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The American Board of Dermatology (ABD) is planning to go ahead with its board certification exam scheduled for July in Tampa, Florida -- upsetting many third-year dermatology residents worried about risks of COVID-19 from traveling to the exam and sitting in a room with a large group for many hours.

"The ABD Initial Certification Exam will be offered, as scheduled, at the American Board of Pathology's test center in Tampa, FL on July 13-17 and 20-23," the board said in an undated announcement on its website. "Please note the July dates could be canceled, depending on the evolving situation with COVID-19." The ABD also noted that it will offer the exam again in December and "if necessary and if circumstances related to COVID-19 warrant it, the ABD will administer the exam in Tampa in March 2021." In addition, the board noted, "the ABD will grant an extra year of eligibility for board certification to residents graduating in 2020. Instead of the normal 5 years of eligibility, residents will have 6 years to pass the exam."

Different From Other 乌鸦传媒

The ABD's decision puts it at odds with other specialty boards. On April 22, the , "For the safety of our candidates, our examiners, our staff, and the public, the General Surgery Board has made the difficult decision to cancel the June administration of the General Surgery Certifying Examination," adding that disrupted candidates would be given priority scheduling for next year's exams.

The American Board of Emergency Medicine canceled its spring oral certification exam, saying it was "currently developing options for candidates who are scheduled for the exam and we will share this information with them as soon as possible."

Dermatology residents aren't comfortable with the idea of flying to the exam, said "Resident #1," a third-year (PGY-4) resident who didn't want to be identified. "It's not clear what the state of things will be" in July, the resident said. "Many people have small kids and wonder if they should be self-quarantining after traveling."

In prior years, one reason for taking the exam in person was that the exam involves dermatopathology slides that have to be passed from person to person. However, the board decided starting this year to make the dermatopathology portion electronic, as is the rest of the exam, Resident #1 noted, adding that the option of a second date in December also might not be advisable since some health experts are forecasting a second wave of COVID-19 during the winter.

One Remote Option

One option the ABD has presented to residents reluctant to go to Tampa involves passing four , which can be taken via online proctoring, and then passing the , which can be taken at a local Pearson VUE test center. The first possible date to complete all portions of this new exam is July 2021.

However, this seems unfair to many residents who have already taken in-service exams, Resident #1 said. "A lot of people are reluctant to do that because, over the next year, they would have to find time to sit" for all those additional exams plus the actual certification exam. "I have not encountered many residents interested in doing that, because it requires a lot of time."

"They didn't really consider everything from our perspective," said "Resident #2," another PGY-4 who asked not to be identified. An example is the residents' expenses; in addition to the $2,500 for the test itself, many residents rely on "lots of study tools based on a timed subscription," such as a prep course that only goes for 2 months as well as question banks and video lecture services, the resident said. Residents who don't want to fly in July to take the test -- and aren't offered a remote option -- would just be out the money for the study aids and would need to pay for them again if they took the exam later on.

"My other concern is how it looks to the public," said Resident #1. "Dermatology practices have closed their doors and moved to teledermatology to protect patients, and now they're saying all graduating dermatologists should fly to Tampa and then return to work? As doctors, we're telling everyone to shelter in place ... yet we as a specialty are not making accommodations for residents to take the exam in a safe manner."

The ABD posted on its website that it doesn't want to administer the exam at remote testing centers because "conducting an online proctored exam requires time and resources from a commercial test vendor, such as Pearson VUE. A limited number of live human proctors, using specialized vendor tools, are available to monitor online exams. Under the best of circumstances, vendor capacity is finite and exam administrations must be arranged many months to over a year in advance. With the COVID-19 crisis, test vendors are scrambling to re-accommodate existing clients with cancelled exams. Schedules are booked beyond the timeframe of our July exam, and availability throughout the remainder of 2020 remains uncertain."

More than 200 dermatology residents signed an April 17 letter to the ABD, asking it to reconsider. "We strongly advocate for a digital format for the upcoming exam offered in July, rather than on-site in Tampa, with the option to delay the digital exam for those disproportionately affected by COVID-19," the letter said.

"Due to the unprecedented nature of this pandemic, we cannot predict when it will be safe for residents to gather in Tampa for the traditional board examination," continued the letter, in which the residents requested either an in-person proctored exam at their institutions or an at-home exam with video monitoring. "Although it is unideal [sic] for the ABD to transition to digital earlier than anticipated, we feel that this would ensure the well-being of exam takers."

The residents also offered to forfeit their in-person exam fee to expedite the change. Both the residents' letter and a separate letter from program directors asking for remotely proctored exams were "shot down," according to Resident #1.

One dermatology program director who didn't want to be named indicated a willingness to remotely proctor a board certification exam. "On a very basic level, there's a pandemic, and safety should come first," the program director said in an email. "Ideally, this test would be offered remotely.... I believe many program directors would volunteer to remotely proctor the exam."

But, the director added, ABD staff members "really are all very good people, with good intentions, and work hard to ensure that dermatologists have a fair and balanced exam and maintenance of certification materials, and there are likely aspects of this that I do not understand" about the situation.

ABD's Response

Asked about its response to the residents' concerns, an ABD spokesperson told 乌鸦传媒 in an email that "the well-being of our candidates is of utmost importance. We will administer the July 2020 Certification Exam in Tampa, as well as the exam dates currently scheduled for December 2020 and early 2021, only if local, state and federal guidelines indicate it is safe to travel and convene in large groups [emphasis ABD's]. By early June, we will make a decision about offering a July exam. At that time, we will outline the social distancing measures (based on the most current CDC recommendations) that will be in place at the testing center should we decide to move forward with the exam."

The board also considered institution-based proctored testing; "however, proctoring within residents' home institutions does not meet the security requirements for an initial certification examination," the spokesperson said, noting that all 24 members of the American Board of Medical 乌鸦传媒 (ABMS) use secure testing centers with professional proctors for their initial certification exams.

乌鸦传媒 asked the ABMS whether the ABD could switch to a remotely proctored exam, given at residents' training institutions, without clearing it first with ABMS. A spokesperson replied that such a change "does not require ABMS approval."

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