Correspondence

To the Editor: I recently completed the fourth examination en route to what I hope will be the maintenance of my board certification as a family physician. In doing so, I remain convinced of the wisdom of the founders of our specialty in setting this requirement, which differentiates us from most other specialties, as one key pillar in cementing the credibility of family medicine in the minds of our fellow physicians and the patients we serve. At the same time, I have real questions about the content of the examination, its practical application to day-to-day practice, and the methods by which it is administered.

I think that members of our specialty may be missing some opportunities that may be available through the examination that would enhance the quality of medicine that we practice and strengthen our role/image in the eyes of the public at large. The greatest opportunity the examination offers is the chance to standardize the knowledge base of family physicians. There is ample information available regarding the core content of family medicine from a conceptual perspective.1 Why not use the examination to underscore this in an effort to foster some degree of uniformity in the specialty? As some of the information from the Future of Family Medicine project clearly indicates, the public does not have a clear or consistent concept of who we are or what we do.2 I suggest that the ABFP in concert with the AAFP refine and publish specific information deemed central to the role of the practicing family physician and make this information available well in advance of the exam, with the expectation that this material will be essential for review.

A second opportunity is to use the exam to diminish the vulnerability of family physicians to malpractice litigation. By surveying malpractice cases with family physicians as defendants, trends could be identified that could then be translated into published case reviews made available on an annual basis that would also be incorporated into the exam via test questions. We would be providing immediate assistance to family physicians in practice and taking careful steps to insure the public that their confidence in us is not misplaced.

A third opportunity is related to highlighting the implementation of new practice guidelines. These are being continually developed; currently, they are the responsibility of individual practitioners to find and implement on their own. Although it is technically feasible to remain current on an individual basis, the value that the Board would add by prioritizing and collating these and subsequently making them available to family physicians would be substantial. This would be further emphasized by their inclusion as content material suitable for testing on the recertification exam.

Instead, the exam as it is now constructed is essentially a National Boards part IV. It is an attempt to encompass the totality of medicine in a 1-day exam that by definition will exclude large amounts of material of real clinical significance. One of the most common questions fielded by the ABFP is “How can I prepare for the certification or re-certification examination?” The Board responds, “The answer is complex; there is no straightforward or simple way to answer it.”3 The authors of this article further expand on the answer, indicating that the best way to prepare is to be “actively involved in the full breadth of family practice,” defined as reading appropriate educational materials and attending CME meetings and hospital conferences.1 The article further expands on the methods for assembling the questions.

In my opinion, it is of no value to memorize information that is immediately available from one’s personal digital assistant, yet many of the test questions require this information. In my attempts to prepare for each recertification examination and to stay as current as I can with the literature, I have taken what I believe were well-run board review courses. Despite the content and organization of these courses, their real relevance to the exam was limited at best and offered very little new information. I also wonder how many examinees look beyond their scores with the intent to sort through the questions answered incorrectly and consider their applicability to clinical practice.

I support of the Board’s progress in moving toward computer-based administration that will diminish the need for what I believe is excessive supervision for written examinees. I also hope that the architects of future exams might consider ways to increase the relevance of the exam such that it might be a key factor in underscoring the essential nature of family medicine and the unique approach of family physicians as health care providers.