The Agony of the MOC

April 11, 2014

Radiologists aren’t exaggerating, exams have transformed, and they’re ugly.

Along with a number of colleagues across the country, I was relieved this week to receive notice that I had passed the ABR’s Maintenance of Certification (MOC) exam. There’s nothing quite like finding out that you will be permitted to continue participating in the only professional livelihood you have ever known…even if the notification “letter” (it was actually a digital file) is dated April 1, and you are unable to entirely dispel the notion that you just might receive a follow-up communiqué proclaiming you to be a no-longer-certified April Fool.

I had considered this outcome to be far from a sure thing, and not just because so much was hanging in the balance. Of course, friends and family were less anxious along the way, and after the good news arrived, some were quick to remind me of this (typified by one Facebook response: “Duh, we all knew you’d pass except you. Dummy.”)

Outsiders to our field probably just think we’re worriers and lacking in self-confidence when we put ourselves under house-arrest for weeks (or months) before a test and pour over study materials, yet still express concerns that failure is a real possibility. They have seen us go through similar motions ever since they can remember, right back through medical school, and as far as they can tell, we always turn out alright. They consider us to be smart, hard workers…how could we not pass?

From first through 12th grade, and often undergraduate college (the educational path these non-medical types shared with us, and thus their frame of reference), the rules were simple: Attend class, pay attention, do your homework and you’re pretty much guaranteed to pass your exams. The only real uncertainty was how comfortably above the passing-mark you’d score...which mattered more to some, such as med school hopefuls, than others. Perhaps, when our friends and family see us stressing out over another round of testing, they recall us agonizing over being at the tippity-top of our high school classes, certain that a single lost point could damage our futures irreparably.

What they’re missing is the ugly transformation that exams underwent around the time of med school, or even some premed courses: The rules changed, without warning. Suddenly, it was fair game to test material that had never been discussed in a single lecture, or any of the assigned reading. Poorly worded questions, with multiple correct answers or none at all, were rife. It was no longer permitted (let alone encouraged as part of the learning process!) for students to approach instructors regarding such things, in the hope that an intellectually-honest teacher would acknowledge “bad” questions and discard them. And if individual professors were thus untouchable, forget all about appealing to the USMLE or a specialty’s Board.

Some of this is to be expected, I suppose. If the goal is for only the best and brightest to make it into the medical field, at some point one needs to weed out the poorer performers, and perhaps identify any potential superstars in the population. But there are only so many times you can nix the bottom 10 percent before it gets very, very hard to identify anybody left in the pool who isn’t competent (if not brilliant) at his job. Attempts to do so become more and more seemingly random, and confidence-crushing, to the professionals who have thus far leapt every hurdle and traversed every hoop presented to them.

Maybe, at that advanced stage of experience and expertise, they’ve earned the right to walk out of an exam feeling good about themselves again.