There and Back Again

The Hill: Hobbiton-across-the Water, by JRR Tolkien

I passed my MOC exam.  Friends and family have been teasing me about worrying that I wouldn't pass. I think it was a mild to moderate worry that I wouldn't pass, versus the severe unpleasantness of the consequences of not passing.

I found out 5 weeks to the day after taking the exam. The ABPN emailed me and told me I could check my score on ABPN Folios, although that would just indicate pass or fail.

They also sent information via mail, including my exact score, a breakdown of my sub-scores, a breakdown of the exam by section, and other information, which I'll get to later on.

One piece of information for people planning to take the exam soon, that I don't think I knew before the exam, or maybe I did, is that the passing standard for 2015 is 66%. I got an 85%. I wasn't planning to share the details of my scores, and it makes me a little uncomfortable to do so, but on consideration, I decided that it might be helpful to see how I did, compared with how I prepared and how I thought I did-see my posts, Done, Percentages, and The Evil Emperor MOC.

So here's the chart I came up with:

I had felt there were proportionally fewer Mood d/o questions. This seems to be a distortion on my part, although it's possible the Mood d/o questions were closer to 11%, and Psychotic, Substance and Anxiety were all closer to 15%. But it's good to know that the bulk of what psychiatrists see was represented in the largest proportion.

I had mentioned that I thought there were a lot of Personality d/o questions. I guess I was right about that. I was also right about the fact that I wasn't as well-prepared for these questions, reflected in my score of 77%.

I had felt well-prepared for the substance and neurocognitive d/o questions ( I don't think I mentioned that latter, in my previous post, but I talked to colleagues about it), and this is also reflected in my scores.

I don't take the lower "% of Exam" area scores very seriously. Like, maybe there were two questions on Dissociative d/o's and I got 1 wrong.

So it looks like I was reasonably well-prepared for the exam. My only advice to people about to take it would be not to bother with CYP-450 stuff, and focus more on personality d/os.

Now for the "back again" part.

The score report came with other information about MOC. Specifically, I'm now automatically enrolled in C-MOC, or Continuous Maintenance of Certification. My new board certificate no longer has an expiration date. I was pleased when I read that part. I thought, well, maybe I won't maintain my MOC, but I'll at least feel like I'm maintaining it.

Most of you reading already know this, but just in case, C-MOC consists of 4 parts. 1. Maintain professional standing. 2. 90 CME category 1 credits, including 24 Self Assessment (SA) credits, every three years. 3. Exam every 10 years. 4. Performance In Practice (PIP) once every three years.

Plus, you have to attest to completed MOC activities annually, and there's also an annual fee of $175, and here I'm quoting:

The annual fee covers maintenance of Board certification status, use of personalized Physician Folios account with customized MOC tracker, development and administrative costs of MOC examinations, including credit towards an MOC examination in a 10 year period.

How much does it cost them for me to "maintain" my board certification status-in other words, do nothing? And I already have a Folios account with a hard-to-use MOC tracker. As to development of MOC exams, I feel like, if I'm paying for it, I should be able to contribute to the decisions about what's covered on the exam. And if the $1750 total is only a "credit towards" another exam, what extra charges am I gonna get?

To me, it sounds like the ABPN is becoming aware that not only are they not the only game in town, but they better make sure to get you hooked in right away, because 10 years down the line, they're likely to lose you.

I thought somehow, by magic, having taken and passed this last exam, I would be spared having to give it a thought for another 10 years. I figured I'd rack up my 300 CME credits, ignore the SA credits, because some time in the next 10 years, the SA thing will be exposed for the racket it is, and be removed. Same for the PIP stuff, which is already circling the drain. And then 10 years from now, the dust will have settled, and I can decide whether it's worthwhile for me to take another exam, or if the ABPN and the ABMS have become a total joke, and my other board certifications are all I need. That's part of the fantasy, that in 10 years, I'll have multiple, non-ABPN, board certifications.

It was not to be. Some time in the next year, I have to decide whether I want to pony up the $175 to continue this trajectory, or take a stand opposing the shameful scam of MOC.

Did you know that in the 2nd Harry Potter movie, Harry Potter and the Chamber of Secrets, there is a large painting of Gandalf just over the door in Dumbledore's office. So in the words of that other great wizard:

"Dark and difficult times lie ahead. Soon, we must all face the choice between what is right, and what is easy."

Leaving the Shire, Ted Nasmith

The Evil Emperor MOC-Or My Review of a Review Course

I seem to have strayed from my Lord of the Rings metaphor for my Board Recertification journey. But I signed up for the Beat the Boards online course, and I decided to do something I've never done before-use flashcards. I'm not sure why I made that decision, but maybe it was because I wanted to try out flashcard apps.

But before I move on, here's a picture of Charles Middleton as the Evil Emperor Ming the Merciless from the Flash Gordon (hence the "flash" cards) series of 1936.

I used to love that show, even though the special effects were laughable-you could see the strings holding up the spaceships.

And here's Max von Sydow as the Evil Emperor Ming in the 1980 Flash Gordon Movie:

And finally, here's the incomparable Ben Kingsley playing the evil Nizam in 2010's Prince of Persia movie, which, as far as I know, has nothing to do with Flash Gordon or MOC:

Turns out, there's a reason I've never used flashcards. I guess I've never understood why I should bother to write bits and pieces of information down on some index cards when someone else has gone to the trouble of writing down the same information in whatever text or source I'm trying to copy it from. Cut out the middleman, I say! I thought I might be inspired to try it this once using smartphone apps, just for the tech-y coolness appeal. But it's at least as much trouble to type things out on my phone as it is to write them on an index card. Well, so much for Flash Gordon.

However, I HAVE been attempting to study for boards. I have a three-pronged approach.

1. Meet every two weeks with the same friend who I studied for Step 3 and the first round of boards with, to go over questions.

2. Watch the Beat the Boards videos and follow along with the written materials on a regular basis. Once in a while when I feel like it seems pretty regular, right?

3. Review the Med-Quick guide from Beat the Boards.

Here's how Beat the Boards is measuring up.

1. The question bank is probably the best learning source, assuming, as they claim, that it accurately reflects the content of the boards. There are supposed to be "100's" of questions, but there have been some repeats, so far. There's a flashcard mode and a test mode. I've only done the flashcard mode, which tells you if you're correct, gives an explanation, and allows you to save the question for later review. I believe the test mode is supposed to simulate testing conditions, and is also the part that gives you CME credit.
    I find I don't agree with some of the answers, so again, I'm taking it on faith that these are the answers the ABPN wants. There are also some questions that don't seem to belong there, like the one about the most effective form of contraception. I would feel remiss if I didn't encourage my patient to have that discussion with her gynecologist.

2. The videos are of varying quality. The ones given by Jack Krasuski, who runs the company, are decent. He doesn't simply repeat what's in the written material, and he has a good way of organizing what he's trying to convey. He does have, well, it's not quite risus sardonicus, but an unnervingly permanent smile glued to his face, that's a little off-putting. Besides his videos, I've only watched those by one other guy, and he is soporific. It's that poor use of power point, where if you're just going to repeat the written material I have in my hand, why should I bother listening to you babble on.
   The presentations are done in such a way that they start off with a multiple choice question, and use that as a jumping off point for the discussion. There's nothing earth-shattering about this approach, but it isn't bad, either.

3. The Med-Quick guide is a pdf in 4 parts. Part 1 is a list of FDA-approved medications 2009-2013. Part 2 is a list of psychiatric disorders with their respective FDA-approved meds. Part 3 is a review of individual medications. And part 4 includes additional board-pertinent information, like drugs to use during pregnancy.
   I sort of remember the site offering the Med-Quick guide for free, when I was first checking it out , but when I tried to access it, the link didn't work. I can understand why. I think if I can memorize this guide, I'm pretty much set. the non-med questions in the question bank are easy and intuitive, except for the statistical ones (what percentage of pedophiles self-identify as heterosexual? 20-40%, 40-60%, 60-80%, 80-100%?) I tend to err on the side of moderation if I don't know the specific number, but that's clearly the wrong approach. But there aren't that many of those, so if I have the meds down, I think I'll pass.

(It just occurred to me that, having documented this process publicly, it'll be really embarrassing if I fail).

Overall, on a scale of 1 to 10, I give Beat the Boards an average thumbs up. Since it's effectively the only game in town, though, I can't complain.