Advice for Physicians Preparing for Maintenance of Certification

June 7, 2013

Many have debated maintenance of certification, but I think reviewing and refreshing ourselves allows us to be well-rounded physicians.

I finished residency almost 10 years ago. At that time, I was eager to enter my solo family medicine practice in my hometown in rural, southwestern Virginia. I had just completed a very rigorous residency program. My program was unopposed, and with the exception of the surgery residents in our hospital, the family practice residents ran the pediatrics, OB/GYN, and internal medicine services. When I trained, there were no weekly time limits on our participation in clinical activities. The time limits actually started the day after I finished my training. I barely missed it.

When I entered private practice, I was very nervous. With each patient I would see, day to day, I was able to reflect on a particular patient that I had treated in residency. "Read about your patients," was a very famous line from many of my attendings both in medical school and in residency. I completed board certification just after finishing residency and thought I was set to go.

Now 10 years have passed. I found myself with the task of having to take the certification exam, yet again. However, this time it was for re-certification. Needless to say, I was very nervous. Sure, I have been reading about my patients. I easily met the annual CME requirements year after year. I had completed each step of the maintenance of certification process for the American Board of Family Medicine (ABFM), for which my class was the first ones to enter. The question still remained: Had I done enough?

As I started to review and prepare for the upcoming exam, I asked myself numerous times: Had I been studious enough over the past 10 years? Many times I would come home after a hard day's work and simply crash. The daily readings were sometimes completed, but had I read enough? Had I prepared enough for the exam? As I took the re-certification exam, I was able to complete the test fortunately in much less time than what was allocated. As I drove home from the testing center, I was both relieved to have finished it and anxious to get my scores back. Just last week, I was thankful to find out that I had received a passing score.

I used a compilation of different study methods for the exam. In the months before the exam, I would quickly review the pertinent journal articles that related to patients I had encountered during each week. The practice questions on the ABFM website were also very useful. Probably the most useful method was to complete the American Academy of Family Physicians (AAFP) home study review course. I was able to watch review lectures on my iPad while exercising each day. My exam prep seemed to fit in easily with my daily schedule.

In the course of a typical year, many of us will receive advertisements in the mail for board prep courses. There are many online sites available that can prepare you for the exam as well. While I chose only the AAFP prep course, I think any review course would be helpful. For my particular practice, I treat mainly very healthy individuals that are very focused on keeping themselves well. With such a focused patient population, one is not exposed to the varied disease states that you would find during residency training. This is why a board review course is helpful. You are forced to relearn things that you have learned in the past and might not have thought about much during private practice. I have not delivered a baby since 2005 (in our hospital's emergency department while on call), therefore I had to refresh my memory regarding typical obstetrics ante partum and postpartum management. That is just one example to site.

The best advice I can give to a colleague looking to re-certify is to complete your daily reading. I was probably not as vigilant as I should have been over the past 10 years, but the next 10 will definitely be different. Read about disease types that you do not regularly treat on a daily basis. Get a good review course and start it a few years before you are due to re-certify so that the material you once learned can be easily recalled again. Continue to read about your patients. This is the best advice that I can pass along. I regularly teach medical students and residents, and this is my constant reminder to them. Read about your patients.

Many have debated the decision to be board certified, but the process of reviewing and refreshing ourselves regarding things we have once learned, and should not forget, is very helpful for allowing us to be well-rounded physicians. Do not overwhelm yourself with too many methods of review or too many courses. You can easily spend too much money and not be able to focus on the material at hand. The one review course and daily reading worked for me, and I think it will do well for you as well.