves right next to a highway to get it.

The test center was pleasant enough. They took palm prints and checked them every time I went in and out of the testing room. There was a large "ergonomic" desk chair at each cubicle, which did nothing for my bad back, but that's just me. They had what they referred to as "noise reduction headphones", which were just headphones with big puffy ear pieces covered in little hygienic shower caps, with absolutely no noise reduction technology. They gave me a dry erase board and marker, which I never used. My stuff was placed in a locker, which I could access on breaks, if I wanted to. The bathroom was down the hall.

The results are meant to be mailed to me in 8 weeks. It's hard to understand why it takes 8 weeks to score a computerized exam, but there you are.

So I'm done. Or I hope I am. I don't care for multiple endings, like in The French Lieutenant's Woman. And I've heard people complain about the dragged out ending of the Lord Of The Rings. I read someplace that Tolkien planned the ending from early on, but I always liked it, because I didn't want to leave Middle Earth.

If I failed and have to retake it, I suppose this is Frodo and Sam being carried out of Mordor by the giant eagles. But hopefully, I didn't fail. And if that's the case, I don't plan to take it again, ever. Either the world will have come to its senses and done away with the exam in 10 years, or I just won't take it. So hopefully, this is the Grey Havens.