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Allowing Resources During the Certification Examination

Allowing Resources During the Certification Examination To the Editor: In their Commentary on the American Board of Internal Medicine (ABIM) Maintenance of Certification examination, Drs Lipner and Lucey1 addressed the issue of whether the test should be changed to an open-book format or kept in its current closed-book status. They stated that the “ABIM's examinations are purposely designed to test cognitive processing, not factual recall, because cognitive errors result more commonly from inappropriate processing of clinical information than from inadequate knowledge.” If the ABIM wants to test cognitive processing rather than factual recall, they should make their examinations open book. An open-book examination eliminates the need for rote memorization and simulates the actual working environment of a physician, which should afford easy access to reference materials. I would argue that it is a lazy and dangerous habit for physicians to rely on memorized facts rather than look them up to verify their accuracy. Closed-book examinations encourage memorization and reinforce the bad habit of relying on the infallibility of memory rather than on reference materials. I disagree with the authors' objection that “an open-book examination that allows access to the entire Web is not feasible in a secure environment.” Internet filters can selectively allow the test taker to have access to the full spectrum of medical reference Web sites that are used in actual practice while blocking contact with outside persons or sites that would assist the test taker in cheating. There is no need for “choosing one product as the designated examination resource [which] would disadvantage physicians unfamiliar with that resource.” Each physician could have full access to the intellectual tools he or she actually uses in daily practice, providing a more accurate measure of how well that physician practices in the real world. Also, I would like the authors to explain their assertion that “open-book examination procedures are most advantageous when the questions focus on factual recall.” It seems tautological that if the purpose is to test factual recall, then that purpose is best served by a closed-book examination. It seems that the best way to assess cognitive processing and eliminate factual recall as a factor is to allow test takers full access to their accustomed medical references during the secure examination. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Lipner RS, Lucey CR. Putting the secure examination to the test. JAMA. 2010;304(12):1379-138020858883PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Allowing Resources During the Certification Examination

JAMA , Volume 305 (1) – Jan 5, 2011

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Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2010.1890
Publisher site
See Article on Publisher Site

Abstract

To the Editor: In their Commentary on the American Board of Internal Medicine (ABIM) Maintenance of Certification examination, Drs Lipner and Lucey1 addressed the issue of whether the test should be changed to an open-book format or kept in its current closed-book status. They stated that the “ABIM's examinations are purposely designed to test cognitive processing, not factual recall, because cognitive errors result more commonly from inappropriate processing of clinical information than from inadequate knowledge.” If the ABIM wants to test cognitive processing rather than factual recall, they should make their examinations open book. An open-book examination eliminates the need for rote memorization and simulates the actual working environment of a physician, which should afford easy access to reference materials. I would argue that it is a lazy and dangerous habit for physicians to rely on memorized facts rather than look them up to verify their accuracy. Closed-book examinations encourage memorization and reinforce the bad habit of relying on the infallibility of memory rather than on reference materials. I disagree with the authors' objection that “an open-book examination that allows access to the entire Web is not feasible in a secure environment.” Internet filters can selectively allow the test taker to have access to the full spectrum of medical reference Web sites that are used in actual practice while blocking contact with outside persons or sites that would assist the test taker in cheating. There is no need for “choosing one product as the designated examination resource [which] would disadvantage physicians unfamiliar with that resource.” Each physician could have full access to the intellectual tools he or she actually uses in daily practice, providing a more accurate measure of how well that physician practices in the real world. Also, I would like the authors to explain their assertion that “open-book examination procedures are most advantageous when the questions focus on factual recall.” It seems tautological that if the purpose is to test factual recall, then that purpose is best served by a closed-book examination. It seems that the best way to assess cognitive processing and eliminate factual recall as a factor is to allow test takers full access to their accustomed medical references during the secure examination. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Lipner RS, Lucey CR. Putting the secure examination to the test. JAMA. 2010;304(12):1379-138020858883PubMedGoogle ScholarCrossref

Journal

JAMAAmerican Medical Association

Published: Jan 5, 2011

References