Letter to the Editor
My thanks to Dr. Graham Walker for publically stating in his Emergentology column what the majority of ABEM-certified physicians think but dare not say at the risk of being labeled a blasphemer for questioning emergency medicine's sacred cow: the ABEM written board certification examination. It is a poor tool for assessing the competence of emergency physicians. (“On My Emergency Medicine Boards,” EMN 2012;34:8; http://bit.ly/EMBoards.)
When I took the recertification exam in 2008, I thought I was given the board exam of another specialty or was playing Emergency Medicine Trivial Pursuit. While I appreciated being thrown a few easy questions, three of those questions were repeated in a different form. This may have helped my score, but repeating questions about the same topics instead of asking about myriad other unaddressed emergency medicine topics did nothing to help assess my competence in emergency medicine.
When I left the exam, I did not know if I had passed or failed. I addressed my specific concerns in a letter to ABEM, concluding that if I were as unconfident about practicing emergency medicine as I was about the questions in its certification examination, I would hang up my stethoscope. Unfortunately, the certification exam has not improved since I first took it in 1988, at which time even a colleague who eventually became the chair of an academic emergency medicine department was convinced she had failed it.
I understand a certain number of questions in the exam are not counted in the scoring because they are being evaluated for future use, or are asked for research, or because questions with a statistically poor number of correct answers are disregarded. Using my score (which miraculously was very good) and the number of questions I remember missing, my calculation is that more than 30 percent of the questions on my exam were disregarded!
While I feel vindicated that the emergency medicine board exam experience of a young buck like Dr. Walker was the same as for a graybeard like me, I truly feel for what Dr. Walker had to endure. After all of the time and effort spent preparing for the exam and the years of training and clinical practice, it is disheartening and frustrating to come out of the exam feeling like you are not competent to practice your profession.
We are customers of ABEM, paying a lot of money to take its certification exam “voluntarily.” Don't we deserve a better evaluation tool for our money?
Fortunately, I am at a point in my career where board certified status does not affect my employment. I have decided not to subject myself to the frustration of taking a fourth board certification exam. I wish Dr. Walker and his generation of emergency physicians luck in what my peers could not or would not accomplish: transforming ABEM board certification into a relevant tool for assessing competency in the everyday practice of emergency medicine.