I take my Psychiatry Board recertification exam tomorrow. I was in the second year of people who had to recertify every 10 years, to prove that you keep up to date, rather than coasting on your laurels for the rest of your life.
The initial exam is a nerve-racking affair, consisting of two parts, about a year apart. Part I is a written (now computerized) exam, 6 hours of delightful multiple choice and K-questions, #2 pencils and monitored bathroom breaks (you know how a watched pot never boils? ... well... you know).
Part II is where at least a third of examinees fall down, succumbing to anxiety-stricken paralysis or fumbling mental status exams as you examine a real live patient in front of two real live psychiatrists for precisely 30 minutes, then spend another 30 minutes getting grilled and probed to determine if you know what you should know. A colleague of mine had a patient who peed in the corner of the room, then just stared, not uttering one word for half an hour. (He passed, with a measure of sympathy thrown in, no doubt.)
The recertification exam is a 5 or 6 hour computer-based test. I haven't studied one iota, lazily figuring that it should test me on real-world knowledge. At $2100, it's a bit of a gamble to not study... but as long as I don't pee in the corner of the room, I figure I should be okay.