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1 in 20 Failed the GM Boards
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American Board of Internal Medicine recognizes “Exam Prep” as the primary step toward certification. Their Study of Studying infographic reminds us of the acute benefits of using board exam prep as a review and assessment tool.
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What do I do if I fail the Geriatric Medicine board exam?
The first thing you should do is just take it easy, sleep on it. Give yourself a few days, a week or two to come to terms with what has happened. Your next exam is six months to a year away. Dr. Jack has more advice in this video, What Do You Do If You Fail Your Medical Board Exam?
Geriatric Medicine Certification Exam Scoring
Overall performance is reported on a standardized score scale ranging from 200 to 800, with a mean of 500. To pass the Geriatric Medicine board examination, your standardized score must equal or exceed the standardized passing score. Your performance on the entire exam determines your pass-fail decision.
The passing standard for the Geriatric Medicine exam is set by ABIM committee using standard-setting techniques that follow best practices in assessment. Because the passing standard is based on a specified level of mastery of Geriatric Medicine content, no predetermined percentage of examinees will pass or fail the exam.
Geriatric Medicine Certification Exam Format
The Geriatric Medicine Certification Exam (CERT) board exam is composed of up to 240 single-best-answer multiple-choice questions. Most questions describe patient scenarios and ask about the tasks performed by physicians in the course of practice. (Note that around 40 of these are new questions that do not count in your score.)
Example of a single-best-answer multiple-choice question format:
A 45-year-old man presents to the hospital with fever and abdominal pain complaints for the past 3 days. He complains of high-grade fever associated with rigors and chills. He also complains of absolute constipation. He has a history of Crohn’s disease and is on infliximab and azathioprine, but his symptoms are poorly controlled. On examination, the patient appears cachexic and toxic-looking, with a blood pressure of 100/80 mmHg, a pulse of 120 beats per minute, a respiratory rate is 28 breaths per minute, and a temperature of 103°F (39.4°C). The abdomen is tense and extremely tender on palpation. Ultrasound abdomen shows a fluid collection in the left iliac fossa suggestive of an intra-abdominal abscess. What would be the most appropriate step in the management of this patient?
◯ A. Surgery
◯ B. Ustekinumab
◯ C. Mesalamine
◯ D. Budesonide
◯ E. Methotrexate
The patient has developed an intraabdominal abscess with intestinal obstruction. Indications for surgery include massive bleeding, perianal fistula, and intestinal obstruction. Trials have supported infliximab postoperatively to reduce the recurrence of symptoms. Repeat endoscopies are needed to identify patients with recurrence of the disease.
Ustekinumab is an incorrect option. Ustekinumab is an Anti-IL -12/ IL 23 antibody used in patients who do not respond to the conventional treatment modalities; however, surgery is indicated in patients with abdominal abscesses and obstruction.
Mesalamine is an incorrect option. The patient has active refractory Crohn’s disease. Although mesalamine has long been used as an initial treatment for Chron’s disease, recent trials do not support the use of mesalamine in treating active Chron’s disease.
Budesonide is an incorrect option. Corticosteroids suppress the inflammatory symptoms but do not alter the course of the disease. However, surgery is indicated in patients with abdominal abscesses and those who are non-responsive to treatment.
Methotrexate is an incorrect option because the patient is already on infliximab and azathioprine and did not respond adequately and has developed complications.
Kasper DL, Hauser SL, Jameson JL, Fauci As, Longo DL, Loscalzo J. Harrison’s Principles of Internal Medicine. Nineteenth Edition. McGraw Hill; 2015;2358-72.