I could potentially see a program using a PRITE score in judging a resident, but I'm sure that resident's overall performance would be seen as much more important than a PRITE. Many faculty I've seen also believe the test is not worth much. For you medstudents and residents, a faculty member is going to think a heck of a lot more of you if you do good work in real practice vs. a PRITE score.
This is unfortunate. Very unfortunate.
As was my opinion until I actually took the real oral board exam. That exam is highly subjective, and a lot of really depends on the person they randomly grab for you to interview. While testers are allegedly told to allow more for room when there's a bad evaluee for the test taker, it's very highly subjective. According to the book
Boarding Time, there isn't much data showing the oral board exam actually separates the wheat from the chaff, nor is there any good data as to the validity and reliability of such a highly subjective test that doesn't use standardized evaluees.
By the way, I passed the second time I took it. The first time I took it, I got a guy who pretty much wouldn't talk to me at all. When a guy refuses to talk to you, just how can you give the guy an Axis I diagnosis? If there was a way to pass that, I would've liked to have known because I failed it that time and don't know what could've been done more than what I did.
And factor in that each oral board exam costs the test taker about $1500, and you have to possibly lose a few days at work, possibly pay for an airplane ticket and hotel stay. Altogether, it's not unrealistic to pay literally a few thousand of dollars for an experience that due to the lack of validity and reliability, puts the test taker in an unacceptable range of getting an unfair grade. While many attendings can afford a few thousand dollars, factor in that some attendings had to take this exam multiple times on the over of more than 5, and that such a financial hit for a resident is harder to endure.
That's a heck of a lot of money to pay for an exam that's not been proven to really test what it's supposed to do. I'd go as far as to say the test is on the order if possibly even unethical and fraudulent given the high level of subjectivity and lack of data to prove it's worthwhile. While no one puts a gun to your head to take it, being board-certified is becoming a standard in many areas that is required in order to be on insurance panels and many higher institutions. Most people I know would flip-out if they had a pay thousands for something that wasn't proven to be effective, and if they didn't do it, they could face professional limitations.
Personally, IMHO, the best way they could've handled this was to have standardized test subjects such as patient actors, the patient actors would've been given one of several possible but highly studied scenarios (e.g. depression, anxiety, etc.) and the test takers would have to grade based on an objective scale, not a completely subjective one. This would add validity and reliability to the test. While such an endeavor would be a lot of work to implement, for the amount of money they make you pay, it could've and should've been done. We're talking a process that must draw in millions of dollars a year. A similar process has already been added to the medical student curriculum.
And I'll also add, (in my attempt to be conciliatory) that I've known several oral board examiners and they are nice people who want everyone to pass. But still, the bottom line is despite this, this exam from what I've read from Boarding Time doesn't justify the cost and limitations of not being board-certified. In total, I see the oral board exam as an archaic and outdated measure of someone's psychiatric ability more on the order of a fraternal type of induction ritual than having actual practical value, similar to the philosophy that residents must be psychologically abused because the older generations also were and the current generation enjoys doing it, and it was about time they dropped it. I just happened to be on the unfortunate last few classes that had to take it.
I'd gladly rescind my accusations if someone were to show me some hard data as to validity and reliability to the oral exam.
I have observed a few "clinical skills evaluations" in my program and, in my opinion, the interviews have been sloppy and the case presentations have been woefully deficient. Nevertheless, because the evaluators want their residents to do well (after all, (1) they're the faculty of the residents being tested and (2) passing Boards scores make the program look good), they've been given passing scores with "suggestions as to what to do differently next time."
And I agree with you there, but I'd rather have that than have to pay about $2500 for an exam (including the travel, food, and lodge) that was not fair to begin with. IMHO the better approach is the one I mentioned. Continue an oral exam, make it so that it separates the wheat from the chaff so that those that are board-certified are of a much better standing to be determined of highly quality. I've said this before. Psychiatrists don't know statistics anywhere near as well as psychologists as a whole, and the oral board exam proves it. Psychologists in general would demand far better testing measures.
