I'm concerned about the lack of transparency regarding Day 2. Yes, the errors are inexcusable, egregious, and I'm not sure how this organization can claim fairness in any way. It is insulting that they are. But even before such a blatant mistake was made...there is actually no guideline or instruction on the "right" way to code on Day 2. It is not something we do *anywhere else* in the field of cardiology, but is an artificial system made up only for this test. Yet...they don't publish parameters? Instructions? Definitions? Do you code a vessel that you can sort of see but is never engaged? Do you code a native severe that is bypassed? Do you code insignificant if there are little lumps and bumps, or nothing? For echo...do you comment on chamber sizes or EF if clear standard views or measurements aren't provided? Who knows! The ECG portion is a touch less offensive purely because there are resources like ecgsource or Okeefe to suggest what "right" might be - although even those resources conflict. For echo and cath? Total black box. There is significant interobserver variability when it comes to stenosis assessment, EF assessment etc. I had several coronary angiograms with lesions that felt profoundly borderline to me. I probably coded them "wrong." Take the theoretical example of a tight left main. Say narrowing looks to be more than 50% but perhaps not so high as 75% relative to the native lumen. Are they going for moderate or severe? Does it matter, if a left main lesion above 50% is clinically significant? But some people may put severe, and others may put moderate, and clinically it is the same, but someone is "wrong". Inability to trust eyesight is why OCT and IVUS were invented, after all.
I know of colleagues/acquaintances who have failed this examination, all for day 2, and all suffering negative job implications. I suspect this faulty testing method has persisted because every year the majority of people pass and move on with their lives and everyone's just too exhausted to expend further energy pointing out how inappropriate this is. I really feel for anyone who may not pass... the associated (misplaced, because this test is garbage) shame, financial loss, and kick to the confidence is unnecessary and could be avoided.
Has anyone failed a test along this (long, long) journey in the past or know of colleagues who have endured that? It gifts the individual depression, heightened anxiety, stress...even before discussing the financial losses and career implications. It is not something to be taken lightly. You'd expect true, full transparency and utter fairness if that may be the consequence. I'm sure no one here disputes the need to set the performance bar high for ourselves and our colleagues. But....the pass rates have fallen steadily over the past few years, and there is no satisfactory response regarding basic inquiries surrounding methods, test validation, or fairness. Unfortunately, that respect is not afford to us.
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