Psychiatr News May 19, 2006
Volume 41, Number 10, page 11
© 2006 American Psychiatric Association
No Sugar Coating Allowed In Board Feedback Program
Mark Moran
Time since graduation from residency and the length of time in
outpatient rotations appear to correlate with poor performance on an APA
diagnostic test to help psychiatrists who have failed Part II of the ABPN
board exam multiple times.
Brutal honesty and candid assessment—that's the best advice for
training directors and faculty providing feedback to psychiatrists preparing
for the oral board exam of the American Board of Psychiatry and Neurology
(ABPN).
And it's especially important for psychiatrists who may have already failed
the exam multiple times, said Nyapati Rao, M.D., past chair of the APA Council
on Medical Education and a professor and director of residency training at
SUNY Downstate Medical Center in Brooklyn, N.Y.
At the recent meeting of the American Association of Directors of
Psychiatric Residency Training (AADPRT) in San Diego, Rao offered an overview
of lessons learned from APA's Diagnostic Evaluation Project to Assist ABPN
Recidivists. This project was designed to help candidates who have failed the
oral exam at least three times.
Through the project candidates have the opportunity to take an oral test
similar to that offered in the board certification exam—including a live
patient interview and oral presentation—in front of
"examiners" who have served as examiners for the real thing.
Data from the ABPN have indicated that the failure rate on the Part II oral
exam rate is high—as much as 50 percent. And it appears that candidates
who fail the exam more than once are at high risk of failing it multiple times
(Psychiatric News, September 2, 2005).
"My interviewers for the live patient were brutal, which is where
I needed the `hold no punches feedback.' "
APA's project has held two diagnostic sessions with candidates, one in 2004
and 2005. Rao told Psychiatric News that of the 24 candidates who
have taken the diagnostic exam, 15 have gone on to pass the ABPN
examination.
Candidates taking the APA diagnostic program are told whether they pass or
fail and—most importantly—if they fail, they are told why. The APA
program does not include remediation strategies, but candidates are encouraged
to use the information that examiners give them to prepare for the real
certification examination.
The advice that candidates taking the APA test are given is
unvarnished.
"Candidates who fail the board exam tell us that they often go to a
colleague and ask for a critique of their performance on a practice
exam," Rao told Psychiatric News. "The people they seek
out don't want to criticize a former or current colleague, and unless they
have been board examiners themselves, they may have only limited experience
with the actual conditions of the exam. So they will sit in on a patient
interview and give the candidate feedback that in the end is not very
helpful."
In some cases, candidates have reported taking commercially offered mock
board exams, sometimes costing thousands of dollars, after which the
candidates are typically told that they will have no problem passing the exam,
Rao said.
Not so with APA's practice exam. Faculty examiners for the APA diagnostic
exam are actual ABPN board examiners, and they pull no punches in their
assessment of candidates' performance. Here is testimony from candidates who
took the diagnostic exam and later passed the ABPN exam:
"Despite doing mock boards with people I knew, I think no matter how
poor you may perform, people who know you are not going to tell you what they
really think, and they want to reassure you and decrease your anxiety. Also,
people can reconcile how good a day-to-day clinician you may be, and they find
it difficult to break the news that you are not playing the role of ABPN
psychiatry candidate well. My interviewers for the live patient were brutal,
which is where I needed the `hold no punches feedback.'"
"The examiners were painfully blunt and direct with their feedback to
me.... Despite how hurt I was by the feedback, I left that evening finally
knowing what I had been doing that was getting in the way of passing the
exam."
In a survey of 36 candidates who took the diagnostic exam, APA has sought
to derive correlations between performance on the live patient interview and
video portion of the diagnostic, and background characteristics of the
candidates.
At the AADPRT meeting in San Diego, Rao told training directors that the
strongest predictor of poor performance is the length of time since graduation
from residency. Somewhat less predictably, the length of time spent in an
outpatient rotation also correlates with poor performance—specifically,
the more time spent in outpatient rotation, the more likely it is that the
candidate will perform poorly on the exam. Rao explained that the correlation
appears to reflect the less-intensive supervision that typically occurs in
outpatient rotations.
"In the inpatient setting, supervisors are liable to be sitting with
the trainee and providing close supervision, and the resident is part of a
group support system," he speculated. "But in the outpatient
setting, the trainee only once a week presents a case to a supervisor who may
have little or nothing to do with the clinic."
No diagnostic session is scheduled for 2006, according to Deborah Hales,
M.D., director of APA's Division of Education and Career Development.
"We will be taking a hiatus in 2006, since the Part II exam is
changing this May, and we want this program to reflect the actual exam as
closely as possible. We will review the new exam procedures and incorporate
them into our program for 2007." 
Related Article:
-
New ABPN Executive Sees Big Changes for Board Exam
- Mark Moran
Psychiatr News 2006 41: 10-63.
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