Pass rates for the maintenance of certification exam have been declining in the past 5 years, and those who took the exam in spring 2006 had the lowest pass rate yet: Only 74% of physicians who took it made the grade.
“What we have been finding recently is that people are coming back sooner. That may lead to a lower pass rate,” said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine, which administers the exams. Because the maintenance of certification (MOC) cycle length is 10 years, physicians who take the exam 7 years into the cycle “may not be as well prepared as those who have more at stake,” she said.
The spring exam had the lowest pass rate in the history of the exam, which was established in 1995. According to the ABIM Web site, 92% of those taking the MOC for the first time passed the exam in 2001. The pass rate for first-timers declined steadily over the next few years, reaching 84% in 2005.
Some physicians may wonder if the lower pass rates reflect the exams. But Dr. Cassel emphasized that the exam has not become more difficult over the years. “We have studied these results very carefully,” she said, adding that the ABIM uses an elaborate statistical method to ensure that exam questions are fair and the level of testing does not change.
Louis Grasso, associate director for psychometrics at the ABIM, said the exam is validated by “a very rigorous process.” The board specifies what types of questions the exam should contain.
Groups of practicing internists also review the questions for relevance to everyday practice. The exam is somewhat self-validating; internal reviews show that physicians with greater medical knowledge tend to score higher, Dr. Grasso said.
Pass rates also might decline if the cohort of internists taking the exam is a less-robust group than previous cohorts. As Dr. Cassel points out, internists who took the original certifying exam about 10 years ago, when internal medicine was a less competitive specialty, did not perform as well on that exam, either. If indeed the lower pass rates were achieved by a less-competitive cohort overall, that validates the fact that the exam fairly reflects the abilities of a particular group of internists.
Dr. Chad Whelan, the director of the hospitalist program at the University of Chicago, shared his thoughts on the spring 2006 exam, which he passed. “I actually thought it was very fair. It felt similar to the [certifying exam] where, if you were up to date, and practicing a wide spectrum of internal medicine, then it was a reasonable task,” he said.
Dr. Cassel confirmed that the ABIM strives to include clinically relevant questions and focuses on the knowledge that physicians who are 10–20 years out of residency really should know.
'If you were up to date, and practicing a wide spectrum of internal medicine, then it was a reasonable task.' DR. WHELAN