An every ten year ritual, starting about four years ago with open book self-tests and this horrid thing called a Practice Improvement Module that started out as a legitimate assessment of how well or poorly I communicate with referring physicians but morphed into a series of complex work flow diagrams when my two secretaries and I were the only ones there to do work. And now the exam. The patients in my practice modules and on the last two exams don't resemble what I actually see most days. I do not think I've ever seen a Fragile X Syndrome or a McCune-Albright "coast of Maine" cafe-au-lait spot. I've been studying from practice exams written by various professors whose biases can be detected from the questions but at least I can extract the principles that I am expected to know from the questions. Did well with the diabetic questions, stunningly poorly with the adrenal questions and somewhere in-between with the reproductive questions.
This is big business. I paid about $1000 to enroll in the program, $120 for the review book published by the Endocrine Society, and the outlay for the review course will set Mercy Hospital back most of my contracted Continuing Education allotment. The pass rate for Endocrinology is reported at 77%, the lowest of any specialty.
To be fair the American Board of Internal Medicine which sponsors this, it has moved ahead of the fraternity hazing of ten years ago. There is legitimate educational content to the practice sessions, the people I've dealt with by phone have been responsive and professional, the Old Boys have been retired and replaced by a CEO from the American College of Physicians who at least has a sense that an annoying process needs to have some off-setting benefit. Still the exam looms a month away as I continue to struggle with the review book and head off to the intensive review course in Cleveland in a few days.