Recertification doesn’t help doctors improve patient care

I’m due to recertify in Internal Medicine soon, so a recent perspective from the New England Journal of Medicine caught my eye.

Of the many criticisms of the Maintenance of Certification Exam, one that stands out is whether the format and questions were relevant to modern clinical practice.

It’s not.

Two contrasting opinions were written, and I’m inclined to agree with the dissenting commentary. There is little data correlating those who recertify and improved medical outcomes.

The major reason is that the format of the exam is antiquated, consisting of hundreds of multiple choice questions that relies on a physician’s recall of obscure facts, largely irrelevant to clinical practice.

As the authors of the commentary write, “The one-size-fits-all secure examination, which requires many hours of preparation and the review of volumes of material, much of which may be irrelevant to one’s daily practice, is a key component of the Maintenance of Certification program. If you fail the examination, you fail to become recertified.”

With the emphasis on reducing medical mistakes and sticking with current clinical guidelines, an exam based on factual recall goes against this trend.

Today’s physician is expected to look things up if he doesn’t know the correct answer, but the “continued overreliance on factual recall runs the risk that physicians will be inappropriately encouraged to trust their ‘recertified memories’ rather than reminded that they should always consult easily accessible, authoritative resources to make sure they are doing the right thing.”

What’s the answer? It’s simple — make the exam “open-book,” or give doctors access to an UpToDate-like source during the exam. Rely less on simple memorization of facts. After all, doctors today don’t practice medicine in a bubble bereft of medical information. Most carry smartphones or PDAs containing extensive resources at their fingertips.

The recertification exam should more accurately replicate this more realistic environment.