“Busy busy.” That’s the usual answer I get from my 82-year-old mother when I ask her how she is doing. One often hears the same refrain from colleagues who have retired, as they inexplicably find their schedules more crowded than when they were working. And it is a universal theme amongst the diplomates who have participated in the multiple focus groups we have conducted during the past several months.
We had that truism in mind when we drafted our fourth mission-supporting principle: “Certification should be challenging and meaningful, yet not burdensome to busy practitioners.” Let me describe a few ways we hope to achieve that aim.
First, we recognize that ophthalmologists fresh out of residency are balancing multiple personal and professional priorities. Approximately two-thirds of graduates pursue fellowship training nowadays, so they already may be focusing their knowledge base from the comprehensive scope of residency by the time they take the written qualifying examination the following spring. Those who successfully pass the written exam are eligible to sit for the oral examination, either that autumn or the following summer. The assignments are based on geography but this means that half the candidates do not become certified for a full two years following residency completion. We are looking into the logistics of moving the written examination closer to the end of residency training as well as having a single oral examination annually. The Board also periodically has considered the pros and cons of administering the oral examination – not all certifying boards conduct them, after all – but thus far has concluded that the exercise has merit. Parenthetically, the fees for the oral examination do not cover its costs, even though our dedicated volunteer examiners pay their own way to the examination.
For our diplomates who are established in practice, we have been encouraged by your favorable responses to the Quarterly Questions pilot. We are optimistic that this program will serve as a suitable replacement for the MOC DOCK examination. More than a thousand of you have participated in the first two quarters of Quarterly Questions and 96% would recommend it to your colleagues. We are eager to unveil the journal article-based component next month and subspecialty-focused questions next year, and look forward to your continued participation. Please remember that Quarterly Questions is a “work in progress” and that your comments and suggestions are valued and respected. For instance, we initially planned to use a one-minute window to answer questions about the journal articles but expanded the interval to five minutes based on your input. We also are working hard to refine the practice improvement modules to make them simpler, more clinically relevant, and, whenever possible, executable through the IRIS registry. By working together, we can develop a certification process that is meaningful to you and your patients, while avoiding unnecessary burden.
Finally, achieving certification should be challenging and aspirational while also being fair. For those candidates taking the examinations for the first time this year, the pass rates were 89% and 80% for the written and oral exams, respectively. The overall pass rate for both examinations typically runs between 75% and 85%. The results have varied little over the past century – at the initial ABO examination in 1916, for instance, seven candidates passed and three failed. In contrast, only a small fraction of diplomates who have participated in Maintenance of Certification have had difficulty with the knowledge assessment component. This makes sense, as each of these colleagues has previously demonstrated a satisfactory understanding of the core material undergirding ophthalmic practice. Current and future enhancements will better identify gaps in knowledge, allowing diplomates to sharpen those areas and serve their patients more effectively and more confidently.