Friday, July 16, 2010

MOCA Changes Exam Rules--Conspiracy!

The American Board of Anesthesiology changed its rules for passing the Maintenance of Certification in Anesthesiology examination this year and I think that is total BS.  The ABA stopped issuing lifetime anesthesiology board certificates after the year 2000.  Now all recently graduated anesthesiologists have to recertify for their boards every ten years with a series of CME credits and this MOCA exam.  Since this process went into effect older anesthesiologist could voluntarily recertify their lifetime certificates by taking the exam.  Their rationale is that anesthesiology board certification rules for employment may change in the future and every anesthesiologist should have recent evidence of anesthesia competency.  Frankly I thought that was a pretty convolulated way to encourage people to pay for an exam they didn't really have to take.  In my group I know of maybe one or two people who took the test even though they had lifetime certificates.  None of the older partners are particularly concerned about not being able to work in the future.

Now ten years after MOCA was begun, the ABA has changed the rules for passing the exam.  Previously, the exam taker could select 150 questions out of 200 that he wanted to answer and be graded only on those.  The other fifty questions, the ones he didn't know the answers to, were simply discarded.  How convenient for the examinee.  I bet the ABA received a lot of exams with 100% correct answers.  When I took my exam in January I had to answer every single one of those 200 questions.  Yes there were some questions that I had no clue the answer to but I couldn't just simply skip them; I had to answer them to the best of my abilities.  Thankfully I was one of the 346 out of 373 examinees who passed the test.  But this change in standards is aggravating and smacks of a double standard against younger anesthesiologists.

It was bad enough that they removed the lifetime certificates two years before I finished residency.  When I started anesthesiology training I didn't know about an impending change in board certification. Now ten years later they changed the rules on me again!  I wonder why they altered the MOCA rules.  Could it be that after ten years of MOCA exams anybody with a lifetime certificate who wanted to take the test have already done so?  Would their pass rate have been lower if the ABA hadn't allowed them to disregard 25% of the exam questions?  Are the new anesthesiologists being held to a higher standard than older anesthesiologists?  What does this say about the competency of older anesthesiologists if they need help from the ABA to cheat their way into a new board certification?  Yes I said cheat.  The ABA's data clearly demonstrates this dichotomy.  Anesthesiologists like me who recertified in their seventh or eighth year after residency had a pass rate of 97% while those who took the test in their ninth or tenth year only passed at an 88% rate.  I wonder what the pass rate would have been for anesthesiologists who were taking the recertification in their fifteenth or eighteenth year of practice if they had to answer all 200 questions?

Think how many tests you have taken in your lifetime.  If you could throw away 25% of the questions in your SAT or MCAT or USMLE don't you think your scores would be higher too?  By allowing the lifetimers to answer only the questions they want to this gives the illusion that these older guys are smarter than they really are and that anesthesiologists around the country are more knowledgeable than they appear. I know plenty of anesthesiologists who could bulls*** their way through a case but who are stuck on pancuronium and isoflurance because that is all they know.  In the meantime we younger guys have to keep jumping through hoops that the older generation created for us just to prove we are worthy of our profession.


  1. I hate this business of changing standards. Worse now is the change in the ABA written exams which looks completely different than the in-training exams. How can you change the exam, the format, the clinical emphasis without first notifying the exam takers of these changes?
    And then there is no passing score/ standard pre-determined by the board. Essentially seems that the board decides after the exam on what to consider a passing score so that about 20% of the applicants have to take the test again and this would generate more revenue for the board. What if for a given year, everyone was very sharp and well prepared to be an excellent anesthesiologist? The board would still fail the approximate 20% without considering the impact this has.
    The purpose of such board certification exams is to ensure meeting of minimum qualifications to provide safe and appropriate anesthesia care and not to "grade" test takers. There are multiple questions on each of the written exams that one cannot find answers for in any of the big anesthesiology reference books. Often times, one finds opinions of authors who contradict each other depending on what reference you use. How can the board test such questions and expect the examinee to answer the question in the same context as one of the references might have, eventhough it contradicts another reference. Is the board seriously expecting residents/ graduates to know all relevant material in detail applicable to various subspecialties like cardiology? I would think they should provide a list of references/ journals that they expect first time examinees to have reviewed and use those as a source for their questions.I recognize the need to review other literature but such questions should be reserved for oral boards where the examinee at least has a chance to explain what his understanding is.
    There is absolutely no recourse for challenging any questions or submitting evidence from established references to prove how some of the other options for answers might be correct. Even for badly worded questions, or ones that are completely wrong, there is no possibility of feedback to the board. One can only hope that this would be caught in their statistical analysis.
    I am very dissapointed in our board and hope that the combined frustration would lead to some action and changes at the boards. I would hope that we would somehow survey all applicants, board certified or eligible, and inquire how many objectively think that our recent examinations are fair and they knew exactly how to prepare for their boards. And how many think that the performance on boards determines how clinically strong an anesthesiologist will be?
    I am lucky that I passsed but can assure you that I completely disagreed with multiple questions and the fact that the board would test such material and not provide any information on the changes and on a list of resources to be used for preperation. If we are evolving into a more clinical emphasis on our examinations, then we should provide such information to the training institutions and to the candidates and educate them on how to better prepare for this.

  2. whoa is you...i think this smells like a conspiracy!

  3. My response to Joy's complaints is that while there might or might not be validity to her charges, the Exam is a Beast. It is in a sense fruitless to examine the Beast too carefully. One must simply slay it, and move on. And while I'm no Board apologist, I will say that The Board has to deal with a lot of moving parts. There are changing public perception of "Board Certification," hospital and insurance company standards, and the Board's and the specialty's reputation. The Board is made up of good people; no sense demonizing them. They've got a tough job. Make it a little easier for them and go out and pass their stinking test!

  4. I agree with Joy! But with the dwindling compensation from Medicare and other insurance companies, do you think it is even worth pursuing it? There is a high percentage of physician burn out because the quality of life is getting worse....Too many sleepless nights and very limited family time.

  5. I hate to be a party pooper, especially since I totally agree with your analyses that younger board certificate holders are paying a political price not exacted from the older folk.
    But please bear with me while I make an observation about statistical analysis. Standardized test results are converted from raw scores to scale scores. Passing grades are then defined above a certain predetermined level. This is done to account for varying severity of questions on exams administered at different times. The same principle holds true for the opportunity to delete 50 questions. It gives a candidate another opportunity, by tossing out harder questions, to smooth out differences between test administrations. It also permits the thoughtful candidate to focus his preparation on subjects with which he or she has greater familiarity, as he has the chance to delete questions outside his expertise. It is one small way to make the test fairer for all. (Of course this can also be accomplished by a modular approach to testing, with varying requirements for different subsections.) Since raw scores are converted to scale scores, no great advantage accrues to those without this deleting opportunity in later years. While the chance to delete items gives a candidate a sense of control, among other perceived benefits, it does not mean that candidates taking this exam years later are at a great disadvantage.
    The much more controversial question is the construct validity of the exam, the purpose of the test, and the "necessity" of a "high" failure rate. Most importantly, no test purporting to measure candidate expertise in a given field should record declining pass rates with the progression of time. Examinees in practice for longer periods of time should simply record higher scores. This is a critical failure in the construction of the exam and in the thought processes of the examiners. This is the question that needs to be addressed in the boardrooms of the ABA.

  6. This is all a pile of feces generated by scam artists who knows nothing about medicine. These are greedy lawyers and businessmen who have politicians in their pockets. Rise up to oppression and stop being manipulated with your SSRI to control your emotions. You are a human not a dog. Do something. Most of the policy makers are FMGs to impede the growth process of the American graduates. Look around our anesthesia departments and you will find tons of anesthesiologists who have not done one day of American training or have taken any American exams. All the best.