Cramming


It’s one of the things I do best,

And better if I feel pressed.

I know how to cram

For any exam.

I good at taking a test.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

I picked up really good study skills in high school, but the teachers emphasized teaching us to work under pressure.  After a few years of learning how to deal with surprise quizzes and papers, I learned that I could acquire a great deal of information in a short period of time and remember until the test. 

Some people, including my wife, assert I don’t forget anything I learn.  I wish I could agree.  But I can remember the standardized test I took in first grade that diagnosed me as mildly retarded. 

An undergraduate psychology course taught us that effective learning depended on motivation, and motivation to a certain extent depends on stress, but every person had an optimal level for the stress.

I’ve been taking tests now for more than half a century, and, judging from results, I’ve gotten good at what I do.  I’ve learned how much stress I need to learn effectively, and I know how to get to that level and stay there for as long as it takes.

If a doctor wants to call him or herself board-certified, he or she has to take Continuing Medical Education courses, generally 50 hours a year, and periodically pass an examination.  The American Board of Family Medicine has a 10 year track, which I bypassed in favor of the 7 year track.

Currently I spend about 4 hours a day cramming for my Boards, coming up on November 8.  Because of scheduling, I missed the Board Review lecture course in Kansas City a few weeks ago, and I ordered the American Academy of Family Practice’s online materials.  Things have changed in the last seven years.

Evidence Based Medicine (EBM) has taken over the test questions.  The Strength Of Recommendation Taxonomy (SORT) now rules.  SORT-A comes from high quality, double-blind, placebo-controlled, randomized prospective studies.  Fewer or lower quality studies get a SORT-B rating. 

Consensus opinions, SORT-C, based on expert panels, does not come from data; like as not the opinions come down to That’s The Way We’ve Always Done It.  The youngest doctor in the family calls those recommendations BOGSAT, for Bunch Of Guys Sitting Around a Table.  Regretfully, most of what we do comes from SORT-C.

The AAFP’s course has 38 half-hour lectures with 15 minutes of practice questions.  The format lets me work at my pace, hit the repeat button as often as I need, and start work early in the morning.

On average, one of my sacred cows ends up slaughtered before the end of the lecture.  I no longer will scrub lacerations with Betadine, nor apply Silvadene to burns. 

I understand the need to keep current, and most years I get more than 200 hours of CME.  I appreciate the update information that I can access 24/7, and I grudgingly enjoy taking tests as long as I do well on them. 

But one of the prime qualities of a good doctor remains listening, and to this day we have no way to measure it.

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4 Responses to “Cramming”

  1. CompHealth Physician Says:

    Would you say that cramming 4 hours a day is more/less/equal to your counterparts? With 200 hours of CME I would expect you to be more up to date than most other physicians.

    • walkaboutdoc Says:

      Cramming 4 hours a day in the course of several weeks gives me the same number of hours as a standard board review course, but I find that spreading the information out over time makes it more enjoyable. Learning theory would also say that it’s more retainable.

  2. Richard Thompson DO Says:

    “one of the prime qualities of a good doctor remains listening”.
    Indeed; also relating.
    I have gone from doctor to patient in the past year, and have experienced a wide spectrum of physician care.
    There is no disguise for those who trade caring for commerce.

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