This past June, I was invited to observe the oral certification examination being administered by the American Board of Ophthalmology to more than 300 ophthalmologists. The experience gave me a deeper appreciation for what physicians have to do in order to become board certified. And, as a public (non-physician) member of the American Board of Medical Specialties, I feel better equipped to discuss issues related to physician certification.
I learned that the path to certification in ophthalmology is similar to the process used by several other specialty boards: a computerbased qualification examination followed by the oral certification exam.
The oral certification examination lasted three hours. Examinees were assigned to panels of six, along with six examiners and a panel leader. Over three hours examinees rotated through six stations, each covering a different area of ophthalmology (glaucoma, neuroophthalmology, pediatrics, and so forth), and each with a different examiner. Following the session, examiners and the panel leader met to discuss the physicians that they had just examined. The certification decision is based on input from these panels.
Administering the oral examination is no small undertaking, even after the patient management problems have been written, fieldtested, and formatted for the exam. It involved 150 physician examiners, some mentoring first-time examiners, as well as the panel leaders and physicians who provided orientation and training.
Dr. George Bartley, Chief Executive Officer of the American Board of Ophthalmology (ABO) as well as a practicing ophthalmologist, was my host. During one of our conversations he commented that from time to time, ABO leadership reconsiders whether or not the oral exam is worthwhile, as administering it is expensive and the costs fall to ophthalmologists who typically are not yet financially established. In light of my experience, I believe it is.
Why administer an oral exam?
An obvious reason is that it tests different things than the computer-based multiple-choice examination. The qualifying exam requires ophthalmologists to demonstrate that they have the knowledge at their disposal—sometimes called “walking around knowledge”— necessary to practice independently. The oral examination requires ophthalmologists to exercise judgement in applying that knowledge to a variety of patients and conditions.