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1 in 7 Failed the Hospice Boards
The Hospice and Palliative Medicine boards is a relatively tough ABIM exam. In 2022, 113 out of 754 first-time takers didn’t pass the Hospice and Palliative Medicine Certification exam. Of 10-Year MOC exam takers roughly 1 in 10 missed the mark.
Exam Prep Works
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 Hospice 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?
Hospice and Palliative 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 Hospice and Palliative 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 Hospice and Palliative 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 Infectious Disease content, no predetermined percentage of examinees will pass or fail the exam.
Hospice and Palliative Medicine Exam Format
The Hospice and Palliative 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:
An 81-year-old man with hypertension and Alzheimer’s disease is admitted to the hospital with fever, dizziness, chills, and rigors. He is a nursing home resident, his history is significant for moderately severe dementia, and he underwent a prostate biopsy 5 days ago for suspected prostate cancer. He developed pneumonia 4 weeks ago, was hospitalized for 10 days, and received cefepime and vancomycin. He is currently taking ciprofloxacin for prophylaxis. Physical examination reveals a temperature of 100°F (37.78°C), a pulse of 78 beats per minute, and blood pressure of 80/60 mm Hg. He is given piperacillin/tazobactam. Reassessment after 36 hours shows no clinical improvement despite a continuous infusion of intravenous fluids and double inotropic support. His blood and urine cultures are awaited. What is the most appropriate next step in management?
◯ A. Add levofloxacin
◯ B. Reassess after 24 hours
◯ C. Add linezolid
◯ D. Change antibiotic to ertapenem
◯ E. Trimethoprim-sulfamethoxazole
D. Change antibiotic to ertapenem
Changing the antibiotic to ertapenem is the correct option. This patient is a nursing home resident with a history of recent antibiotic use and prostate biopsy. Therefore, extended-spectrum beta-lactamase-producing gram-negative bacteria are the most likely pathogens. Ertapenem or meropenem are the drugs of choice and should be initiated till the results of culture and sensitivity are available.
Adding levofloxacin is incorrect because it treats Legionella and mycoplasma pneumonia. Moreover, this patient is resistant to ciprofloxacin, so he may have fluoroquinolone-resistant organisms.
Reassessing after 24 hours is incorrect. This patient has not improved despite the escalation of antibiotic therapy and has a fever with hypotension. His antibiotic regimen should be changed.
Adding linezolid is incorrect. In the absence of documented methicillin-resistant staphylococcus infection or an indwelling catheter, staphylococcus aureus is less likely.
Trimethoprim-sulfamethoxazole is an incorrect option because it is not active against extended-spectrum beta-lactamase-producing gram-negative bacteria.
Tufa T, Fuchs A, Mackenzie C. High rate of extended-spectrum beta-lactamase-producing gram-negative infections and associated mortality in Ethiopia: a systematic review and meta-analysis. Antimicrob Resist Infect Control 9, 128 (2020). https://doi.org/10.1186/s13756-020-00782-x