Almost two years ago I proposed a study of the certification process (see TAP 26/2). Its purpose was to assess whether the members of the Certification Committee are a reasonably valid sample of The American's population of certified analysts with regard to judgments of approval/deferral of applications for certification. The design of the study involves a comparison of such judgments by a random sample of The American's population of certified analysts, excluding from the random sample any who had served formerly as members of the Certification Committee. My concern about certification was based on two related facts—the low approval rate of applications and the degree of pain and suffering experienced by applicants who are not approved. Through 1986 the average approval rate for first-time applicants was 50%, a figure substantially lower than that for comparable exams in other medical specialties. That 50% of institute graduates were unable to demonstrate analytic competence seemed unreasonable. Further, the failure to be approved has been devastating to some applicants, who have been so hurt and angry that they became alienated not only from The American, but from their local institute and indeed from psychoanalysis. Our struggling profession can ill afford to demoralize its young.
Was the approval rate so low because analysts selected for the Certification Committee employed an unduly high standard and one too narrowly defined? The proposed study would provide data that might answer that question. The study was criticized for being potentially divisive. But if its results suggested that the committee was using criteria systematically different from those employed by other reasonably competent judges, then such a finding should be discussed.
As I have been regarded as a loose cannon, I would like to note that I attempted to enlist the cooperation of Dan Buie, co-chair of the Task Force on Certification; Arthur Rosenbaum, chair of the Certification Committee; and Marvin Margolis, chair of the Board on Professional Standards. None was in favor of supporting the study. I also requested support from 16 institutes/societies/study groups; only 4 agreed to cosponsor.
To assess the desirability and feasibility of the study, 190 randomly selected male certified analysts were polled. The response rate was 48%, with no difference between training and non-training analysts; 75% felt that the study should be carried out, while 16% were unsure or had mixed feelings and 8% opposed the study. A sufficient proportion of both training and non-training analysts were willing to serve as volunteer judges to make the study feasible.
In May 1992, when I served as a participant observer on the Certification Committee, it approved 8 of 13 first-time written applications, a 61% approval rate. My personal judgment would have been to approve 9 of the 13, a 70% approval rate. At the December 1991 meeting of the committee, the approval rate for such applications had been 62%. Five applicants deferred in December participated in interview examinations in May 1992; 4 were approved. Thus, of those who first applied in December 1991, if written and follow-up interview applications are combined, a total of 75% were approved, a figure much higher than the earlier rates of 50%. Some of the applicants deferred on written applications were told that they may phone a committee member to discuss the problems with their application; some were encouraged to apply for the interview examination.
This 75% approval rate for first-time applicants is more in line with the rates for various other medical specialties. The approval rate for first-time applicants on the last examination was 55% for psychiatry (written and oral combined), 78% for internal medicine, 83% for general pediatrics, and 91% for dermatology. (In dermatology, a very detailed report on each candidate is filed each year throughout the training period, providing a picture of the candidate's experience and competence. Clarence Livingood, Executive Director of the American Board of Dermatology, commented, “We're not that impressed with the examination.”)
In December 1992, only 13 of 30 first-time written applications were approved. This 43% approval rate is lower than the 61% approval rate in May 1992 and the 62% approval rate in December 1991. Whether the drop in the approval rate is a random fluctuation can be gauged best by examining future approval rates. Given this uncertainty whether the increased approval rate is permanent, I suggest postponing a decision whether to implement the proposed study of the certification process.
In December 1992, 17 first-time written applications were deferred, and judging from the reactions of those previously deferred, 17 motivated and dedicated young analysts are now very likely hurt and angry, and possibly questioning their commitment to psychoanalysis. In regard to the impact upon The American, it is noteworthy that 18 members died during 1992, and given our aging membership this number is likely to increase each year.
Several significant issues remain. The fact that 75% of a random sample of male certified analysts favor the study suggests that they question the fairness or validity of the certification process. Even if analysts more critical of the certification process were more likely to respond to the questionnaire, it is nonetheless likely that a majority of male certified analysts question the process. This is a larger proportion found to be critical than is reported by the Task Force on Certification.
That the committee has virtually absolute power over one of the most important rites of passage of our profession is another problem. An applicant may appeal only after three deferrals, and the new three-person committee is constituted from those “who have had experience with the procedures and policies of the Committee on Certification… . at least two of them will not have participated in any prior discussion of the application to be reviewed” (Standards, Procedures, and Guidelines, January 1992).
How can most analysts who currently question the certification process become convinced that the process is indeed both valid and fair? At present Marvin Margolis, as Chair of BOPS, consults with institutes in selecting members for the Certification Committee. But consulting with the education or executive committee of an institute regarding an appointment may not result in a representative selection. This is suggested by the fact that when the decision whether to support the research proposal was made by an education or executive committee, only one-quarter of societies/institutes/study groups favored support, as compared to three-quarters of male certified analysts. Further, the chair of BOPS is under no formal obligation to consult institutes at all but may select members however he/she sees fit; there are no criteria.
Several analysts have suggested that institutes elect representatives to the Certification Committee instead of having them appointed. This more democratic selection would assure that the current diversity of analytic views will be well represented and would do much to develop analysts' faith and respect with regard to the certification process. Those favoring this alternative method of selecting members for the committee are asked to drop me a note to that effect. If a reasonable number of letters are received, the Pittsburgh Committee on Certification is willing to poll certified members to ascertain the proportion favoring such an arrangement.
Joseph Schachter, M.D., P.h.D., chairs the Committee on Certification of the Pittsburgh Psychoanalytic Institute.