Cardiac boards [rant]

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Agree with above, standard exam fare. Okay questions, some way out of left field, some with two arguably correct answers, and one of two where I didn’t agree with any of the answers.
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DolphinVA said:
, I can tell you no one agrees on whether ACP or RCP is more effective).
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This question was egregiously bad. Like something a med student would've written after reading one single-center study.

And like others mentioned, multiple people (and the SCA ARC review material) said there would be no TEE on there, yet there was. Not that any of the TEE q's were difficult, just that it's false advertising.

But I'm pretty confident I passed, and I think anyone who has spent any time doing the full scope of cardiovascular anesthesia (and who spends a little time reviewing some of the obscure stuff on the content outline) should easily pass.
 
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One more comment, something I mulled over a bit on the ~90 min drive home from the test center.

I'm operating under the assumption that I passed and will soon have a shiny new board certification to my name. But I feel more and more that this test was just simply unnecessary. In comparison to the other board exams I've taken, at the end of this process I don't feel like I know any more, or that I'm a better doctor.

USMLEs were obvious milestones.

Anesthesia written board - for a while after taking and passing it I really felt like I was at the peak of my (book) knowledge. I was proud to pass.

Anesthesia oral board - as much of an ordeal as it was, all of the practice that went into my preparation actually did make me better at articulating and communicating important things. I was proud to pass.

Advanced PTE exam from NBE - really detailed, comprehensive exam with a deserved reputation for being difficult. I worked hard for a year as a fellow and put in a lot of study and acquired a new, useful skill and accompanying body of knowledge. I was proud to pass.

This exam? I feel like there was very, very little content that really separates the cardiac anesthesiologists from generalists. For example there were a lot of questions on pacemaker and ICD management - stuff that generalists certainly can do, every day. Lots of hemodynamic management questions - answering them, I certainly benefited from my day-to-day experience managing people with sick hearts and bad valves, but nothing really esoteric that generalists can't or don't know.

I feel like all of the non-ACTA-fellowship trained people I know who do basic cardiac anesthesia (CABGs & valves) probably would've done fine on this test, maybe even without any preparation, but especially with a few weeks of focused review of the same materials I used (SCA modules and Kaplan). Maybe they'd have struggled with some of the LVAD or transplant or adult congenital stuff, having rarely/never done it, but maybe not. I don't think passing this exam really sets me apart from them in terms of knowledge or skill set.

But you know what does? TEE does. The NBE certification does. No generalist doing a heart has has ever called me into the room to ask me about pacemakers, or how best to manage a person with mitral stenosis, or how thermodilution cardiac output measurement works. (They wouldn't ask me what some ****ing south Asian herb was, either.) But I do get asked to help with more complex echo assessments.

NBE is the certification I'm proud of. This one ... (assuming I passed and will get it) ... it's akin to the sense of accomplishment I get from mowing the lawn or cleaning the kitchen. Today I completed a chore. And I don't really expect that anyone who knows anything about it will be impressed that I did.
 
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pgg said:
This exam? I feel like there was very, very little content that really separates the cardiac anesthesiologists from generalists.
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Couldn't have said it better myself.

The test proves itself useless by its very content: It only has 200 questions, but many of those questions were wasted on non-specialty topics like statistics, TEE items we are already boarded in, or soft stuff like management and diversity.

Either this test is needed to maintain a minimum level of competency in our field (in which case it'd better be busting at the seams with upper echelon cardiac management), or it's not needed at all. So which is it ABA?
 
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Does anyone know if we can claim cme for the sca university modules? Will it automatically get sent to the aba ?
 
pgg said:
One more comment, something I mulled over a bit on the ~90 min drive home from the test center.

I'm operating under the assumption that I passed and will soon have a shiny new board certification to my name. But I feel more and more that this test was just simply unnecessary. In comparison to the other board exams I've taken, at the end of this process I don't feel like I know any more, or that I'm a better doctor.

USMLEs were obvious milestones.

Anesthesia written board - for a while after taking and passing it I really felt like I was at the peak of my (book) knowledge. I was proud to pass.

Anesthesia oral board - as much of an ordeal as it was, all of the practice that went into my preparation actually did make me better at articulating and communicating important things. I was proud to pass.

Advanced PTE exam from NBE - really detailed, comprehensive exam with a deserved reputation for being difficult. I worked hard for a year as a fellow and put in a lot of study and acquired a new, useful skill and accompanying body of knowledge. I was proud to pass.

This exam? I feel like there was very, very little content that really separates the cardiac anesthesiologists from generalists. For example there were a lot of questions on pacemaker and ICD management - stuff that generalists certainly can do, every day. Lots of hemodynamic management questions - answering them, I certainly benefited from my day-to-day experience managing people with sick hearts and bad valves, but nothing really esoteric that generalists can't or don't know.

I feel like all of the non-ACTA-fellowship trained people I know who do basic cardiac anesthesia (CABGs & valves) probably would've done fine on this test, maybe even without any preparation, but especially with a few weeks of focused review of the same materials I used (SCA modules and Kaplan). Maybe they'd have struggled with some of the LVAD or transplant or adult congenital stuff, having rarely/never done it, but maybe not. I don't think passing this exam really sets me apart from them in terms of knowledge or skill set.

But you know what does? TEE does. The NBE certification does. No generalist doing a heart has has ever called me into the room to ask me about pacemakers, or how best to manage a person with mitral stenosis, or how thermodilution cardiac output measurement works. (They wouldn't ask me what some ****ing south Asian herb was, either.) But I do get asked to help with more complex echo assessments.

NBE is the certification I'm proud of. This one ... (assuming I passed and will get it) ... it's akin to the sense of accomplishment I get from mowing the lawn or cleaning the kitchen. Today I completed a chore. And I don't really expect that anyone who knows anything about it will be impressed that I did.
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Amen Amen. You said it all perfectly.

Admittedly last year during fellowship we had the content outline for this test and that was used to guide the lecture series. So it was tailored to the content of the exam. Reviewing SCA University felt like I was digging to find something I didn't already know from last year (except that dang congenital crap I always forget).

I did barely any studying for this exam. Maybe made it through 1/2 of SCA university and it still felt like most of the test was a slam dunk.
 
spidermann said:
Does anyone know if we can claim cme for the sca university modules? Will it automatically get sent to the aba ?
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That would be a no. Typically, if CME is involved there is verification of hours and some kind of feedback to give.

I forget if this was mentioned, but I think ABA typically gives credit for certification exams. Maybe 10-20 hrs.
 
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spidermann said:
Does anyone know if we can claim cme for the sca university modules? Will it automatically get sent to the aba ?
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No, but it appears you can get 60 hours of CME credit for passing this exam. See this thread:

forums.studentdoctor.net

CME Credit For New ABA Cardiac Board Exam?

I feel a little dirty for signing up for this thing in December, but am looking for silver linings to taking it. AMA will award 60 cat 1 CME hours for passing a board exam for an ABMS member organization. https://edhub.ama-assn.org/pages/applications#direct-credit-info "Initial...
forums.studentdoctor.net forums.studentdoctor.net
 
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There are several places on the ABA website that have the following disclaimer about CME from board exams:

"These credits can NOT be applied to your MOCA cycle, but can be applied for meeting state board requirements."
 
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Additionally, time spent studying for this can be documented for MOCA part 4 credit (self-directed study), if that's still permitted. I think I claimed 10 hrs for studying for CCM boards several years ago. Combined with some M&M / Process Improvement projects that I already had to do, and I never paid for part 4 hours, or had to do a sim center.

So there's one good thing
 
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psychbender said:
Additionally, time spent studying for this can be documented for MOCA part 4 credit (self-directed study), if that's still permitted. I think I claimed 10 hrs for studying for CCM boards several years ago. Combined with some M&M / Process Improvement projects that I already had to do, and I never paid for part 4 hours, or had to do a sim center.

So there's one good thing
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This would probably count under the following category, right? I guess if I get audited I just tell them I spent time studying, and actually up to 15 hours can be claimed...


"Point-of-care learning – Self-directed knowledge acquired during patient care (i.e.., researching cases and outcomes) "
 
spidermann said:
This would probably count under the following category, right? I guess if I get audited I just tell them I spent time studying, and actually up to 15 hours can be claimed...


"Point-of-care learning – Self-directed knowledge acquired during patient care (i.e.., researching cases and outcomes) "
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Yep, that's the one! I couldn't Geneve what it was called.
 
GassYous said:
It's funny because 30 years ago you just did your 2 years of residency and went straight into practice doing everything but now with 3 years of residency and a year of fellowship you are still required to jump through multiple hoops, pay thousands of dollars for everything from examinations to state licenses, then you need to spend a lot of time and go through so much heartache just to be able to do your job.
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We have a split camp in our cardiac group. A quarter grandfathered in, a quarter fellowship trained but in the very early echo days and the rest recent grads from high volume centre's.


There is absolutely no doubt who is who, no doubt who the surgeons want to do their cases and even less doubt about patient outcomes...
 
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PpfSuxTube said:
We have a split camp in our cardiac group. A quarter grandfathered in, a quarter fellowship trained but in the very early echo days and the rest recent grads from high volume centre's.


There is absolutely no doubt who is who, no doubt who the surgeons want to do their cases and even less doubt about patient outcomes...
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Interesting. Is this PP or academics? Does this actually impact anything?
 
BlueRug said:
Interesting. Is this PP or academics? Does this actually impact anything?
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Pp.
If anything it impacts us new guys negatively. Our Grandads often get the easier cases, and if they do get a double valve for example call us in to help them do the echo aka basically do the case, while they get paid...

Most of them are good guys and try make it up in other ways but some do use it to their advantage to do as little as possible...

Very rarely we'll have to take over when they're murdering someone...

I can't wait for them to go honestly, I'm done with the situation. It's the only frustrating thing about my otherwise amazing job and group.


It's extraordinarily frustrating to watch a colleague screw up

For example rsi a tamponade deliberately...this was just 10 dsys ago... it worked out OK, as I got them to run the levo peripherally at least but still it wasn't pleasant.

When they cover our csicu, our patients lose days in their recovery. Fluid overload missed, sepsis untreated, generous benzos, sometimes much much worse
 
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PpfSuxTube said:
Pp.
If anything it impacts us new guys negatively. Our Grandads often get the easier cases, and if they do get a double valve for example call us in to help them do the echo aka basically do the case, while they get paid...

Most of them are good guys and try make it up in other ways but some do use it to their advantage to do as little as possible...

Very rarely we'll have to take over when they're murdering someone...

I can't wait for them to go honestly, I'm done with the situation. It's the only frustrating thing about my otherwise amazing job and group.


It's extraordinarily frustrating to watch a colleague screw up

For example rsi a tamponade deliberately...this was just 10 dsys ago... it worked out OK, as I got them to run the levo peripherally at least but still it wasn't pleasant.

When they cover our csicu, our patients lose days in their recovery. Fluid overload missed, sepsis untreated, generous benzos, sometimes much much worse
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This was happening in my group. Fellowship trained ppl were being pulled from their rooms to help the old guys do TEE. Your surgeons need to advocate for you and complain to med staff. It’s a matter of patient safety. Got rid of them granddaddies real quick.
 
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spidermann said:
This was happening in my group. Fellowship trained ppl were being pulled from their rooms to help the old guys do TEE. Your surgeons need to advocate for you and complain to med staff. It’s a matter of patient safety. Got rid of them granddaddies real quick.
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There's a paper trail years long at this stage... but nada unfortunately... 2 more years for the worst offender he has hinted until his retirement...

Some of the others have been allowed to go part time which unfortunately has given them a whole new lease of life... there might be another 5 years left in them...

It's crazy... we're about 2000 open chest cases per year and at times the surgeon will have to do MVR at night on a sick endocarditis without tee. Just last week. Same night someone had to go on ecmo, again no tee...
 
PpfSuxTube said:
...

It's crazy... we're about 2000 open chest cases per year and at times the surgeon will have to do MVR at night on a sick endocarditis without tee. Just last week. Same night someone had to go on ecmo, again no tee...
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That's fckin wild, especially for being a tertiary center with volume that high.

Also, I'm annoyed by the fact that old farts like that immediately cast suspicion and doubt on folks like myself who are not fellowship trained but who have put serious, serious effort into mastering echo and cardiac anesthesia.
 
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vector2 said:
That's fckin wild, especially for being a tertiary center with volume that high.

Also, I'm annoyed by the fact that old farts like that immediately cast suspicion and doubt on folks like myself who are not fellowship trained but who have put serious, serious effort into mastering echo and cardiac anesthesia.
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And yet, they also get an absolute free pass to be boarded, if they ever bother to learn echo.
 
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Lol board certified in cardiac anesthesia but can barely turn the TEE machine on .

It’s also painfully obvious in my small group who the recent grads are vs the dinosaurs .
 
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PpfSuxTube said:
We have a split camp in our cardiac group. A quarter grandfathered in, a quarter fellowship trained but in the very early echo days and the rest recent grads from high volume centre's.


There is absolutely no doubt who is who, no doubt who the surgeons want to do their cases and even less doubt about patient outcomes...
Click to expand...
Two thoughts:

1) do you have a Cardiac Medical Director? If so, empower them to select who can do hearts. It shouldn’t be a case of “I want to do this”. If they never did fellowship, or certified in TEE, then only thing separating them from a current new grad is years of experience. That doesn’t sound sufficient from your descriptions.

2) can you rewrite the DOPs to mandate fellowship, or advanced PTE cert?
 
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PpfSuxTube said:
There's a paper trail years long at this stage... but nada unfortunately... 2 more years for the worst offender he has hinted until his retirement...

Some of the others have been allowed to go part time which unfortunately has given them a whole new lease of life... there might be another 5 years left in them...

It's crazy... we're about 2000 open chest cases per year and at times the surgeon will have to do MVR at night on a sick endocarditis without tee. Just last week. Same night someone had to go on ecmo, again no tee...
Click to expand...
Wow the surgeons put up with this? The admin doesn’t know? The cost to the patients and system must be significant to say the least…

With 2000 cases a year too? No transplant or LVADs?
 
I'm told tomorrow we should get results. Friend called them the other day. Who knows though.
 
vector2 said:
ABA says portal not gonna be back up til tomorrow so no result presumably til then either
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Yeah, I called as well today and the lady told me "6-8 weeks" despite the fact that the exam at the end said 4-6 weeks and even gave me a printout saying as much (and this Saturday is 6 weeks).
 
Looks like the portal is up but results are not out yet… I went ahead and payed to start my MOCA minute questions for the year before they add an extra $100 for another certification.
 
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Neosynephrine said:
Looks like the portal is up but results are not out yet… I went ahead and payed to start my MOCA minute questions for the year before they add an extra $100 for another certification.
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Presumably the hefty exam fee would cover the subspecialty certification fee for the first year?
 
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EBTrailRunner said:
Presumably the hefty exam fee would cover the subspecialty certification fee for the first year?
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My thoughts exactly. This was the case for ABA cert.

On a separate note. EBTrailRunner, what area of the country are you in? As a fellow (amateur) trail runner, just curious if we'd be close enough to cross paths. Ultras?
 
I'm pretty sure I remember paying the extra $100 MOCA fee for critical care after passing the boards..
 
I’m curious why it’s taking so long to grade, couldn’t be that many people who took it. I mean there are only ten’s of us.
 
0kazak1 said:
I’m curious why it’s taking so long to grade, couldn’t be that many people who took it. I mean there are only ten’s of us.
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The stock line is always some nebulous answer about how they have to go over all the test questions again and look at the correct vs. incorrect rate for "quality control" purposes blah blah
 
0kazak1 said:
I’m curious why it’s taking so long to grade, couldn’t be that many people who took it. I mean there are only ten’s of us.
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Probably figuring out how to set the curve with the least tokenism.
 
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0kazak1 said:
I’m curious why it’s taking so long to grade, couldn’t be that many people who took it. I mean there are only ten’s of us.
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1704856592297.gif
 
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EBTrailRunner said:
Presumably the hefty exam fee would cover the subspecialty certification fee for the first year?
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I spoke with the Aba this am and they confirmed there would be no extra MOCA fee for maintaining cardiac board certification for this year and that the increased fee to maintain the cardiac cert starts next year.

The person I spoke to also did not know when the results were supposed to come in. At first she said up to eight weeks but then acknowledged that cardiac was supposed to be 4-6. I guess we find out when we find out
 
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instrumentrearwindow said:
The person I spoke to also did not know when the results were supposed to come in. At first she said up to eight weeks but then acknowledged that cardiac was supposed to be 4-6. I guess we find out when we find out
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I think more of us need to call the ABA. I mean you tell a group of Type A people 4-6 weeks and we’ll expect 4-6weeks. 6 weeks is this Saturday I believe.
 
Shouldn't the results for any multiple choice exam be able to be released within 1-2 weeks? The exam dates are known well in advance. All the analysis of the results can be done by software that will flag questions for review. The committee just needs to schedule a virtual meeting for the week after the test is done being administered to review the data and set the curve or cut off line for pass/fail. Seems pretty simple.

If anyone has insights into why that isn't the case, please feel free to enlighten me.
 
mysideofthedrape said:
Shouldn't the results for any multiple choice exam be able to be released within 1-2 weeks? The exam dates are known well in advance. All the analysis of the results can be done by software that will flag questions for review. The committee just needs to schedule a virtual meeting for the week after the test is done being administered to review the data and set the curve or cut off line for pass/fail. Seems pretty simple.

If anyone has insights into why that isn't the case, please feel free to enlighten me.
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I’m guessing that is what they are doing now, and for efficiency are rolling their work into MOCA for the future as well.
 
www.beckersphysicianleadership.com

5 key numbers on the anesthesiologist shortage

"Discover the latest numbers on the ongoing anesthesia shortages and their impact on physician leaders, including a predicted shortage of 12,500 anesthesiologis
www.beckersphysicianleadership.com www.beckersphysicianleadership.com


How it should be….

“ASCs are struggling to afford to pay anesthesiologists as costs soar. "Anesthesia used to be a seemingly unlimited commodity," Jeff Dottl, principal at Ventura, Calif.-based Physicians Surgery Centers, told Becker's. "They were lucky to be invited to work at your surgery center. The tables have turned, and now if centers have anyone to cover anesthesia, it usually comes at a hefty price."
 
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mysideofthedrape said:
Shouldn't the results for any multiple choice exam be able to be released within 1-2 weeks? The exam dates are known well in advance. All the analysis of the results can be done by software that will flag questions for review. The committee just needs to schedule a virtual meeting for the week after the test is done being administered to review the data and set the curve or cut off line for pass/fail. Seems pretty simple.

If anyone has insights into why that isn't the case, please feel free to enlighten me.
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This group took 2+ years to put together those 200 questions. A task that I'd bet the users on this thread could collectively accomplish by the end of this weekend, with better questions. It's amateur hour and we may be waiting a while.
 
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They have no competition and there are no consequences for doing it late, or poorly. We're a captive audience.

In their defense, the people doing this work mostly have day jobs and aren't full-time ABA minions, so slowness is to be expected. I imagine there are nontrivial scheduling hurdles to getting them all together to work. If working remotely, there will endless rounds of asynchronous discussion. They're probably doing their best at a job they do at least partly out of a sense of duty, or to check boxes on some dumb academic promotion track/game.

The regular MOCA questions have improved dramatically since the first year. They were truly awful the first 5 or 6 quarters.

(This isn't my endorsement of MOCA or this exam, just that I think the worker bees implementing policy are acting on good faith.)
 
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So ACA is MOCA?

I do appreciate not having to take a recertification exam, but now I’m MOC’ing 3 certifications between Anes, tee, and ACA.

I’ll bet within 2 years I’m MOC’ing BLS/ACLS
 
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