Whether having meals with physician-relatives, attending a professional society meeting, or walking the halls of a hospital, I find that a common issue on physicians’ minds during our discussions is the American Board of Medical Specialties’ (ABMS) Board Certification process – and particularly our program for maintaining certification known as Maintenance of Certification (MOC).
Questions range from “I know you’re old enough to have grandmother status – do YOU do MOC?” (Yes) to “How can I fit this into my already insanely busy life?” Comments range from appreciation for some aspect of the program to frustration with one of the program components.
As the relatively new leader of ABMS, I welcome the opportunity to discuss issues pertaining to Board Certification and MOC. I hope this post will generate thoughtful dialogue that will result in continuing improvements to the certification process developed by ABMS and our 24 Member Boards. That, in turn, will help us render MOC more relevant and meaningful to participating physicians and will assist them in their efforts to provide quality patient care and improve our health care system.
For many years there were few, if any, requirements for maintaining ABMS Board Certification. Physicians took an exam after graduating from their residencies and thereafter had no further obligations for testing or evaluation. However, over time the error of this approach became obvious. Medical science continuously changes, and the pace of that change has accelerated.
Continue reading “Why Maintenance of Certification Will Make You a Better Doctor”
Filed Under: Physicians, THCB
Tagged: American Board of Medical Specialties (ABMS), Maintenance of Certification (MOC), Medical Education, Physicians
Nov 13, 2013
You’re a loyal THCB reader. You have a symptom. You Google it. One of the first three hits will be an entry about the symptom or an associated condition on Wikipedia.
As an informed lay person, you wonder, “How accurate is Wikipedia for medical information?”
You’ve always been a little skeptical of Wikipedia, but over the years you’ve found it more and more reliable for celebrity tidbits (e.g. “How old is Jane Lynch?” or “What was the name of that guy in “Crash?”) and sports trivia (“How many Super Bowls have the Minnesota Vikings lost?”).
In fact, it’s become quite useful for understanding geopolitics, ancient and recent history, and helping explain science topics (Higgs Boson, anyone?).
So why not medicine?
We in academic medicine look down our noses at Wikipedia. “Show us original texts,” we harrumph. “Where does the original data come from?” we ask our residents and students.
Just like high schoolers and college kids are warned NOT to use Wikipedia as a research tool, medical professors hold the site lowly in regard to seriousness of purpose.
Well, it’s time to accept reality.
We all use it, whether we admit it or not. Some of us a lot. The good news is, Wikipedia’s going to get even better in the medical realm.
Continue reading “UCSF’s Wikipedia Experiment: Should Med Students Get Credit For Curating Medical Information Online?”
Filed Under: Tech, THCB
Tagged: FutureMed, John Schumann, Medical Education, UCSF, Wikipedia
Nov 8, 2013
Since its Sundance premiere in 2012, ESCAPE FIRE has screened for national leaders, medical experts, thousands of students, and the general public. The film opened in theatres last October, and had its broadcast premiere on CNN March 10th. From the Pentagon to local communities, ESCAPE FIRE has reached an incredibly diverse audience.
Last year, ESCAPE FIRE: The Fight to Rescue American Healthcare screened on college campuses nation-wide two weeks before opening in theaters. Almost 6,000 students came together to watch the award-winning documentary, and to host discussions about the current state of the American healthcare system. The sentiments from these discussions became calls to action: service projects, course work, and blogs for undergraduates and medical students across the nation.
This year we’re doing it all again. On September 17th, ESCAPE FIRE will play at more than 60 college and university campuses across the country, followed by panel discussions and Q&As. We’ve partnered with the Institute for Healthcare Improvement (IHI), one of the widest-reaching non-profit health organizations in the US, to make sure as many students are aware of the opportunity as possible.
We’re taking the event a step further this year by donating an Educational copy of ESCAPE FIRE to each participating campus, allowing the event to incite change for years to come. Our hope is that students, after attending an entertaining event and participating in thoughtful conversations about their communities, will take on an active role in transforming healthcare.
In order to make sure this discussion doesn’t stop after school or with student groups, we have accredited ESCAPE FIRE for both Continuing Medical Education units and Continuing Nursing Education contact hours. Now, anyone who views the film, can get educational credit. And for the week of September 17th through 30th, the film will be available on iTunes for $0.99.
This is a unique and unprecedented chance for healthcare providers to utilise the film to elevate and deepen the national dialogue about our healthcare system and our role in leading it out of crisis.
Spread the word about this event on Facebook and Twitter. And find a screening near you.
Filed Under: THCB
Tagged: ESCAPE FIRE, Health Care Reform, Institute for Healthcare Improvement, Medical Education
Sep 7, 2013
A fashion faux pas almost prevented me from getting into my dream medical school. Midway through the interview there, the interviewer pointed to my left earlobe and said, “Do you really think we accept men who wear … those things?”
I had no idea what he was talking about at first, but then remembered the gold post I’d forgotten to remove. In a disdainful southern drawl the interviewer let me know how dark a shadow this stylistic error cast on my otherwise favorable application.
I left his office fairly sure I would not be admitted. I also doubted whether I wanted to be admitted to a school that selected physicians on the basis of their jewelry. Really?
Twenty years later, medical schools around the country still struggle to find the right way to decide who should be the physicians of the future, and who should not. Most have evolved past caring about male earrings, but what are the right criteria for admission – what makes a good proto-doctor?
Over forty thousand students apply to medical school each year. Each applicant spends thousand of dollars in fees and plane tickets, and institutions spend still more to screen, host, interview and pick among the hordes of black-suited applicants. Increasingly, medical schools are considering innovative and creative ways to distinguish the most promising applicants from the rest.
New approaches include:
1. Using a more holistic review rubric that de-emphasizes grades and MCAT scores, such as at Boston University;
2. Suspending traditional pre-med requirements for humanities students, such as at the Icahn School of Medicine at Mt Sinai; and,
3. Creative admissions interviews that include problem solving, multiple mini-interviews and even observed standardized patient interactions.
Each of these innovative methods sounds great. Used in combination I suspect they will identify applicants with the necessary academic chops plus a great bedside manner.
Continue reading “A Modest Proposal: Replace the Med School Interview With fMRI”
Filed Under: Physicians, THCB
Tagged: FutureMed, Malcolm Gladwell, Medical Education, Nalini Ambady, practice of medicine, Tim Lahey
Aug 12, 2013
Consider the doctor’s office: the sanctum of care in American medicine, where a patient enters with a need — a question or an ailment or a concern — and leaves with an answer, a diagnosis or a treatment. That room, with its emblematic atmosphere of exam table and tiny sink and bottles of antiseptic, is in many ways the engine of our health care system, the locus of all our collective knowledge and all our collective resources. It’s where health care happens.
But in a less sentimental light, the doctor’s office doesn’t seem so exalted. Yes, it remains the essential hub for clinical care. But what occurs in that room isn’t exactly ideal, nor state-of-the-art. The doctor-patient encounter is fraught with tension, asymmetrical information, and flat-out incomprehension. It is a high-cost, high-resource encounter with surprisingly limited value and limited returns. It is too cursory to be exhaustive (the infamous fifteen-minute median office visit), too infrequent to create an honest relationship (one or two times a year visits at best), and too anonymous to be personal (the average primary care doc has more than 2,300 patients).
At best, it offers a rare personal connection between doctor and patient. At worst, it is theater. The doctor pretends she remembers the patient, and that she has actually had the time to read the patient’s chart in full; the patient pretends that he hasn’t spent hours on the Internet trying to diagnosis himsef, half-admitting what he’s really doing day to day, and pretending he won’t second- guess the doctor’s orders the moment he gets back to a computer.
As woeful as that sounds, we know that there’s real value here. This encounter can be meaningful; it should and must be meaningful. The doctor is a necessary interface to medicine, and his office is a source of care, expertise, and trust. The patient is eager and receptive to learning, primed for guidance and direction. Pragmatically, the doctor’s visit is a powerful part of modern medicine. The problem is that we, collectively, are not optimizing this resource; we have not reconsidered and re-evaluated how we might exploit the visit to its full advantage.
So how can we improve this situation? How can we fix this thing?
Continue reading “Flipping the Doctor’s Office”
Filed Under: Tech, THCB
Tagged: Betty Irene Moore School of Nursing, Camden Coalition of Healthcare Providers, clinicians, FutureMed, Khan Academy, Medical Education, Patient-centered care, Patients, practice of medicine, RWJF, Thomas Goetz, UC Davis
Jul 17, 2013
This week there’s been a debate brewing about why so many young doctors are failing their board exams. On one side John Schumann writes that young clinicians may not have the time or study habits to engage in lifelong learning, so they default to “lifelong googling.” On the other, David Shaywitz blames the tests themselves as being outmoded rites of passage administered by guild-like medical societies. He poses the question: Are young doctors failing their boards, or are we failing them?
The answer is: (C) All of the above.
I can say this with high confidence because as a young doctor-in-training who just completed my second year of medical school, I’ve become pretty good at answering test questions. Well before our White Coat Ceremonies, medical students have been honed into lean, mean, test-taking machines by a series of now-distant acronyms: AP, SAT, ACT, MCAT. Looming ahead are even more acronyms, only these are slightly longer and significantly more expensive: NBME, COMLEX, USMLE, ABIM. Even though their letters and demographics differ, what each of these acronyms share is the ability to ideologically divide a room in less time than Limbaugh.
This controversy directly results from the clear dichotomy* between the theory behind the exams and their practical consequences. In theory these exams do serve necessary and even agreeable purposes, including:
1) Ensuring a minimum body of knowledge or skill before advancing a student to the next level in her education,
2) Providing an “objective” measure to compare applicants in situations where demand for positions exceeds supply.
So apart from the common, albeit inconvenient, side effects that students experience (fatigue, irritability, proctalgia), what are the problems with these tests in practice? These are five of the core issues that are cited as the basis for reformations to our current examination model:
1) Lack of objectivity. Tests are created by humans and thus are inherently biased. While they aim to assess a broad base of knowledge or skills, performance can be underestimated not due to a lack of this base but due to issues with the testing format, such as duration, question types, and scoring procedure (e.g. the SAT penalizes guessers, whereas the ACT does not). Just as our current model of clinical trial testing is antithetical to personalized medicine (What is a standard dose? Or, more puzzlingly, a standard patient?), our current model of testing does not take into account these individual differences.
Continue reading “The Real Problem with Board Exams-and How to Solve It”
Filed Under: Physicians, THCB
Tagged: Apps, Certification, Medical Education, Medical Students, Physicians, Residency, Shiv Gaglani, Tech
Jul 5, 2013
A short piece in The Health Care Blog reveals (albeit unintentionally) why so many outside of healthcare think the medical establishment still doesn’t get it.
The post, written by a general internist and residency program director, asked why an increasing number of internal medicine doctors are failing their internal medicine board exams. The pass rate has reportedly declined over the last several years from 90% to 84%. (Disclosure: I passed this required test about a decade ago.)
His differential included two possibilities:
(1) The test is getting harder – The testing agency said this wasn’t the case.
(2) Millennials lack the study habits of their elders, and have become great “looker-upers.” – The author suggested this was a key factor, and several commentators enthusiastically agreed.
The basic thesis here that in the Days of Giants, doctors worked harder, learned more, and were better. Nowadays, doctors are relatively complacent, less invested, less informed, and are generally worse – which is what’s reflected on the board exams.
Let me suggest a third possibility – perhaps today’s doctors are providing better care to patients than their predecessors were a generation ago. Maybe today’s doctors have figured out that in our information age, your ability to regurgitate information is less important than your ability to access data and intelligently process it. Maybe what makes you a truly effective doctor isn’t your ability to assert dominance by the sheer number of facts you’ve amassed, but rather how well you are able to lead a care team, and ensure each patient receives the best care possible.
In other words, what if the problem isn’t the doctors, who are appropriately adapting, but rather the tests (and the medical establishment), which may not be?
Continue reading “Are Young Doctors Failing Their Boards? Or Are We Failing Them?”
Filed Under: OP-ED, Physicians, THCB
Tagged: David Shaywitz, FutureMed, Medical Education, Physicians, Residency, Tech
Jul 2, 2013
An interesting conversation recently took place among residency program directors in my field of Internal Medicine.
At issue was the declining pass rate of first-time test takers of the ABIM Certification Exam.
It’s a mouthful to say, but the ABIM exam is the ultimate accolade for internists; one is only eligible to take the exam after having successfully completed a three-year residency training period (the part that includes “internship,” right after medical school).
An easy analogy is to say that the board exam is for a doctor what the bar exam is for a lawyer. The difference is that a doctor can still practice if s/he does not pass–they might be excluded from certain jobs or hospital staffs; but certification, while important, is a bit of gilding the lily. [Licensure to practice comes from a different set of exams.]
There’s no doubt it’s a hard test. I was tremendously relieved to have passed it on my first try. Over the last few years, the pass rate for first time takers has fallen from ~90% to a low of 84%.
It may not seem significant, but for 7300 annual test takers, the difference in pass rates affects about 365 people–or one additional non-passing doctor for every day of the year.
In any event, we program directors have taken note. And the falling pass rate has raised questions:
- Has the test increased in difficulty? No, says the ABIM.
- Are the study habits of millennials not up to the level of Baby Boomers and Gen X’ers? Now you may be on to something.
Continue reading “Why Are So Many Younger Doctors Failing Their Boards?”
Filed Under: Physicians, THCB
Tagged: ABIM Certification Exam, Board Exams, FutureMed, John Schumann, Medical Education, Physicians
Jul 1, 2013
I am an emergency room physician who has worked at Atlanta’s Grady Memorial Hospital for 17 years. I am also the first black woman to ever be hired as a faculty member, and thus have had the opportunity to teach students and doctors in training. Given that 85% of the patients of the 120,000 patients that cross our threshold annually are black, my hiring carried enormous symbolic weight.
Beyond the symbolism, I’ve found a real effect on patient care. There are a few earlier studies which suggest that patients prefer doctors who look like them if given the opportunity.
Though we can’t yet confirm that physicians and patients of the same race improve health for minorities , we can still argue that increasing diversity in the healthcare professions is a worthy goal. We must move to a place where physicians can comfortably care for people of all cultures and patients can feel comfortable being cared for physicians from different cultures.
In my own experience, African-American grandmothers, mothers, sisters, aunts all want to give me a hug when they see me walk in the room to treat them or their loved ones: “Go ahead sister,” they might say, “we’re so glad and proud to see you”. I have also had many black patients tell me they were more comfortable talking with me about their history of abuse or addiction. That kind of rapport leads to better care and a healthier population.
If the Supreme Court had ruled in favor of Abigail Fisher in Fisher vs. The University of Texas today, which they did not, opportunities for physicians of color who could establish that rapport might have been significantly diminished.
To eliminate or significantly weaken affirmative action, which would have been the result of a Fisher victory, would deal a significant blow to the ability of undergraduate programs to recruit and create a diverse student population—some of whom will continue on to medical school. To be sure, that blow would weaken medical schools nationwide.
Continue reading “Why Affirmative Action Still Matters in Medicine. And Probably Always Will…”
Filed Under: OP-ED, THCB
Tagged: affirmative action, Diversity, Grady Memorial Hospital, Medical Education, medical schools, Op-Ed Project, SCOTUS, Sheryl Heron
Jun 24, 2013
From SFO, I carefully followed my Droid Navigator’s directions off Highway 101 into a warren of non-descript low-slung office buildings—non-descript except for the telltale proliferation of Google signs and young adults riding colorful Google bikes. I drove around to the back of several of those complexes and finally found the correct numbered grouping. It really could have been any office or doctors’ office complex in the U.S. The Khan suite is on the second floor. There’s a simple brass plate saying “Khan Academy” on what looked like oak double doors. I let myself in and immediately encountered a large, central open space—with long dining tables, food, an ample sitting area with couches conducive for group discussions—and a friendly greeting by programmers and staff. Oh, and computers—there were lots of computers. As far as I could tell, nobody had their own office—though maybe Sal does. Everyone was also open, friendly and passionate about the great work happening there.
After some trial and error, Rishi and I found an unused office and huddled around his Mac for a Google Hangout interview with a Bay Area reporter about the Khan/RWJF health care education project. Later, I met with Shantanu, the Khan COO and former “math jock” high school friend of Sal, as well as Charlotte, external relations, and Matt, software engineer. They’re all long termers at Khan—that means they’ve been there for about two years. Overall, the energy was pretty electric. One other small thing—do not be fooled—these incredible people are, how should I put it—ferociously—intense and focused.
Pioneers in flipping the med school classroom
The next morning, Rishi and I met at Stanford Medical School—in the Li Ka Shing Center for Learning and Knowledge—an enormous and beautiful building off Campus Drive near the hospital that did not exist back in my days as an earnest Stanford law student. We were there to observe some pioneers in medical education attempt to use Khan-like videos to flip the medical school classroom. This work at Stanford is part of the current Khan Academy and RWJF collaboration. We’re trying to understand what happens when a medical school attempts to use the Khan-style videos to change the classroom interaction.
Continue reading “What the Khan Academy Teaches Us About What Medical Education Will Look Like Ten Years From Now”
Filed Under: OP-ED, Physicians, THCB
Tagged: Khan Academy, Medical Education, Michael Painter, MOOCs, RWJF, Stanford School of Medicine
Jun 14, 2013