Examining Examsmanship: The ‘je ne sais quoi’ of advanced practice

INTRODUCTION The Canadian Association of Medical Radiation Technologists (CAMRT), the certifying organization for Advanced Practice Registered Technologist (Radiation Therapy) (“APRT(T)”) in Canada, utilizes a Competency-Based Oral Exam (CBOE) as the final step for certification. THE PROBLEM To date, eight candidates have attempted the CBOE with only one candidate passing on first attempt. Review of stakeholder feedback and CBOE statistics suggested a lack of candidate preparedness, but not necessarily for their command of the advanced subject matter in clinical, technical or professional practice domains. The challenge was observed in the exam's real-time demand to justify clinical reasoning and engage in professional critical thinking and discussion, as arbitrated by an interprofessional panel of colleagues. This was seen to emulate the expectation of advanced practice and was thus a critical but underappreciated aspect of competence. This elusive skill was termed by the APRT Certification Committee as representing “examsmanship” and is defined as the skill of taking examinations (Wiktionary). It became evident early in the evolution of the CBOE, that radiation therapy professionals were not well versed in the rigour required for acceptable oral examination performance. THE GAP Upon embarking on the APRT(T) initiative, CAMRT deliberately set its role as one of a certifying body, not one of educator or trainer. As such, applicants are responsible for seeking and accessing all necessary education and preparatory materials to meet established standards independently. Upon analysis, it became evident that exam candidates were not prepared for the CBOE format and struggled to be able to formulate and defend clinical judgment and decisions in a systematic way. It was hypothesized that this kind of training was not naturally inherently incorporated in the radiation therapists training or practice and required explicit support. While not originally planned or intended, it became clear that the CAMRT's investment in equipping candidates in basic examsmanship principles might minimize first exam failures and both optimize use of CAMRT resources and reduce candidate anxiety and time to certification. THE INTERVENTION Utilizing evidence from medical education literature, data from the APRT(T) pilot phase, and learnings from subsequent oral examinations, candidate ‘CBOE preparedness’ was identified as a priority for the CAMRT. Immediate work focused on revising information on the website to more clearly describe the CBOE format and process and on instituting a model of support for candidates by matching them with a member of the Steering Committee and with a APRT(T) mentor. All elements of the existing and planning program will be described and rationalized. CONCLUSIONS The novel nature of the CBOE format required unique attention to ensure candidates were equipped to demonstrate their competence in this high stakes evaluation. Further plans include a preparation ‘program’ that will include reference materials as well as video clips of prior examinations to permit familiarization with the format and examples of good examsmanship.