Maintenance of Certification: The DOCK Demystified

This article is from March 2007 and may contain outdated material.

The first closed-book exam for the new Maintenance of Certification requirements was adminstered last September. Its notoriety proceeded its administration. Now several test takers share their study advice and DOCK experience with future examinees.

First DOCK Exam

Last September, hundreds of ophthal-mologists were among the first to brave the closed-book DOCK exam—the Demonstration of Ophthalmic Cognitive Knowledge—which is one component of the new Maintenance of Certification (MOC) requirements mandated by the American Board of Ophthalmology (ABO).

Richard L. Abbott, MD, health sciences professor of ophthalmology at the University of California, San Francisco, has been involved with the ABO’s development and implementation of the MOC requirements for a number of years.¹ While the MOC process requires evidence of professional standing, evaluation of practice performance (an office record review) and evidence of commitment to lifelong learning and self-assessment (CME over 10 years and an open-book Periodic Ophthalmic Review Test known as PORT), “the part that people find most intimidating is the closed-book examination,” said Dr. Abbott.

“Consequently, the ABO decided that it would be in the best interest of the candidates to design a curriculum that was most clinically relevant to practice,” Dr. Abbott said. The ABO invited the American Academy of Ophthalmology to organize and create a curriculum—titled the Practicing Ophthalmologists Curriculum. This new curriculum would then serve as the basis for questions in the DOCK examination. The DOCK is a multiple choice test, with 100 questions divided into two “practice emphasis” sections and 50 questions in core general ophthalmology.

Does the DOCK truly reflect clinically relevant subject matter? Or does it ask less clinically relevant questions, much like the written qualifying examination for initial Board certification? How much should you study for it? What should you study? In essence, what can ophthalmologists who will be taking the exam this September expect?

For answers, EyeNet turned to five ophthalmologists who successfully passed the DOCK exam last September.

EyeNet: How did you find out about the MOC requirements, and what was your reaction?

DR. FINNEN: The whole MOC caught me by surprise. I didn’t expect it, and first heard about the DOCK exam in a letter I received in the mail. I was expecting an open-book test.

DR. KAISER: In my class, those with fellowships or practices on the West Coast were able to take the oral Boards six months after the written and therefore were certified a year before those on the East Coast. I did my fellowship in Florida, so half my classmates did not have to take the closed-book exam, and I just missed the boat.

DR. KUBIS: I knew the DOCK was coming because the ABO has been talking about this since we were residents. I was aware we wouldn’t be grandfathered-in like our older colleagues, so it was not a surprise to me to go through the process.

DR. KUSTER BAINTER: I did know recertification was coming but didn’t know whether it would include a closed-book or open-book exam. I heard about it through a colleague and then received the material from the ABO. I wasn’t shocked because I figured ophthalmology would follow the recertification trend of other medical specialties.

DR. LOPEZ: I had heard announcements at the Academy meetings that the requirements would change—that instead of a take-home exam, we would have a closed-book exam. I was a bit disappointed at the change. I have three children at home, and it is challenging enough managing a practice and family, much less studying for the exam.

EyeNet: How did you study for the exam?

Dr. Finnen: I took the Academy’s course in Chicago, and it did a nice job. After that, I spent about one or two hours a day reviewing the material from the course. It was helpful because I could refamiliarize myself with the things I don’t practice all the time. And it is like taking any test—you can’t cram for it in one day. So I reviewed over the time span of a month.

Dr. Kaiser: I took both the Academy and ABO practice tests to get a feel for the DOCK, whether it was more clinical or basic science based. I then boned up on some of the questions that I was unsure of. I felt pretty confident about the subspecialty exams—I took retina—since I am on the panel that publishes the BCSC, so hopefully my knowledge is up-to-date.

Dr. Kubis: I used no preparation materials from the Academy. I just took the required practice tests provided by the ABO—the two PORT open-book exams—about three weeks before the DOCK examination. Otherwise, I went in “cold.” I made sure to get a good night sleep prior to the examination.

Dr. Kuster Bainter: I decided to kill two birds with one stone. I prepared for the DOCK by reviewing theBCSC, which allowed me to earn CME credits at the same time. Since I used those books to study for the first Boards, I assumed that it would be good preparation for the second round of Boards [the DOCK]. I read through the spring and summer, whenever I had free time.

Dr. Lopez: At the Academy meeting, I had heard that the ABO would be using the Academy Practicing Ophthalmologists Curriculum as the basis for the DOCK questions. So I purchased the Academy’s study books and practice tests, and decided to attend the July course in Chicago. [The Academy’s study materials and review course are also based on the POC. See “Study Aids.”] The tools were actually very good. There were only a few questions that were not covered in those books, but most of those questions were manageable, so I felt well-prepared. As for the three-day course: It provided a lot of good information, but it was a long three days.

EyeNet: What was your experience the day of the test, and do you have any tips for those who will be taking the DOCK this September?

Dr. Finnen: I found that the test was more practical-knowledge-based, and not as esoteric as the previous Board exam. I was able to take two sections on retina and one on the core, and found the test pretty reasonable. It was generally a fair test, and some of the test questions were simpler than the sample questions.

Dr. Kaiser: I liked the convenience of the test—I could take it close to home in a Sylvan learning center. I was able to take it on a Saturday morning, and thus it did not disrupt my practice. It was very practical and contained questions that the practicing ophthalmologist should be ready to answer. They didn’t try to make it ridiculously difficult. For the most part, it was a fair representation of ophthalmic knowledge. I want to say that this is not a test you want to go into cold. You should do at least some review before taking it.

Dr. Kubis: I took the two neuro-ophthalmology parts and the core test. Without giving specifics away, I thought it was a comprehensive exam that was very fair. I had planned to take an entire day off but was done in half a day. I would certainly recommend that ophthalmologists take the examination in their specialty.

Dr. Kuster Bainter: I took the DOCK at a testing center in San Francisco. The center checked my ID carefully and sat me in a cubicle with a desktop computer. There was a camera watching each person, and the people sitting next to me were taking tests in architecture, accounting and real estate. I was probably the only ophthalmologist there. I was a little nervous, but not as nervous as the first time I took the Boards. I did one section of general [core], one cataract and one cornea. I was pleased that it was much more clinically oriented than what I remember from eight years ago. If you study from the BCSC, you will do very well, although the test itself was more clinically oriented than some of the information covered in the BCSC.But if you want to get a lot of CME credit while studying from home at your own pace and schedule, then using the BCSC is convenient.

Dr. Lopez: We were given 60 minutes for each of the three parts of the test. I took the core and two glaucoma tests. Once I started taking the exam, the questions seemed reasonable and I felt confident. I didn’t require the full amount of time to complete the test. The questions were very relevant and pertained to things I do on a regular basis. There were no questions about obscure minutiae like there were on the original Boards. I would recommend that ophthalmologists purchase the Academy materials. They proved very helpful.

Closing Thoughts

While these tips may prove helpful to those ophthalmologists taking the DOCK in September 2007, Dr. Abbott noted, “The ABO will continue to revise the test and update the questions. It wants to continue to improve the examination to make it psychometrically more sound—to make the questions more valid so that the Board can differentiate between someone who has the knowledge and someone who simply guesses.”

In the meantime, these five pioneering DOCK test takers don’t have to worry about taking another closed-book test—at least for another 10 years.

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1 Dr. Abbott is chairman of the Academy’s Practicing Ophthalmologist Curriculum Program, which developed the POC at the request of the ABO. He currently has no affiliation with the ABO; however, he did serve as an ABO director from 1995 to 2003.