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Ought to Pediatricians Fret Their Falling Board Scores?

Few pediatricians have heat, fuzzy reminiscences about taking their preliminary board examination.

However many reacted strongly after they learn a recent post on Twitter by Bryan Carmody, MD, who famous that the passing fee for first-time take a look at takers had dipped to its lowest stage in 5 years—hitting 81% in 2021, down from 91% 3 years earlier.

dr bryan carmody

“It is actually an awfully written examination,” replied one one who posted. One other requested: “At what level is the examination simply not reflective of scientific observe?” And, inevitably, the query of the impact of COVID-19 surfaced: “Is any of this attributable to pulling early profession physicians into the pandemic?”

However Carmody, an affiliate professor of pediatrics on the College of Japanese Virginia Medical College, in Norfolk, is not shopping for that rationalization. He researched board scores for inner medication, common surgical procedure, and household medication for 2021. All have been steady throughout the identical interval, he mentioned, main him to dismiss the concept the pandemic drove the decline. “It is not likely clear to me why different specialties would not have seen comparable drops,” Carmody mentioned.

The slip has caught the eye of the American Board of Pediatrics, in line with Judy Schaechter, MD, MBA, who was chair of the Division of Pediatrics on the College Miami earlier than taking a submit as president and CEO of the American Board of Pediatrics (ABP ) in 2021.

“So, our first query was, was this throughout the vary of what one would possibly anticipate?” Schaechter mentioned. “Have been there different components which may have come into play?”

The board performs an in depth evaluation yearly earlier than releasing scores, and it did not uncover any modifications within the problem or content material of the take a look at in 2021, nor did the rating that was wanted to cross enhance. Schaechter identified that the passing fee that 12 months was not unprecedented ― in 2016, it additionally dipped to 81%.

Schaechter mentioned COVID-19 may need affected take a look at takers. “Keep in mind, pediatrics was totally different from some other specialty in the course of the pandemic,” she mentioned. The census in pediatrics wards across the nation dropped dramatically within the first two winters of the pandemic, leaving residents with much less hands-on expertise with sufferers and mentorship from attendings ― each of which will help test-takers cross the examination.

Eyal Ben-Isaac, MD, an affiliate professor of the Division of Pediatrics on the Keck College of Drugs on the College of Southern California, in Los Angeles, mentioned residents doubtless suffered in the course of the pandemic, when midday lectures and grand rounds grew to become digital occasions.

“I am certain that clearly affected an individual’s capability to take a seat and pay attention and actually study the fabric, versus both doing it arms on or studying the fabric from a college member nose to nose,” Ben-Isaac mentioned.

However how a lot do the didactic experiences of residency packages contribute to residents’ readiness to take the boards? Thomas Welch, MD, professor and chair emeritus of the Division of Pediatrics at SUNY Upstate Medical College, in Syracuse, credit his personal success in advancing by faculty, medical college, pediatric residency, and nephrology fellowship to his talent as a take a look at taker .

He confirmed his suspicions by conducting a research that evaluated correlations between residents’ efficiency on the US Medical Licensing Examination (USMLE) taken throughout medical college and their board scores after finishing residency.

Welch mentioned he wasn’t shocked to search out that “the very best predictor of 1’s passing the pediatric boards was not the coaching program during which one labored. It was their efficiency on Step 2 [taken during the fourth year of medical school] of the USMLE.”

Though Ben-Isaac felt that modifications in residency coaching alternatives may need partially defined the drop in passing charges, he agreed that different components contribute to success on boards. As director of the pediatric residency program at Youngsters’s Hospital of Los Angeles from 1994 to 2019, considered one of his first targets was to extend the cross fee of graduates. I’ve developed a board overview course for residents, revising it over time on the premise of residents’ suggestions and including particular person teaching for residents who wished extra assist.

“With no query, it raised our board cross fee to being one of many highest within the nation,” he mentioned.

Welch mentioned that whereas “being up all evening with a sick baby teaches you numerous about medication and definitely makes you a greater physician, it would not do something to enhance your board scores.”

Not one of the pediatricians was too fearful a few 1-year drop in scores, and the consensus was that supporting residents with overview programs and training on the way to take a number of selection exams would increase passing charges.

“There are positively people who find themselves wonderful clinicians who didn’t cross the boards on their first try,” Ben-Isaac mentioned.

However Schaechter defended the significance of the examination. “Our first obligation is actually to the general public,” she mentioned. The ABP’s function is to make sure that pediatricians “present the care that oldsters need their children to have.”

As Welch put it, “Would I belief somebody who did not cross the board examination to handle my very own child? Most likely not.”

Ann Thomas, MD, MPH, is a pediatrician and epidemiologist residing in Portland, Oregon.

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