FEATURE
ry, rather than binding. “The intent was for there
to be much independent review and comment
once the report was released.”
From Recommendation to Action
“The fact that ABIM wants to re-examine the
mandated 10-year secure exam and recognize the
importance of sub-specialization is encouraging, but the devil is in the details,” Dr. Kahn said.
Right now, however, those details are missing.
“Conceptually, it is all hard to argue with, but
without details it is hard to put together what it
will all mean.”
The prospect of replacing the 10-year secure
exam is the most exciting aspect of the Task
Force’s report, according to Dr. Kahn, because it
is viewed as burdensome by many physicians.
“I write secure exams, and I like multiplechoice tests, but I acknowledge that they are
not the best way to teach adults,” Dr. Kahn said.
“The main problem with the secure exam is that
if someone gets a question wrong, there is no
feedback.”
The last thing that patients or third-party payers want is physicians trying to “guess” the right
answer to a clinical question without any outside
help, he said. This form of assessment does not
represent real-world practice. In reality, if a physician does not know the answer to something,
he or she can do some research or ask colleagues
for help – learning throughout the process.
Dr. M. Williams agreed that many physicians
find the 10-year exam taxing.
“Preparing for the exam is a very highpressure process,” he said. “Physicians worry
that failing the exam will have repercussions for
tice in very specialized areas (such as coagulation
or a specific hematologic malignancy) are also
frustrated by the breadth of the knowledge tested
by the 10-year exam, Dr. M. Williams said.
“Having to prepare for a general exam in areas that they do not practice in their day-to-day
clinical effort is seen as a waste of their time,” he
said. “It is also not reflective of a sub-specialist’s
great expertise within a narrow focus.”
And, as Dr. Kahn pointed out, that is just one
specialty area. Many hematologists are seeking
to maintain certification in multiple specialties:
internal medicine, hematology, and occasionally
oncology. That means preparing – and paying for
– three separate exams.
“In practice, people become very focused,
which is a good thing,” Dr. Kahn said. “ABIM
needs to understand that narrow specialization
helps the field; it doesn’t hurt it.”
Examination Alternatives
What are the alternatives to the standard secure
exam procedure? One proposal would involve
physicians having to complete three modules
within a five-year period, rather than a massive,
once-every-10-year exam, Dr. M. Williams said.
“For example, a hematologist specializing in
hemostasis and thrombosis would complete two
modules in that area and perhaps one module in
general hematology,” Dr. M. Williams explained.
“It is important for sub-specialists board-certified
in hematology to maintain some knowledge and
awareness of the field in general and to keep
abreast of the many advances in the discipline.”
Another alternative testing model that has
gotten some attention recently is the American
“ABIM certification has always had an
implied authority. It has been around a
long time, bu