Will Virtual Oral Board Exams Remain an Option After the COVID-19 Pandemic?

by Linda Kossoff •

Looking Ahead

The next ABO-HNS exam, in October 2021, will be virtual, but according to Dr. Nussenbaum, no decisions beyond that have been made. “The board will think about what to do in 2022,” he said. “We’re planning to have one more virtual administration to incorporate the things we learned from the February 2021 exam, continue to improve the process and the experience for the examiners and candidates, and then we’ll make a decision shortly afterward based on operational considerations, feedback, and public health safety.”

Having taken the virtual exam, Dr. Holcomb concluded that the advantages of the format outweigh the disadvantages. “Given the significant benefits of convenience and cost, and as long as the threat of COVID-19 resurgence or future pandemics remains, this format remains the safest for candidates and examiners.”

Anticipating the October exam, Dr. Fox has been keeping her ear to the ground. “The folks I have spoken to who took the exam in February didn’t report any technological issues, and the [ABO-HNS] does provide a time to check technology with their system prior to the time of examination,” she said. “I think that if the virtual format is effective, then the board should consider instituting it permanently.”

So far, examiner feedback on the virtual oral exam format has been positive. Moreover, scoring results from February’s test revealed a failure rate consistent with past in-person exams. For this ultimate success, Dr. Nussenbaum credits the board’s “exceptional” group of volunteers. “Without their incredible dedication and commitment to learning this new electronic virtual platform and process, this couldn’t be done,” he concluded. “The incredible, collective team effort from ABO-HNS staff and the examiners was truly inspirational to me.”

Linda Kossoff is a freelance medical writer based in Woodland Hills, Calif.

Security Matters

Administering a medical board exam virtually brings up significant security risks, both in terms of the test material and the administration itself. In devising the virtual format for its recent oral exam, the American Board of Otolaryngology–Head and Neck Surgery (ABO-HNS) took prudent measures. “We went to an online secure portal to deliver the content and electronically submit scoring. None of the exam content was downloadable. and everything was only accessible with secure portal access,” said Brian Nussenbaum, MD, ABO-HNS executive director.

With in-person exams, candidates are prohibited from bringing in their smartphone, smart watch, headphones, or other similar devices. However, in a virtual situation, it simply isn’t possible to obtain full visual confirmation that examinees are abiding by the rules. “We required the candidate to provide, via webcam, a 360-degree security scan of the room in which they’re taking the exam,” said Dr. Nussenbaum.

“We were allowed to bring several blank pieces of paper with us and were required to show these to the examiners,” recalled Andrew J. Holcomb, MD, who took the ABO-HNS primary board certification exam in February 2021. “We weren’t required to share our screens, so a candidate certainly could have notes minimized in a separate window, but I know that screen sharing presents other security challenges. So, in general, I was in favor of the approach that was used.”

In addition to these measures, ABO-HNS also provided live proctors to confirm candidate identity and watch candidates during the exam, and significantly revised its cheating policy to include additional considerations specific to virtual exams. “We reviewed the policy several times with candidates, and all candidates were required to attest that they agreed to that policy and understood the consequences of any violations,” explained Dr. Nussenbaum.