Boards and Wards

As a little detour before I start my medical school clerkship rotations as a 3rd year student, I’d like to take a moment to appreciate—yes appreciate—board exams. I just sat for the daunting and arduous United States Medical Licensing Exam (USMLE) called “Step 1.” It is roughly an eight-hour endeavor to prove that some of the tomes of information I was exposed to throughout my first two years of medical school made it somewhere into my hippocampus. That said, yes board exams are always daunting and yes, they can even be quite stressful. There’s a lot depending on your scores, in any field you find yourself testing in. Some are pass/fail and some provide you with a scaled score performance.

For what feels like forever ago to me now, I sat for a state licensure exam for the Illinois Department of Public Health as an Emergency Medical Technician Basic provider, or EMT-B. I absolutely failed it—missed it by a point or so. Scheduled a retake, studied hard, and passed round two. Lesson learned. That license opened many doors for me back in the day, and that’s precisely the point: professional certification, official licensures, and (often) professional society membership will bolster anyone looking to get ahead in their career.

Other times, these board exams are highly encouraged. After graduate school at Rush for my MLS degree I had to sit for the ASCP BOC Board Exam for the professional credentials of a Medical Laboratory Scientist, or MLS (ASCP). When I passed, I was able to advance in my career then and have excellent opportunities that would be unavailable otherwise. More so, certain jobs would have been completely unavailable to me without those clinical credentials! I would say that like ASCP cites 70% of patient results originate from the lab, 70% of my CV depends on those professional credentials.

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Figure 1. A previously renewed ASCP BOC certificate, proudly displayed.

This brings up a somewhat related point. There is a professional debate that’s been going on for a few years: board certification vs. regulatory licensure. Organizations like ASCP and CAP have been on board with licensure for a while, citing the critical roles we play in patient care and the specialized education training required. An article from 2015 had circulated well explaining the advantages and regulatory compliance improvement offered by licensure as medical laboratory science evolved since the Clinical Laboratory Improvement Act of 1988 (known as CLIA ’88). Those authors established that virtually all laboratory professional organizations, as well as local state public health departments, favor licensure to guarantee regulatory oversight for the quality of personal and testing results (Rohde et al., 2015). With so many questions today about what qualifies laboratory personnel since the Center for Medicaid Services decision in 2016 that says a bachelor’s degree in nursing is sufficient to perform and manage laboratory moderate to complex testing, professional organizations like ASCP, CAP, and ASCLS continue to investigate what measures would maintain quality and regulations for positive patient outcomes.

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Figure 2. States with licensure, and without. I was trained and practiced medical laboratory science in Chicago, Illinois, a state that does not require licensure. (Rohde et al., 2015)
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Figure 3. These graphs show the number of sanctions under CLIA imposed on labs in the following states. This demonstrates the ineffectiveness of CLIA improving laboratory testing or personnel quality. (Rohde et al., 2015)

Like the EMS exam, the USMLE is absolutely mandatory if I in any capacity wish to continue my medical education, match into a residency program, and ultimately practice as a physician. So, as daunting as these tests might be, they provide a good benchmark standard for the quality of physicians from around the world who want to practice in the United States. USMLE actually has a series of four board exams I’ll be taking in the coming years—so bear with me as I try to stay positive. The Step exams check the depth and breadth of one’s understanding of medical concepts from anatomy to the minutiae of biochemistry. Like ASCP’s board exam, it was a mix of hematology, microbiology, immunology, with added clinical vignettes and patient outcomes. At the end of the test day, I didn’t have a single neuron left working at 100%, but I’ve since recovered. And now it’s onto the next chapter: clinicals. Hope to catch you all again soon, as I’ll try to write up some interesting lab-related cases I will most assuredly come across. Thanks!

 

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Figure 4. One of many medical students’ bibles. (Stock photo from Amazon.com)

References

Rohde, R., Falleur, D. Ellis, J. (2015) “Almost anyone can perform your medical laboratory tests – wait, what?” Elsevier.com March 10th, 2015; retrieved from: https://www.elsevier.com/connect/almost-anyone-can-perform-your-medical-laboratory-tests-wait-what

 

Centers for Medicaid and Medicare Services (2016) Personnel Policies for Individuals Directing or Performing Non-waived Tests, Revised due to typographical error under citation of §493.1443(b)(3). Center for Clinical Standards and Quality/Survey & Certification Group. April 1, 2016; retrieved from: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-16-18.pdf

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

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