Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The art of medicine cannot be measured by selecting letters on an exam

Amanda Breviu, MD
Education
September 4, 2016
Share
Tweet
Share

You are currently on inpatient wards and notice your chief medical resident has been demonstrating erratic behavior, frequently muttering about MEN syndromes and antibodies associated with rheumatologic diseases and has been reciting gene translocations. What is the most likely cause of her symptoms?

A. Hospital-associated delirium
B. Conversion disorder
C. Symptoms related to completing an excess number of multiple choice questions in preparation for taking internal medicine boards

If you guessed C, you understand what I have been going through in the past several weeks. Although I hope no one actually thought my behavior was erratic, I spent the majority of my free time prior to August 19th preparing for the American Board of Internal Medicine Certification Exam.

And I’m in good company. Recent graduates of internal medicine residencies across the country have also been preparing for and taking this exam in late August, often concurrently with starting their first “real” jobs or completing training with fellowships.  It is a test that you prepare for throughout residency with didactics lectures and annual practice exams (in-training exams). Attendings are constantly preaching important clinical information on rounds, typically using the phrase, “this will definitely be on your boards.” As a chief medical resident, I have found myself spouting board-style questions to start off our morning reports and often using that same phrase to enforce the importance of this information to interns and residents.

Despite the significance of this exam to our training, I can’t help but wonder why this test alone is used as a judge of my capability to be a “board certified” physician. Having recently taken the exam, I believe the content is reasonable, but the truth is that no 240-question, multiple-choice exam can reflect all of the knowledge that is truly required to practice internal medicine. Most medical situations with real patients are not as simple as choosing a single answer.  The clinical decision-making that goes into a case of a patient who is presenting with inconclusive workup is much different than the characteristic cases seen on typical board exams. Most patients don’t present with the keywords or pictures we learn to associate with different diseases. Far beyond knowledge alone, the communication and art of medicine is certainly not measured by selecting letters on an exam.

Admittedly, there is no perfect way to assess this knowledge for physicians today. Now more than ever, we actively rely on resources to look up information that we haven’t memorized and to collaborate across specialties to coordinate care. At the same time, it is appropriate to have some type of standard for a knowledge base that is important for trainees. Despite much criticism (and I haven’t even mentioned the cost!), board exam scores are important for obtaining and keeping positions as well as conveying to the public that we are appropriately trained and certified for our positions. However, I can’t help but wish this assessment of knowledge could be focused on clinical care of actual patients rather than selecting answers to a hypothetical situation on a computer.

I would rather house staff learn how to deal with the reality of clinical uncertainty in medicine than memorize Reynolds’ pentad or how to treat babesiosis. I would rather have patients truly trust in residents and understand their explanations of the risks and benefits of anticoagulation than have them memorize the coagulation pathway. Despite the reality of standardized tests, I hope to frame knowledge to students and residents as important to the patient care they provide and not simply because “it will be on your boards.” Even with an always looming exam, there is a lot more to medicine than choosing A, B, C, or D.

Amanda Breviu is an internal medicine chief resident who blogs at Insights on Residency Training, a part of NEJM Journal Watch.

Image credit: Shutterstock.com

Prev

The subtle arrogance of good health

September 4, 2016 Kevin 3
…
Next

Is burnout inevitable during medical training?

September 5, 2016 Kevin 17
…

Tagged as: Primary Care

Post navigation

< Previous Post
The subtle arrogance of good health
Next Post >
Is burnout inevitable during medical training?

ADVERTISEMENT

More by Amanda Breviu, MD

  • A dying patient stirs up personal memories for this doctor

    Amanda Breviu, MD

Related Posts

  • The art of medicine: a patient’s perspective

    Michele Luckenbaugh
  • Can technology and the art of medicine coexist?

    Lianne Marks, MD
  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • The art of medicine is slowly being pushed out. Is that a good thing?

    Steven Zhang, MD
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD
  • KevinMD at the Richmond Academy of Medicine

    Kevin Pho, MD

More in Education

  • How Filipino cultural values shape silence around mental health

    Victor Fu and Charmaigne Lopez
  • Why leadership training in medicine needs to start with self-awareness

    Amelie Oshikoya, MD, MHA
  • Learning medicine in the age of AI: Why future doctors need digital fluency

    Kelly D. França
  • Why health care must adopt a harm reduction model

    Dylan Angle
  • Gen Z’s DIY approach to health care

    Amanda Heidemann, MD
  • What street medicine taught me about healing

    Alina Kang
  • Most Popular

  • Past Week

    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • Physician practice ownership: risks, rewards, and reality

      Paul Morton, CFP | Finance
    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast
    • Unity in primary care: Why I believe physicians and NPs/PAs must work together toward the same goal

      Jerina Gani, MD, MPH | Physician
    • My improbable survival of stage 4 cancer

      Kelly Curtin-Hallinan, DO | Conditions
    • How Filipino cultural values shape silence around mental health

      Victor Fu and Charmaigne Lopez | Education
    • Why leadership training in medicine needs to start with self-awareness

      Amelie Oshikoya, MD, MHA | Education
    • Federal shakeup of vaccine policy and the battle for public trust [PODCAST]

      American College of Physicians & The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 11 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • Physician practice ownership: risks, rewards, and reality

      Paul Morton, CFP | Finance
    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast
    • Unity in primary care: Why I believe physicians and NPs/PAs must work together toward the same goal

      Jerina Gani, MD, MPH | Physician
    • My improbable survival of stage 4 cancer

      Kelly Curtin-Hallinan, DO | Conditions
    • How Filipino cultural values shape silence around mental health

      Victor Fu and Charmaigne Lopez | Education
    • Why leadership training in medicine needs to start with self-awareness

      Amelie Oshikoya, MD, MHA | Education
    • Federal shakeup of vaccine policy and the battle for public trust [PODCAST]

      American College of Physicians & The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The art of medicine cannot be measured by selecting letters on an exam
11 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...