When I was interviewing this year, I spoke with a few attendings at various programs who are on the board of the ABA/intimately involved with developing the basic exam. They said that the purpose of the new exam was to help identify weaknesses early on in residency. Without prompting, one or two of them flat out said that if a resident fails the basic exam they would likely be fired, so I guess you can only work on your weaknesses if you don't outright fail it...
I just don't buy this reasoning at all.
IT'S ALL BECAUSE OF MONEY!!!!
They simply SPLIT the written examination's content into two exams now. Over the course of the three years they are now going to be earning
DOUBLE for testing residents on the EXACT same content they were previously.
The material and format have not changed. They have just turned the previous exam into the Written Parts 1 and 2.
Some thoughts....
If you read the newsletter, the ABA grants an UNLIMITED amount of times to take any exam with the caveat that you have to complete certification requirements within SEVEN years of graduating residency. I repeat...SEVEN YEARS. This was a recent change as well. Previously (as of three or four years ago) you had three attempts at the written or oral exam and if you failed your third attempt, you essentially had to start over. It appears the ABA felt that this was too harsh, so now they adopted the unlimited attempts at exams and complete certification requirements within seven years from graduating residency. With the beleif that you pass the BASIC after CA1 year, this means you have SEVEN years to pass two exams. That now is what the ABA beleives to be reasonable.
So a dude could fail the ADVANCED (written part 2 at end of CA3 year) five times, pass on his sixth, then pass the APPLIED on his first attempt, and be considered a board certified anesthesiologist.
...But you are telling me that the reason for the BASIC is to identify which residents are weak after CA1 year, and could possibly be terminated after a failed attempt or two??????????
...Does not make sense.
...I will tell you the reason and the reality.
The reason for the BASIC is mo' money. Plain and simple. Any reasoning for improved education, avoidance of cramming, encouragement of three year long studying, is all window dressing. All you have to do is look at the facts.
The ABA felt the previous restrictions on certification were too harsh--three strikes and you're out?? Ouch. Imagine you failed your orals twice--people here have failed the oral twice (just look at the most recent thread)--can you imagine going to oral for a third time knowing that if you don't pass (remember you have a job and are like 3-4 years out of residency), you have to .... START OVER (maybe even do another year in residency??). Ouch!! ABA thought that was harsh. New system is more lenient. Take the tests as many times as you want (one test per calendar year), but you gotta get it done within seven years of residency, otherwise you gotta re-apply for certification (and I don't think you have to go back to a year of residency anymore).
So since they obviously are trying to be more lenient in the certification process, you are telling me that the ABA wants this BASIC examination early to fire people early on??? That is a complete contradiction from their most recent rule change in allowing unlimited attempts. So again the reason is money. Another fact--The original written exam is just split now into two exams!! It's not like there is a written and a skilled exam early. They just divided the traditional written content into two parts.
In radiology there are three exams for board certification. These are taken during residency. You have a physics board, a written board, and an oral board. The physics board is taken after your PGY2 year i believe. Anyway, when I heard this, I just thought that was interesting because our boards are all after residency. I also thought that someday the ABA would say we have to pass a pharmacology board after CA1 year. Why? Because they can. It would be tough to argue. Anesthesiologists should know their pharm. It would also be a source of extra income for the ABA. And guess what. That's what they did.
The reality. In the newsletter they are clear on what failure of the BASIC exam will mean. If resident fails in July, they can take it in January. If they fail in January that resident will require to receive an unsatisfactory report for medical knowledge in their residency report. If they fail a third time, they require an additional six months of training. From there on, the resident will require an additional six months of training for every subsequent failure of the BASIC.
THE REAL REALITY. Program directors can fire residents. Failure of the BASIC will be ammunition to FIRE a resident. Why do I know this? Because I know some residencies fire residents for not doing well on the ITE's.
I am not saying all programs will do this, but it gives ammuntion to some.
What I see most likely occurring is that if you fail the BASIC a second time, some programs will fire that resident based on their belief that the resident is lacking in medical competence, but this will not be in accordance with what the ABA says. Furthermore, being fired from anesthesiology residency for failing the BASIC twice is going to make it extremely difficult for you to get back into an anesthesiology residency and ever get board certified. Yet if you pass the BASIC and graduate residency, you could fail the ADVANCED and APPLIED multiple times within seven years and the ABA says that is OK.
So the reality is the ABA still feels it is OK to fail the BASIC a few times, but there needs to be some punishments if you are failing it multiple time. The real REALITY is that residencies are likely not going to tolerate multiple failures and FIRE you (not what the ABA recommends based on the newsletter), and then it will be very difficult to enter a new residency and become board certified
