Medical Board Exams
In order to qualify for an internship and be granted a license to practice medicine one must go through a series of National Board Examinations. These tests are given in stages that occur at the end of medical school, the end of internship, and again at the end of residency. If a person wants to on to a subspecialty, there is yet another exam at the end of a fellowship. Unlike the Law Boards, which mirror the infinity of legal time and allows a flunky to have an infinite number of second tries, the Medical Boards only allow three strikes.
For example, John Kennedy Junior finally made the Bar after his seventh try, only to discover that practically applied examinations in aircraft Instrument Landing Systems are much less forgiving on a first-time failure. They do not allow for multiple mulligans. Perhaps this accounts for why parole boards are so lenient when they give convicted felons so many second or third opportunities to get out of jail only to again become offenders .This contrasts with a physician’s opportunity that allows only one chance to get the heart attack diagnosis and therapy or the gall bladder surgery done correctly the first time. Personally speaking, I would not want to deal with any attorney or physician who had to take these tests more than once, because if a person fully applies his or herself to the required study time, the tests are incredibly difficult to fail. This makes it a reflection of personal ethical dedication and pride.
Required study time is another issue altogether, as for example in order to pass Internal Medicine, I devoted one entire year to reading and re-reading the 2000 page text of anything and everything that can go wrong with a person― how to recognize it― then how to treat it. The same process applied itself to the Cardiology Boards that were more difficult because the studying had to be done at night after my regular workday was over.
The only good aspect of “studying for the Boards” was that it made for convenient alibis to avoid mandatory attendance at boring or undesirable social events and family gatherings―or for good excuses to break up with a girlfriend.
- I can’t see you anymore. I have to study.
- OK. I get it. You have another girlfriend, you cowardly shit-heel. Why don’t you just say so?
- No. You don’t understand. I really do have to study.
- What, you don’t want me anymore and you’re throwing me over for a book? I always thought you were just a closet queer anyway.
Fostering a perpetual feeling of being in school, endless studying also went a long way to ensure the continued delay of gratification that goes with medical training and helped to postpone having to face up to the horrifying prospect of one day having to grow up. For example, even though I was paid a salary as a house officer, it was still not equivalent to having a real job, as well as the fact that because of how long it took to be trained, I was not able to go into private practice or be fully responsible for my own professional actions until I was thirty years old. Any colleague who had become a schoolteacher, a police or fireman or any other litany of civil service jobs, including a career in the military was already halfway to a pension before I had even opened up shop.
The entire Board process was also thankfully made easier before I had to endure them by eliminating the grueling experience of having to take oral exams. The terrifying prospect was dealing with either a pleasant and forgiving proctor, or as some people I knew, having had to deal with an unpleasantly unforgiving oral inquisitor the likes of Dr. Iber. (prior post). In fact, it was because of the imbalance in personalities―combined with the excessively subjective and personal bias inherent in oral exams―that the system eventually abandoned this torture and reverted to multiple-choice tests.
Under the oral exam system, some professorial proctors who equally qualified as bastards, were blackballing truly qualified individuals for no good reason other than effete arrogant spite. The interviewer at Harvard who nailed his window shut would have qualified as being one of these pigs. On my part, I had no doubt that with my luck, that if orals were still being given, I would have drawn this old Tarot nemesis to be my proctor; The Black Card Iber: Death.
While Board exams do in truth test a broad knowledge base, they are also really a test of being able to understand double negatives, as well as being able to reason by a process of exclusion or exception. The best way to take them is to burn through them quickly and to answer every sure question, then go back and boil down any unknown answer to at least two choices. This improves the odds of the guess to a 50:50 chance of being correct. The worst thing to do is to waste time fretting over choices and to leave questions blank. Blank answers always ensure complete failure.
Why these tests are structured as such is beyond me, except for my roommate’s theory that they were designed to weed out foreign graduates who were not facile with the English language. He referred to this as “The Turban Factor,” which he qualified by reiterating the fact that not only did the exams test knowledge, but equally as important they tested the ability of any given person to be able to speak English, to understand English, to understand logic, and to do it quickly enough to get through all the questions in the time allotted to take the test. Somewhat contrarily I argued that the process was more the case of queries being posed by erudite academic pudits who then sit back and chuckle to themselves at their innate ability to create inverse logic or literary Venn diagrams.
For example, why does the question always read:
- All the following are false except.
Is it not easier to understand:
- Among the following there is only one true statement. So, pick it.
In addition, all the choices then will probably contain true double negatives, meaning that each statement is false, except for the false double negative, which is the true answer, such that by the end of the ordeal the only thing ringing as absolute truth is a splitting frontal headache. It’s like the scene in The Princess Bride when Vizzini plays the double negative inverse logic game with Westley over the goblet of Iocaine poisoned wine, then gets completely confused by his own perverse reasoning―only to then succeed in poisoning himself.
Real life does not operate on the principle of double negatives unless one fully understands vernacular such as “I don’t got none” as really meaning that a person really does not have some.This person, making a statement as to the absence of having none, really does have some, although he stupidly does not know what he really meant and therefore validating my roommate’s theory that this functional illiterate would not pass the double negative Boards.
- He would not make for no good of a doctor anyway.
It is also not true that a person with no cough, no sputum production, no fever and no infiltrate on a chest X-Ray in fact does have pneumonia.
See what I mean? Yes…or no?