Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Oh, the pain of recertification and MOC points!Aug 1, 2012 22:34 EDT
What happened to the good old days when you opened a textbook, read a few chapters, and then took a board exam? Ten years following my initial cardiology boards, the process was still straightforward. I ordered a CD, popped it into my laptop, studied it, and then took my internal medicine and cardiology recertification at the same setting. I still recall that high-five feeling as I marched out of the testing center both proud and relieved. I knew I was good to go for another 10 years, a date that seemed light-years away, yet here it is. I'm now having an affair with CardioSource every day of my life, while my husband sits neglected and waiting. Where did the past decade go, and why did it take with it the easy read-and-regurgitate approach to testing?
When it comes to computer skills, I'm not the brightest icon on the screen, but I do work part-time on the net. My experience really should count for something, but despite my frequent dalliances with the worldwide web, I am finding the new recertification process daunting. My secretary ordered the study kit online months ago. After procrastinating for weeks, I decided I'd start in February, but I had to wait until March for the new Adult Clinical Cardiology Self-Assessment Program 8 (ACCSAP 8) to be released. The anticipation generated all the excitement needed for the process, but my enthusiasm soon dampened.
I dealt with internet glitches right off the bat, both locally and from the central site. My server went haywire after a violent electrical storm melted my surge protector on my office nuclear camera and shut down my home PC. It crashed my computer without warning, screwed up my wireless, and blasted my connection to the printer. For days I shut down the computer repeatedly and unplugged the little cords that hook into the blue box behind it. After mentally counting one-one thousand, two-one thousand, three-one thousand, etc, I then rebooted. I did this a gazillion times to the point of madness, but my efforts were to no avail. Finally, our eldest daughter's nice boyfriend who came over for a dinner (that I did not cook), bestowed his wonderful geekiness upon my HP and got me back online. Unfortunately, the misery was not over.
I tried all weekend to log on to CardioSource at least eight million times unsuccessfully. After pulling my hair, smushing my face with my hands, slapping myself out of frustration, then going for a walk, I contacted the central office and left a message. That was on Saturday. On Monday morning, a representative called me promptly but could not locate my name anywhere on the site. "How did you get this information without a log-on number?" she asked. After suggesting the very helpful and well-meaning person at the other end check under the "Ws" instead of the "Ss," my information was located. I cursed the day (again) that I took a hyphenated last name, accepted that I deserved this punishment, but was encouraged that I had been revalidated as a human being who actually exists, indeed has a doctorate degree and possesses a magic number with which to log in. An explanation for the glitch is that "they had been working on the site." "Okay," I thought, "fair enough," and so, several weeks and five chapters and a million modules later, chapter 6—"Acute Coronary Syndromes"—awaits me.
Perhaps it's not just the recertification process that is so different. I think it's me. I get up very early several days per week, glide by my dining-room table where I've set up my study nest, punch my computer "on" button, and make a cup of coffee. I locate a pair of readers I started wearing this past year (color-coordinated with my nightshirt, of course). I sit on a travel pillow my daughter brought back from a mission trip to Peru because I have this paresthesia that feels like water running down my left leg from sitting too long—a symptom I definitely did not have 10 years ago. I read voraciously, all the while selfishly hoping my husband and my kids sleep just a little longer. If no one turns on the TV or if the phone doesn't ring, I might reach some imaginary benchmark for the day. I check my progress frequently and do the mental math to see if it's possible to finish the entire process in time to take the spring exam. I fight the temptation to check Facebook, a vortex that certainly sucks another 20 minutes out of anyone's day for no good reason. Sometimes I have steellike concentration that only Superman could rival, and other times, I must read the same paragraph twice. Then, I worry about the Maintenance of Certification (MOC) points.
I have 30 MOC points that magically appeared on my screen, leftovers from an abandoned attempt to read through the general internal-medicine recertification a few years ago. After several catastrophic family illnesses, I finally gave up the effort (temporarily I hope) because it was optional and because cardiology is my priority. I called the American Board of Internal Medicine (ABIM) to see how long MOC points last. "They never go away," the voice said at the other end of the line. "But where are my CMEs?" I asked. "You have to enter those on your own," she said and then attempted to tell me how to do it. I hung up, thanking the person and knowing full well that I still don't know how to enter them or where to enter them, but I'd figure that out later.
And what about those weird practice-improvement MOC points? They are the final 20 or so points needed to make up 100 total in order to sit for the exam, or at least that's my feeble understanding. Those 20 points are part of some crazy requirement to write up some practice-improvement thing, submit it, and then write up how it improved my practice. What the heck? Can I not just read this octopus of a recertification document and go somewhere and take a test? The answer is obviously "no," or I would not be sitting here, writing an extensive whine while I could be reading Dr Sunil Rao's chapter 6 on ACS. (I'm actually looking forward to it.)
But let me not digress from my very rewarding and therapeutic whine. My legs are numb every day after an hour of reading. I'm on raloxifene (Evista, Lilly), so I try to stand and walk. I fear a DVT. My coffee cup is empty too often, so I make more frequent trips to the bathroom. I don't think I made so many pilgrimages to the bathroom 10 years ago. My mind wanders again. I need to call my mom and see if she got dad to take his meds. "Is he being compliant with his BiPap?" I tap myself on my cheek. "Stay on topic. You have to study." My daughter and her boyfriend broke up. My other daughter thinks she might get married. Our local medical politics are in the crapper, and it's time to go the office. I take a 30-minute walk with my whopper 3-lb weights. I jump in the shower and "sleep" my Mac Book so I don't have to chance going through another log in and spending 20 minutes trying to figure that out. I came back that evening only to find my youngest daughter has a "dorm checklist" on the screen; my heart sinks, but luckily she minimized my CardioSource. Thanks, Aaron!
Don't get me wrong; I fully understand the importance of keeping current, keeping up, and constantly seeking to learn something that will help me when I turn the knob on my exam-room door. I'm just a bit frustrated that the current process is so cumbersome. I am grateful for excellent material and the academicians and clinicians who can provide this program for the benefit of my learning process, but the challenge of time management for a mature private-practice cardiologist is where most of us live every day. I fear I won't figure out how to gain those MOC points that don't increase every time I take a chapter test and get CMEs. Furthermore, my anxiety regarding accumulating enough of those MOC points in time is 1000% higher than my fear of taking of the exam.
No matter the depth of my gratitude and admiration for the ACCSAP 8 material, I insist that just reading the information for recertification and then showing up to take an exam is faster, easier, more efficient, and less stressful. Proving one is still worthy of practicing cardiac medicine after 22 years should not be so complicated. My CME credits I earn for reading the material should be credited automatically, and MOC points should be earned from CMEs and practice tests. If we could simplify the recertification process and make it far less painful, I could have a much better day, get on with my life, and then hope the next 10 years pass much more slowly.