Important Psychiatry Certification Exam Change for 2021

In 2021 the ABPN® made a substantive change to the Psychiatry Certification Exam. There are two types of questions on the exam, ‘stand-alone’ questions and ‘linked-item set’ questions, which were previously named ‘vignette’ questions. For the 2021 psychiatry certification exam, the number of ‘linked-item set’ questions is reduced from 50% of the exam, as it was in previous years, now to 38% of the exam.

The two question types are presented separately in their own sections. There are a total of eight sections and the ‘stand-alone’ question sections alternate with the ‘linked-item set’ question sections. The number of sections with each question type has not changed from previous years. There are still four ‘linked-item set’ question sections, but they now have fewer questions (35-45) per section than do the ‘stand-alone’ sections (61-67) per sections. In previous years both section types averaged the same number of questions.

The important question for the exam candidate is “How does this affect me and my chances of passing?” I have good news – I think this change will be an overall benefit to psychiatrists taking the psychiatry certification exam. On average, most exam candidates found the ‘vignette’ questions, now called the ‘linked-item set’ questions, harder than the stand-alone questions. The reasons for this are two:

1. The ‘linked-item set’ questions are often not single best answer type questions. Each question specifies whether the exam-taker chooses 1, 2, or 3 response options from the ones provided, which is usually 5 or 6 options. Many exam-takers find this question type more challenging. And, by the way, to get these questions correct, the exam-taker must choose all the correct options. For example, if you are required to “choose two,” you must get both right; if you are required to “choose 3,” you must get all three right. Additional point: each question, although linked to a vignette that is the focus of several questions, is scored individually. That is, if a vignette has 8 questions linked to it, you do NOT need to get all 8 questions correct to get credit for that vignette’s questions. Each question stands alone in being scored correct or incorrect.
2. The ‘linked-item set’ questions are more often more heavily judgment based. The response options are not so much right and wrong as they are more and less relevant, urgent, or beneficial. For example, if you are presented with a case vignette with a patient in some sort of crisis and you are required to “choose 3” options on which “next clinical steps” to take, you may wish to choose all the options presented because you would implement all the interventions presented when managing the patient as presented. However, you are limited to choosing only 3 and, therefore, they most represent the most urgent or currently most relevant interventions. The remaining options, although still relevant to the patient’s assessment or management, may have to wait until later, once the patient is stabilized. So, the point is the choose the options presented that represent the most crucial interventions needed now, to first stabilize the patient, prior to moving to more routine work-up and non-urgent treatment.

You may have noticed that I wrote above that this exam change for 2021 is ‘on average’ a beneficial one. I added this caveat because, of course, there are some psychiatrists who did not struggle with the ‘linked-item set’ type questions. However, for most exam-takers this was the harder question type. Of course, I do not know if my belief that this change will be a beneficial one, leading to a higher pass rate, will be borne out. After the 2021 psychiatry certification exam results are released by the ABPN, I will provide an update on those results.