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 Montillation of MOC

Supposedly, the last week and a half has been a vacation for me. True, I wasn't working. And I watched a lot of dumb TV. Baked bread. Etc. But I also attempted to study for boards. I did this by running through questions in the Beat The Boards question bank. And I made a list of factoids I thought would be important for me to remember for the exam-important either because I got the answer wrong, or I got it right but the information still seemed to just be hovering on the edge of my memory's awareness, not reliable enough to count on in a pinch.

Some of the factoids:

5-10% of whites are poor CYP 2D6 metabolizers.

Lifetime prevalence of alcohol dependence is 12.5%.

8% of non-twin siblings of someone with schizophrenia will develop schizophrenia, but 12% of dizygotic twins and 47% of monozygotic twins.

Not all of the factoids include statistics, but the ones I have difficulty remembering do. I'm not even sure if they're true.

In fact, I've been doubting the accuracy of a number of review questions. For example, this question came up:


A phase I clinical trial is conducted to accomplish which one of the following goals?
 

A - Permit safety and efficacy data to be collected for new drugs

B - Compare the results of people taking a new treatment with the results of people taking the standard treatment

C - Determine if a treatment results in fewer or more side effects

D - Evaluate side effects of a new treatment that were not apparent before

E - Determine the effects of drugs in populations which were not originally tested

Now, feel free to look this up, but I'm pretty sure the purpose of a Phase I Clinical Trial is to take a drug that some company is trying to get FDA approval for, and which has already been tested in animals, and to try it in healthy volunteers, to see if it's safe for humans.

None of the above answers is correct. Consider:

Choice A is wrong because the purpose is to collect safety and not efficacy data. In fact, it makes no sense to collect efficacy data in healthy volunteers.

Choice B is wrong because that's not the function of a Phase I trial, and in any case, to get a drug approved by the FDA, you just need to show it's better than placebo, not than some other treatment that works perfectly well, which is dumb but that's how it is.

Choice C is wrong  because "fewer or more side effects" than what?

Choice D is also wrong from a test-taking standpoint because "not apparent before" is one of those phrases you're not supposed to choose, and before what?

Choice E could be correct, if what's meant by it is testing for tolerability in human rather than animal populations, but clearly, they don't want you to pick E.


You can decide which one you'd choose, but the answer they listed as correct is, "A-Permit safety and efficacy data to be collected for new drugs".

Well, it occurred to me, maybe thy Beat The Boards people know it's wrong, but they're using a question from an actual board exam, and that was considered the right answer. In which case, that's the answer I want to choose.

But what if they don't know it's wrong?

So I emailed them and asked. That was on December 29th. Their support people got back to me right away, and said they'd pass on the question to the education department people, who will get back to me within 72 hours. I'm assuming that means business days, because I haven't heard from them yet, and New Year's Day intervened. Clearly, I'm being generous.

I started to muse about this issue in a broader way. There's the obvious question: What do I get out of an exam if all I'm doing is giving them the answers they want, even if they're wrong or meaningless? It reminds me of:

The Montillation of Traxoline  

It is very important that you learn about Traxoline. Traxoline is a 
new form of zointer. It is montilled in Ceristanna. The 
Ceristannians gristeriate large amounts of fevon and then bracter it 
to quasel traxoline. Traxoline may well be one of our most lukized 
snezlaus in the future because of our zointer lescelidge. 

Questions: 
1. What is traxoline? 

2. Where is traxoline montilled? 

3. How is traxoline quaselled? 

4. Why is it important to know about traxoline?

Could you answer all the questions about Traxoline? I bet you could.