Ten years ago I flew from New Orleans to Dallas to take the ABEM recertification exam for the first time. The examiners seated us in a large room, filling every other chair. We used pencil and paper. God help you if you accidently skipped a question and the numbers went out of sequence. I remember being reasonably nervous – uptight but not diaphoretic. This was likely related to memories of the initial certification examination I had taken 10 years before. There was a sense of camaraderie in the shared suffering.

Before the examination, the proctor asked for a show of hands regarding our place in the spectrum of test takers. Most of the hands were raised for those who were recertifying for the first time. Only a handful of doctors were taking it for the second time. There was a brief round of applause for them. These docs had taken the original certification exam and had been practicing for much more than 20 years. I’m sure that many of the larger group wondered if they would be around to take the test again in 10 years.

I began studying about 9 months before I took the recertification exam for the second time this fall. I purchased a two-volume written study guide from Ohio ACEP and read it cover to cover. That description does not really do it justice.

The thing dwarfs the New York City phone book. There are 2,500 pages of densely packed information. I could endure about 20 pages in a sitting before crushing depression would start to set in.

I usually took a volume to work with me and would read a few pages between patients. My colleague, Catherine Marco, asked me one day, in the middle of the summer, why I was studying. “The exam is not that difficult.”

Maybe not for her.

Dr. Marco is the equivalent of the high school class valedictorian telling you that the SAT is a breeze. If she had been talking about an algebra quiz, I might have considered blowing off studying to watch a baseball game. Failing the boards has a bit more implications than flagging a math test, so I kept studying.

After finishing the tome, I started answering review questions. I borrowed two books (from my friend the valedictorian) and started with the post tests. I hated both of the books because there was an abundance of what I can best describe as PIMP questions. I found myself in a bad mood each time I completed a few pages.