Many of my friends are taking their emergency medicine recertification board exams tomorrow.  The ConCert exam, so named for ‘continuing certification,’ is a delightful ritual we enjoy every 10 years to the tune of $1800.

It is prefaced by taking a smaller test each year in the interim, and then as the exam approaches, by a deep, aching anxiety about whether or not we know enough to pass.  This anxiety lives in an as-yet-unnamed part of the physician brain, somewhere at a junction of wakefulness, hunger and sexuality (I say this because he exam invariably affects all three in negative ways).  We’ll call it the ‘Nucleus Examinatus.’)  The Nucleus Examinatus (hereafter Leap’s Area) is poorly developed until the student declares that he or she intends to pursue a medical career, whereupon it grows dramatically and continues to do so during medical school and residency.  In most cases, it is of sufficient size to suppress all sense of good judgment about things like staying up all night, eating cheeseburgers at 3 am, or putting our hands into that, well whatever that fluid is around some organ in a total stranger.

It is this area of the brain that always reminds us of its presence with those dreams that we forgot to take a final exam, or in my case, forgot to show up for French class until the week before finals.  I shiver as I type.

It is this area of the brain that leads young physicians to bury their heads in books like Tintinalli’s emergency medicine text, cramming information, even as said physician’s wife makes overtly lewd gestures in a darkened room.  ‘Just one more section honey, I’ve got to read up on infectious diarrhea.’  (We’re bringing sexy back…)

As such, I offer a hearty slap on the back and a ‘good luck, God speed’ to my fellow travelers.  I took the ConCert last year, so I have the rare pleasure of wishing my colleagues a great journey as I stand on the docks.  (I’m usually the last one to do anything.)

All of those lads and lassies are, even now, trying to ease the ache in heir Nuclei Examinati, which is pulsing and throbbing, reminding them that they don’t yet know enough about the clotting cascade, or the legal ramification of spider bites, or when to consult the pediatric gastroenterologist for hiccups.

But it’s OK.  It’s how we’re wired. And to all of my friends out there, I say, ‘relax!’  The fact is, if you’re practicing emergency medicine, you’ll be fine.  You’ll be surprised at how much you know. And if all else fails, and you know me well, realize this stunner.  I passed.  Trust me, you’re smarter than I am.

And before you go into the test, or as you reflect back on it, I give you this scenario for a laugh:

 If the board exams, oral or written, were really like practice, they would be conducted at 3 am after you had 2 hours of sleep because your kids vomited all day.  Every 30 seconds a nurse would interrupt you with a question like ‘the protocol for fever says to give Tylenol.  Is that OK?’  Or a secretary would put a transfer form in your face as a hospitalist said ‘you can’t answer that question because you aren’t allowed to according to Medicare rules.’  Every 10 questions your password on the test computer would have to be reset and at least once during the exam the entire system would shut down in order to perform a back-up.  This would not be credited to you as time.  At any given point during the exam, the proctor would ask, ‘how much longer will you be,’ and at least once, a paid actor would attempt to assault you, or ask for a cup of ice.  You would be allowed to urinate but would be repeatedly paged while doing so.  On your single break, the only snack you would be given would be a dry granola bar, cranberry and nettle flavored.  And when you finished the test, you’d still have to stay two hours afterward to finish charting about it.  Finally, the test proctor could deduct 10 points for your bad attitude.  (Test proctor satisfaction score and all you know.)  Now THAT’s a board exam!

You’ll all be in my prayers tomorrow!







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