What happens if doctors fail boards

Now it just might be the way your brain is wired. So what does this look like in an example? Bilateral paraspinal muscle spasms are present. They note decreased sensation on her left shin and her foot. Left foot dorsiflexion three out of five. And I was gonna lose a clue as something else comes in. Ooh, straight leg test equals pain at 40 degrees. And now the impact of this is he lost that this is an acute situation.

Both of those answer options are gonna be down there. Well, he could feel like he just needs to study the concept more. They overcompensate. Well, they could then maybe start to not trust his knowledge, which is just a slippery slope. Or he feels tricked by the test maker, which is extremely dangerous. A tricky question means you really need to pay attention and be diligent and look at all the clues.

Whereas a trick question gives you clearance to not trust a given clue and dismiss a given clue. And when we start doing that, that takes that 10 plus 10 plus two. Or what if that plus is a minus? The whole thing falls apart. So the solution here, we wanna install a system that limits the burden on working memory. We wanna develop awareness of these negative patterns. So the more aware you become of those behaviors, that can be the start to changing the test-taking issues because bad test-taking is bad behavior.

Issue number two, the reading sequence. We wanna think about the sequence we are using to read questions. This applies to our training and practice.

And of course, how that translates to test day. And there are many right ways to read questions. I just think we wanna use a process for us, for the bad test taker, that number one limits burden on working memory.

We also wanna compartmentalize the reading sequence so that when we assess, we can see where we went wrong. And if that works for somebody, again, great. That probably does work for the majority of med students. What does that majority mean? So the way I look at reading these questions, we wanna break it into multiple regions. So I wanna look at the last sentence, call it the prompt. I wanna give it new vocabulary to give us more control over the system that we wanna call everything above the prompt the passage.

That can include labs and images as well. And then of course the answer options. So I wanna first break any question into these three zones. So to resolve these issues, we wanna talk about a very direct and simple system for reading each and every question. So we wanna always start by reading the prompt. So the last sentence that states the precise question being asked. This has gotten a lot of traction in the last 10 years.

Then we wanna read the passage, keeping the prompt in mind on the one hand, and then identifying three key clues from the passage itself on the other.

It gives us something actively to do as we read. And it will create a framework that we can build off of. Of course, of course. And then we wanna read each option one by one, comparing it to the specific question being asked back to that prompt, turning each question into a set of many questions. This compartmentalization will free up working memory space. So issue three. I think one of the most damaging things we see is this sort of limited binary mentality.

So this binary test-taking mentality is the belief that you have, that you need to know everything to get a question right. This is what you saw in undergrad. This is what you saw maybe in your grad program. Maybe even some first year classes. And actually carrying this binary mentality, this idea that you need to know everything, can actually be damaging for a lot of these test takers.

So instead we wanna use the opposite of the binary mentality and we can call that a partial knowledge test-taking mentality. We also wanna learn how to avoid what I call the prediction trap. So many of us have been told, predict the answer. I hate this advice with a passion.

How often at a step level, or especially at board level, can you confidently predict the answer without looking at the answer choices? It makes me feel like game over. It stresses me out. Prediction is a key part of reading and thinking and comprehension and transaction. So many bad test takers are trying to rule answer options in. We can make a square peg fit in a round hole. You know how you do it? You hit it really, really hard.

But we wanna flip the rule in and to rule out. Same equation as with partial true versus partial false. A little bit false is all false. A little bit wrong is all wrong. So issue four. In the meantime, however, I have a more fundamental question: Is an exam like the ABIM the best indicator of how a physician best applies his or her knowledge to the optimal care of patients?

Do we want performance on this test to be the standard by which we judge the competence of physicians? I thought we were getting away from that approach. Then we can see who orders the right tests, prescribes the right treatment, etc.?

Interesting post- I did hear the question banks did need to get refreshed after a board review cheating scandal a few years ago…. What affect is lower objective academic standards for med school acceptance to increase diversity having on the objective success rate down stream?

I agree re Topol — these health IT guys go on about the benefits of technology and are removed from real practice. Add societal and millenial ADD, plus the availability of Google, and you get a real laziness-piecemeal thinking-lack of hours to learn what is needed trifecta.

And this only adds to the ordering a pile of tests-stuck with our face in the keyboard-going through the industrial factory line of patients issues that current practitioners are already dealing with. Not sure how we bring some of the humanity, laying of hands, and broad knowledge back to the care of people.

They are being dumbed down by the HIT devices they are forced to use. I see this every minute of every day. Nurses have become stupid but good clickers , interns know nothing thye use their smarties to look up , students think the computer is the patient, and folks like Topol [pontificate about HIT innovations but never examine or manage patients in the clinic.

Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. Health In 2 Point Tweets by THCBstaff. Spread the love. Not Walking Away From Medicare. Thank you. Interesting post- I did hear the question banks did need to get refreshed after a board review cheating scandal a few years ago… infusing new questions into the pool esp if they did not have time to test the questions could make the test harder…just a thought.

She has 25 years of experience in healthcare, wellness, and finance. You do what these clients did, you come to us. Toni is phenomenal. She helped me pass my Boards, find new employment and navigate the trials of life with applied wisdom and a renewed mind.

I would highly recommend her course to anyone struggling with how to live their best life! So you think you did a lot more practice questions again? Mike: Yeah, I probably did a whole another question bank, one or two times. I was probably at another 2, questions by the next three months.

But it was really just going through reviewing and like trying to find the stuff that you were weaken, hitting it hard and then, finding your weaknesses and moving through it. And I failed again two months from match day. Mike: Yeah, again, back to margin of error.

And so then everything starts over and so then you have to be alive. Mike: Yeah, so now you have to get approved to be able to take it for the third time. And then your-. Mike: So they, you get dressed up, you go to the meeting again, you try and talk to these people about it.

And so they, luckily you said, one more shot. You get the third chance, you take it, this is it. You pass it or fail it. And so-. Like every move is like, this is the biggest battle. Mike: I called you, panicked. So we have these intertwining episodes of the five years of med school. Ryan: I had just left my spot at Marshall. But I knew at that point, I had decided at that point that like the models were different and the demographics were different.

I was working with a Marshall. Take a bad test taker and turn them into a good test taker on medical board exams. But I was just building it. And I think, we talked about it. You were panicked. And I was like, I wish he was calling me six months later when I had this thing built. I say it all the time like test taking is a weak link system. Some things are strong link systems, some things are weak link systems.

What I care about is you at your worst, when you are abusing the question. As I develop this. Mike: I think I was the third person that take the class, like, you tried it once.

And then I think I was the second or third person to go through it. And you were still putting stuff together and you had notebooks, you were mailing out, and so crazy. Ryan: It was crazy, very crazy. And I was upset for you. I mean, I was like, oh my gosh, no, not at this point. And you were just crestfallen and scared and traumatized. So this means like, using like Google Hangouts or whatever weird portal we were using at that time.

And my background with like the way the ADHD brain works, the way reading and learning works, where gifted learning works and like learning disabilities work.

Somebody might only be doing two or three of them. But you, you were like checking so many of the boxes. It was a great early like avatar to build through. He does that. He does this. So we get in there and we start installing the system. You go from prompt to passage, to triangulate what we now call status checked and taking each option one by one not weighing them together, giving them one of these codes.

How accurate, how honest are those? And then if you go to a tie break, how do you break that tie? This is all stuff that you can see some videos on our website about this. This is our statement boards workshop. But on the one hand we have to install the system. When you got ahold of me, till I turn the ship around. And so we start installing the system, like hammering it into place. So we had to teach you to play the game the way we want you to play it.

And then ultimately you guys are smart people. My med students physicians are smart. They have to be their own coach. Like every time you do questions, you have to use the system. This is less important and all that. So we get this thing up and going and I think we did it for free, right. Like I owe him forever. How you operate in these questions, right.

You know this stuff. And if you have weaker executive functioning, weak or working memory, which I think applies to you, it just all gets exposed and it all gets amplified. Part of having a good test taking solution at this level is finding out where the weaknesses are, and then having a system that limits the burden on those weaknesses.

And you really wanna build that system out to sort of buffer that. What might. You just have to execute like you train on test day. You miss a question, you read the answer explanation, you then sort it into one of two categories. Was it a knowledge miss or a test taking miss?