How I Re-certified for the ID Boards

Unlike my experience preparing for the Internal Medicine re-certification exam, I quite enjoyed refreshing my knowledge of infectious disease for the re-certification examination for the Infectious Disease Subspecialty of the American Board of Internal Medicine (here-forth known as the ID Boards).

That is not surprising because I love this field. For the past ten years I have been in clinical practice seeing patients in the hospital setting mostly, but also taking care of a small contingent of people living with HIV. I have read journal abstracts, gone to IDSA conferences, and read through the daily EIN digest. Even when I have a “bread & butter” consult I read through the relevant section of UpToDate. All this to say, I didn’t have to “study” like I did for the Internal Medicine re-certification boards.

Preparing for the ID Boards

My study material was the George Washington Infectious Disease Board Review course home study (2018). I took the live course for my initial certification back in 2009 so I used those notes as a backbone refresher. Yes, good things can come out of being a hoarder of books and study materials. Since I practice clinical infectious disease it was easy for me to juxtapose what is done now versus what used to be true in 2009.

It amused me though to re-learn tidbits written by my own hand a decade ago. It humbled me to realise how much had changed in my specialty in just a few years. The anti-retroviral medications that are no more. The new antibiotics on the block. The new treatment protocols for C.difficile and H.pylori infections. Changes I have incorporated in my day-to-day clinical activities through the natural process of keeping up with literature and of sharing knowledge between colleagues.

I listened to the 2018 course MP3 audio files during my commute to and from work to reinforce these updates. Most of the lectures were good. Some I felt would have been better were I to have been reading the slides while listening to the lecture.

At home after work I did the 2018 practice test questions making sure I understood the rationales behind the answers. I didn’t flip through the 2018 binders nor watch the video files because I simply didn’t have the time nor desire. Also, I knew that passively watching videos would put me to sleep. The people behind the George Washington course say they have no affiliation with the actual infectious disease board examination, but let me tell you, there were a couple of questions on the actual boards that seemed familiar to me from the practice questions.

So if nothing else, practice questions are a must. I have found that the @WuidQ Twitter account has excellent high-yield board style questions. Excellent! I have heard that The Pass Machine is good and that Board Vitals is “okay”. There is also a new book coming out titled Comprehensive Review of Infectious Diseases that provides over 500 board-style questions.

Don’t sweat the minutiae

This might sound contradictory since exams commonly test the minutiae. I know I was all over memorising the minutiae for my initial certification back in 2009. I was so worried because I had not read Mandell PPID cover to cover like I promised myself I would at the outset of fellowship. Ambitious much? Who was I kidding? I did find though that reading the entire infectious disease section of Harrison’s back then was an excellent very high-yield alternative.

Anyway, back to recertification. I think it’s helpful to take a look at the ABIM Certification Exam Blueprint to settle nerves. It describes the content of the exam. For example, it says 5% of the exam covers Travel and Tropical Medicine. In addition to the actual principles of travel medicine, this includes all the protozoa, the ectoparasites, and the worms. The ascaris vs. the strongyloides, the clonorchis vs the paragonimus, the cyclospora vs the cytoisospora, and of course the malaria. In a 240 question exam, that amounts to about 12 questions covering these topics (5%). Puts things in perspective doesn’t it? Why spend hours learning the minutiae in this sub-topic when there are higher yield, more relevant sub-topics such as HIV/AIDS testing protocols, anti-retroviral medication initiation/selection, drug interaction, laboratory monitoring and resistance testing as well as bacterial diseases and optimal antibiotic use?

As is true for the initial certification, one should expect non ID internal medicine questions as well. Since I just recertified for internal medicine a couple years ago I didn’t feel the need to particularly review anything.

Taking the ID Board Exam

About two weeks prior to my exam I learnt that I would have access to UpToDate as a reference. This is a change incorporated within the past year. Since I use it quite frequently in my clinical practice I am well versed in finding the answers I need to clinical questions. That said, if when you have an average of two minutes for an exam question, there’s not that much time to pull up UpToDate to refer to prior to selecting your best answer. I am a fast test-taker but I found that I couldn’t help double checking my answers in UpToDate. After all, isn’t that how one learns? So for the first time in my exam-taking life, I spent the entire 8 hours racing against the clock. After a close call with one of the sections, I decided to complete all answers in a section like I normally would before going through the section a second time this time referencing UpToDate.

Again the people at Pearson Professional Center were intent on turning me into an icicle. Despite it being a warm May day, I wore 3 layers (including a light jacket I was given permission to wear), and still couldn’t wait for the end of each question block so I could go outside to warm up in the sun. Sigh!

Also new for Spring 2019 was an option to take a 2-year knowledge check-in but I much preferred to stick with the traditional 10-year recertification exam I was familiar with. It wasn’t clear to me how much effort I needed to put into the 2 year KCI. I didn’t want to have to guess which topics to review more so than others. I didn’t want to waste my time taking it “cold”. I also didn’t like the idea of giving up a day of my time (or half-day) every two years just for the sole purpose of taking an exam. Nope! It will be interesting though to see what the 2 year KCI takers think.

Final Thoughts

Honestly, the best part of “studying” for the ten year re-certification was realising how much things had changed in a decade, and how, despite not being in academics, very little was new to me. I will say though that I learnt that guidelines call for routine meningococcal vaccine in HIV-infected people. After polling other private practice ID physicians, I felt less embarrassed that I didn’t already know this, because they didn’t seem to know either. Somehow, we all missed the memo from 2016.

Overall, I felt that the re-certification ID board exam was a fair assessment of knowledge. Again, I think being actively engaged in clinical practice and continuous education helped immensely. Of course, this doesn’t take away from my gripe about why an expensive, anxiety-provoking, high stakes pass-or-fail exam that can tank my career is necessary in the first place. The inclusion of UpToDate as a reference for the exam seems silly when you think you’ve taken a day off work to sit in a frigid exam room where you are padded down and have your glasses scrutinized each time you enter the exam room.  I really do think an initial certification and then on-going personal education through journals, UpToDate, medical conferences is enough.

Online Resources

• George Washington University (IDBR) Question Bank: this course is known as the “gold standard” for preparing physicians to pass the ID boards
• @WuidQ: a University of Washington based Twitter forum for teaching/learning infectious disease via questions, pearls, & case discussions
• Partners Infectious Disease Images: a digital library of images and cases from Massachusetts General Hospital
• The Gorgas Courses in Tropical Medicine: a bit heavy-handed for board review but a refreshing site from the University of Alabama for learning about tropical (parasitic & fungal) disease with lots of pictures & slides
• National STD Curriculum: a free educational website from the UW STD Prevention Training Center and the University of Washington.
• National HIV Curriculum: a free educational website from the AIDS Education and Training Centers and the University of Washington
• IDSA Academy Maintenance of Certification (MOC) modules: IDSA’s own study materials