Finally Back! With Commentary on Standardized Testing

I apologize for the long hiatus! The primary board certification exam was quite the hurdle and I'm quite relieved to be through with it. The testing center was filled exclusively with anesthesia residents and recent graduates; overhearing conversations, I realized there was a big contingent from UCSF as well. As a five hour test, it wasn't all that bad. Graduate medical education has really gotten into standardized testing, so much that a half day test seems like nothing. The exam itself was pretty much all querying fund of knowledge. But the fund of knowledge required for an anesthesiologist is really broad. Questions ranged from newborn blood gases to geriatric anesthesia, from ICU management of nutrition to mechanisms of action of neuropathic pain medications. There was a lot of subspecialty anesthesia probing complicated neurologic physiology, obstetric disease states, pediatric emergencies, and echocardiography. While all anesthesiologists should be well-versed in such broad topics, the truth is, there are few jobs that engage everything. Ultimately, we only use a subset of our training, but that's probably true in all aspects of medicine. I do think that board certification should mean that an anesthesiologist is competent in all domains of our field, but it's important to recognize that we are testing a broad fund of knowledge which is not necessary for most jobs.

Furthermore, fund of knowledge is not all that important. On tests, it's easy to ask questions about facts. Some questions give a list of congenital anomalies and ask about the syndrome. But for the most part, this is not an important thing to memorize. I can always look it up. It's more important for me to recognize when congenital anomalies might constitute a syndrome so I do look it up. Likewise, in clinical medicine, I rarely need to know the mechanism of action of a drug, and if I did, I'd simply do an Internet search. Instead, board certification should be about testing things which are not easily Googled, where diagnosis or patient management depends on a practitioner's clinical acumen. For example, the signs of malignant hyperthermia, an anesthetic emergency, is a reasonable question because recognizing MH can be challenging, and knowing the manifestations and treatment immediately can lead to quicker patient care. If I ever saw MH, I'd act first, then confirm my decisions by looking it up. It's difficult for a multiple choice test to test clinical judgement, and much of anesthesia is practical, applied, and nuanced. Most decisions I make during a day are not clear-cut or black-and-white. I suppose this is why there is an oral part to the certification exam as well.