The first reason for the low pass rate is that our industry wants this to be difficult. This isn't the slam dunk of a private pilot certificate. This certificate is different than all others. It allows you to train, endorse, sign-off, check, and examine students. That's a whole lot of responsibility. CFIs are the gatekeepers in the system.
Signature’s Requirements Medicare requires that services provided/ordered be authenticated by the author. The signature for each entry must be legible and should include the practitioner’s first and last name. For clarification purposes, we recommend you include your applicable credentials (e.g., P.A., D.O., or M.D.).