Should Pediatricians Fret Their Falling Board Scores?

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

However many reacted strongly once they learn a current put up on Twitter by Bryan Carmody, MD, who famous that the passing charge for first-time check takers had dipped to its lowest degree 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 Jap Virginia Medical College, in Norfolk, is not shopping for that rationalization. He researched board scores for inside drugs, basic surgical procedure, and household drugs for 2021. All had been steady throughout the identical interval, he stated, main him to dismiss the concept that the pandemic drove the decline. “It is not likely clear to me why different specialties would not have seen comparable drops,” Carmody stated.

The slip has caught the eye of the American Board of Pediatrics, based on Judy Schaechter, MD, MBA, who was chair of the Division of Pediatrics on the College Miami earlier than taking a put up 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 may count on?” Schaechter stated. “Had 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 adjustments within the problem or content material of the check in 2021, nor did the rating that was wanted to move improve. Schaechter identified that the passing charge that yr was not unprecedented ― in 2016, it additionally dipped to 81%.

Schaechter stated COVID-19 may need affected check takers. “Bear in mind, pediatrics was totally different from every other specialty in the course of the pandemic,” she stated. The census in pediatric 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 move 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, stated residents possible suffered in the course of the pandemic, when midday lectures and grand rounds turned digital occasions.

“I am positive that clearly affected an individual’s capability to take a seat and hear and actually be taught the fabric, versus both doing it fingers on or studying the fabric from a college member head to head,” Ben-Isaac stated.

However how a lot do the didactic experiences of residency applications 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 way of faculty, medical faculty, pediatric residency, and nephrology fellowship to his ability as a check 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 faculty and their board scores after finishing residency.

Welch stated he wasn’t stunned to seek out that “one of the best predictor of 1’s passing the pediatric boards was not the coaching program wherein 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 adjustments 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 Kids’s Hospital of Los Angeles from 1994 to 2019, one in every of his first targets was to extend the move charge of graduates. He developed a board evaluate 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 move charge to being one of many highest within the nation,” he stated.

Welch stated that whereas “being up all night time with a sick little one teaches you numerous about drugs and positively makes you a greater physician, it does not do something to enhance your board scores.”

Not one of the pediatricians was too apprehensive a few 1-year drop in scores, and the consensus was that supporting residents with evaluate programs and training on learn how to take a number of alternative checks would increase passing charges.

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

However Schaechter defended the significance of the examination. “Our first obligation is absolutely to the general public,” she stated. The ABP’s position 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 move the board examination to maintain my very own child? Most likely not.”

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

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