Chirag/Royce Editorial, Goodman Article, Potters Response on Job Market 031121

[elementaryschooleconomics]

I haven't heard a number yet, and nothing has been posted on the ABR website about the 2020 exams, let alone 2021. I have anecdotally heard the pass rates for the writtens were very high, and have also heard tales of specific people who failed orals in the spring, but not the overall pass rate. Isn't 90% consistent with historical pass rates for first-time test takers for orals?

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[thecarbonionangle]

They should have passed everyone in this God-forsaken class (my class) for the ish we've been through. Unless you were blatantly incompetent or killed someone during the exam.

Lord Wallner had other thoughts!

 

[w00tz]

Not sure how long this has been up

 

[elementaryschooleconomics]

Not sure how long this has been up
View attachment 342959

Wow they must have just posted that, I checked the website before making my post ~45 minutes ago, good catch!

 

[w00tz]

Wow they must have just posted that, I checked the website before making my post ~45 minutes ago, good catch!

Interesting the 2020 for qualifying exam results not posted. Perhaps this is a sign it will be posted soon.

 

[Ray D. Ayshun]

I continue to find reasons to tell myself to pick another field should I ever bump into a flux capacitor.

 

[thecarbonionangle]

Do we really believe that 12 percent of residents who “fail” oral boards are “incompetent”? If you have 1/10 people graduating residency who cannot truly do the job this is a gigantic failure for the education system. The culture of this field is toxic. That is a very high failure rate even if it is line historically for a so called “exam of competency and not excellence”. Clearly some people think this is ok but this is messed up.

 

[elementaryschooleconomics]

Do we really believe that 12 percent of residents who “fail” oral boards are “incompetent”? If you have 1/10 people graduating residency who cannot truly do the job this is a gigantic failure for the education system. The culture of this field is toxic. That is a very high failure rate even if it is line historically for a so called “exam of competency and not excellence”. Clearly some people think this is ok but this is messed up.

Agreed that 12% is too high - it's pretty wild, in fact, given that the people sitting for this exam managed to graduate residency, pass all three written exams, and (presumably) practice as an attending for a year (not to mention all the exams and boards from medical school, the MCAT, etc).

The question is: does this reflect reality in any way? As in, for these 12% who failed, do their patients experience worse outcomes compared to those who passed? My suspicion is no, outcomes are no different...but I guess we'll never know.

 

[Mandelin Rain]

Agreed that 12% is too high - it's pretty wild, in fact, given that the people sitting for this exam managed to graduate residency, pass all three written exams, and (presumably) practice as an attending for a year (not to mention all the exams and boards from medical school, the MCAT, etc).

The question is: does this reflect reality in any way? As in, for these 12% who failed, do their patients experience worse outcomes compared to those who passed? My suspicion is no, outcomes are no different...but I guess we'll never know.

I'd guess performance anxiety for many/most who fail. Tripped up on minutia or didn't say what the examiner wanted to hear. Maybe didn't know how to treat some random, rare malignancy that a generalist practice might see twice in a 30 year career and would certainly need to review relevant literature prior to treating.

The bar to officially declare someone "incompetent" after a year of treating patients should be pretty damn high. And maybe the remedy shouldn't be letting this incompetent doctor continue to see patients for another year while studying to do it again.

We should call it what it is; a sanctioned hazing exercise.

 

[OTN]

I'd guess performance anxiety for many/most who fail. Tripped up on minutia or didn't say what the examiner wanted to hear. Maybe didn't know how to treat some random, rare malignancy that a generalist practice might see twice in a 30 year career and would certainly need to review relevant literature prior to treating.

The bar to officially declare someone "incompetent" after a year of treating patients should be pretty damn high. And maybe the remedy shouldn't be letting this incompetent doctor continue to see patients for another year while studying to do it again.

We should call it what it is; a sanctioned hazing exercise.

The ABIM got rid of their oral boards after data demonstrated the only variable on multivariate analysis which predicted pass or fail was which examiner they had.

I'm not holding my breath with the ABR, though. Academicians trying to claim superiority over radonc "generalists" is a huge part of their entire M.O., so I expect them to continue to expect all future radoncs to supplicate before them every year to beg for certification...just so they and their patients can be told that they're not nearly as good as someone who treats only a single disease site.

 

[metallica81788]

Do we really believe that 12 percent of residents who “fail” oral boards are “incompetent”? If you have 1/10 people graduating residency who cannot truly do the job this is a gigantic failure for the education system. The culture of this field is toxic. That is a very high failure rate even if it is line historically for a so called “exam of competency and not excellence”. Clearly some people think this is ok but this is messed up.

Agreed that 12% is too high - it's pretty wild, in fact, given that the people sitting for this exam managed to graduate residency, pass all three written exams, and (presumably) practice as an attending for a year (not to mention all the exams and boards from medical school, the MCAT, etc).

The question is: does this reflect reality in any way? As in, for these 12% who failed, do their patients experience worse outcomes compared to those who passed? My suspicion is no, outcomes are no different...but I guess we'll never know.

I'd guess performance anxiety for many/most who fail. Tripped up on minutia or didn't say what the examiner wanted to hear. Maybe didn't know how to treat some random, rare malignancy that a generalist practice might see twice in a 30 year career and would certainly need to review relevant literature prior to treating.

The bar to officially declare someone "incompetent" after a year of treating patients should be pretty damn high. And maybe the remedy shouldn't be letting this incompetent doctor continue to see patients for another year while studying to do it again.

We should call it what it is; a sanctioned hazing exercise.

99% of the residents who have graduated in the past few years are more competent than the innumerable dinosaurs running around with their millions while grandfathered in not knowing how to actually do their job correctly.

I would trust new grads (recent, not in the next 5 years haha) to treat me or my family more than some old timer big-wigs that don't know how to contour, look at a CT, or use an EMR.

 

[TheWallnerus]

I would trust new grads (recent, not in the next 5 years haha)

So sad but so true. It’s not hard to predict it.

 

[DebtRising]

Do we really believe that 12 percent of residents who “fail” oral boards are “incompetent”? If you have 1/10 people graduating residency who cannot truly do the job this is a gigantic failure for the education system. The culture of this field is toxic. That is a very high failure rate even if it is line historically for a so called “exam of competency and not excellence”. Clearly some people think this is ok but this is messed up.

yes, I do. The teaching and oversight standards for education is so bad and there are so many poor programs, that I could easily believe 10% of a graduating class is not competent.

the oral boards are the only time basic competence is actually assessed - and while stressful - the only worthwhile exam of any we have to take.

 

[medgator]

The ABIM got rid of their oral boards after data demonstrated the only variable on multivariate analysis which predicted pass or fail was which examiner they had.

I'm not holding my breath with the ABR, though. Academicians trying to claim superiority over radonc "generalists" is a huge part of their entire M.O., so I expect them to continue to expect all future radoncs to supplicate before them every year to beg for certification...just so they and their patients can be told that they're not nearly as good as someone who treats only a single disease site.

Unfortunately it is literally the only competency barrier i trust at this point to vet the near 200 or so grads that are leaving training annually.

Until we reduce slots and improve program quality significantly (esp newer questionable ones), i don't see the argument to get rid of the oral exam going anywhere

 

[TheWallnerus]

Unfortunately it is literally the only competency barrier i trust at this point to vet the near 200 or so grads that are leaving training annually.

Until we reduce slots and improve program quality significantly (esp newer questionable ones), i don't see the argument to get rid of the oral exam going anywhere

It’s a weird situation though right

Do we foresee the powers that be passing only 50% or less of first time test takers in 5 years further tanking… nay, assassinating… rad onc’s match prospects?

I do not foresee this.

I foresee in 5 years the orals becoming a participation trophy

 

[radoncftw]

one of my attendings recently told us he loves to ask about drug pathways on the oral exam. how that is relevant to the practice of day to day radiation oncology is beyond me.

 

[RSAOaky]

Agreed that 12% is too high - it's pretty wild, in fact, given that the people sitting for this exam managed to graduate residency, pass all three written exams, and (presumably) practice as an attending for a year (not to mention all the exams and boards from medical school, the MCAT, etc).

The question is: does this reflect reality in any way? As in, for these 12% who failed, do their patients experience worse outcomes compared to those who passed? My suspicion is no, outcomes are no different...but I guess we'll never know.

I'm not sure what the outright failure rate is. This includes people who conditioned a section or two. I know some very bright radoncs that conditioned. On the flip side, I know a pathetic excuse for a former coresident who somehow entered our timeline after disrupting the spacetime continuum when he was accepted via the 2034 radonc SOAP and somehow became board certified on his first try. There's really no rhyme or reason to some of it.

 

[Lamount]

The ABIM got rid of their oral boards after data demonstrated the only variable on multivariate analysis which predicted pass or fail was which examiner they had.

I'm not holding my breath with the ABR, though. Academicians trying to claim superiority over radonc "generalists" is a huge part of their entire M.O., so I expect them to continue to expect all future radoncs to supplicate before them every year to beg for certification...just so they and their patients can be told that they're not nearly as good as someone who treats only a single disease site.

FWIW, I bet generalists do better on orals than specialists. Do you think I remember the first thing about treating breast or cervical cancer? 🤔

 

[TheWallnerus]

one of my attendings recently told us he loves to ask about drug pathways on the oral exam. how that is relevant to the practice of day to day radiation oncology is beyond me.

. There's really no rhyme or reason to some of it.

If memory serves from an old talk by Bob Kuske. The examiners are supposed to have very tight pre-defined scripts to which to adhere but can "riff" in the 71/72 region. By the time in breast e.g. if you get a question about choroidal metastasis (or drug pathways) you're a guarantee 71 in that section. A 70 is a pass... you have to fill the bottom part all the way to the brim. A 69 is condition, 68 fail. 71s and 72s in other sections can take 69s in other sections to a 70 but can never take a 68 to a 69.

This is all subjective and at the end all the examiners get together and hem, haw, and argue for/against slight numerical fudging to vote people on or off the island.

 

[Ray D. Ayshun]

If memory serves from an old talk by Bob Kuske. The examiners are supposed to have very tight pre-defined scripts to which to adhere but can "riff" in the 71/72 region. By the time in breast e.g. if you get a question about choroidal metastasis (or drug pathways) you're a guarantee 71 in that section. A 70 is a pass... you have to fill the bottom part all the way to the brim. A 69 is condition, 68 fail. 71s and 72s in other sections can take 69s in other sections to a 70 but can never take a 68 to a 69.

Good news for me is that all the other boards and in-services have helped make up for the absolute dearth of penis cancer training I received. I should be able to dominate a node+ oligmetastatic penis. The one thing I don't want to do is 69 a penis.

 

[Neuronix]

If memory serves from an old talk by Bob Kuske. The examiners are supposed to have very tight pre-defined scripts to which to adhere but can "riff" in the 71/72 region. By the time in breast e.g. if you get a question about choroidal metastasis (or drug pathways) you're a guarantee 71 in that section. A 70 is a pass... you have to fill the bottom part all the way to the brim. A 69 is condition, 68 fail. 71s and 72s in other sections can take 69s in other sections to a 70 but can never take a 68 to a 69.

This is all subjective and at the end all the examiners get together and hem, haw, and argue for/against slight numerical fudging to vote people on or off the island.

As a more recent boards taker this seems a little out of date. There was no H&P and I don't recall any staging or grading on my exams. It was focused on image review (including anatomy), decision making, and all the stuff there in the 70 column. They seem to be trying to make it more objective with specific questions and answers they want you to give and grade on.

Cases were a bit all over the place as far as difficulty. Some sections started off the bat with weird stuff. Some built from normal to odd in the usual progression. Others were only bread and butter cases, not sure how people really got up in the 71-72.

 

[TheWallnerus]

Good news for me is that all the other boards and in-services have helped make up for the absolute dearth of penis cancer training I received. I should be able to dominate a node+ oligmetastatic penis. The one thing I don't want to do is 69 a penis.

Can make a ton of proper burns/jokes against the whole system. But in seriousness the scoring system again shows some of the long-standing problems in the field. Why not just score 1,2,3,4,5 and 3 or above be passing? The 68-72 range, with 70 being a pass, is from the old days of college and H.S. grading where 70-77 was a D, 78-85 a C, 86-94 a B, and 95-100 an A. And 69 and below was an F. So you could be the most brilliant radiation resident ever on oral exams but your score can never ever even reach "C" (average) level work.

 

[Ray D. Ayshun]

Can make a ton of proper burns/jokes against the whole system. But in seriousness the scoring system again shows some of the long-standing problems in the field. Why not just score 1,2,3,4,5 and 3 or above be passing? The 68-72 range, with 70 being a pass, is from the old days of college and H.S. grading where 70-77 was a D, 78-85 a C, 86-94 a B, and 95-100 an A. And 69 and below was an F. So you could be the most brilliant radiation resident ever on oral exams but your score can never ever even reach "C" (average) level work.

The thing that bothers me is that I did a residency, at a very respected place no less, which I would think could serve as a gateway to board certification in a more real sense. As in, graduating residency would represent going through 4 years of oral exams and passing. It's annoying that's not the case. What is absurd, though, is that I hear all the time as I prep for oral boards, "just say what NCCN says, and not what you did in residency." WTF are we doing here?

 

[TheWallnerus]

As a more recent boards taker this seems a little out of date. There was no H&P and I don't recall any staging or grading on my exams. It was focused on image review (including anatomy), decision making, and all the stuff there in the 70 column. They seem to be trying to make it more objective with specific questions and answers they want you to give and grade on.

Cases were a bit all over the place as far as difficulty. Some sections started off the bat with weird stuff. Some built from normal to odd in the usual progression. Others were only bread and butter cases, not sure how people really got up in the 71-72.

It was always supposed to be very objective in the 68-70 range with "must get" questions. They do have a "menu" of cases and I'm sure some start with the 9.9 degree of difficulty cases just to be a-holes.

Where it gets subjective is in the post-test closed sessions where examinees are discussed by the examiners. It might go

Lung guy: "Neuronix totally nailed all the cases and knew that obscure drug pathway backwards and forwards."
Lymphoma guy: "Yeah but he didn't want to do neck RT for that palatal plasmacytoma."
Lung guy: "Aw c'mon let's cut him some slack and pass him outright since lymphoma was his only rusty section. And neck RT is a soft call there anyways."

subjective stuff like this is what I have heard.

What is absurd, though, is that I hear all the time as I prep for oral boards, "just say what NCCN says, and not what you did in residency." WTF are we doing here?

Duh. Googling the NCCN guidelines with regularity so we can become BC rad oncs!

 

[metallica81788]

It was always supposed to be very objective in the 68-70 range with "must get" questions. They do have a "menu" of cases and I'm sure some start with the 9.9 degree of difficulty cases just to be a-holes.

This is where the oral boards fails. This year I had some sections go very smoothly with normal progression of softball to weird, and some that started out with really random/difficult stuff. The progression and confidence really messes you up as you go through the cases. And I had good examiners that worked with me - can only imagine the stress with a d-bag examiner. The subjectivity is insane.

I completed a 4 year residency, passed all the other stupid boards, am treating 20-25 people of nearly all disease sites daily as solo generalist for nearly two years, and yet could potentially be failed because I don't know the exact volume or dose to exact cGy of a Wilms tumor with focal anaplasia s/p neoadjuvant chemotherapy or something weird? Screw off ABR

 

[thecarbonionangle]

A few years ago i heard of someone failing breast because they gave ddAC taxol and herceptin instead of THCP for a her2+ tumor. We don’t even give chemo. This chemo is not even concurrent. Even if concurrent we still would not give it.
Is our children learning? That is the question!

 

[communitydoc13]

I'm pro boards. I wouldn't hold a conditional on the oral exams against anyone and there are people who failed based on examiner personality or other unfair things. But, there are people out there who can't get through the series of boards in time (it's a small number), and these people probably shouldn't be practicing.

Many, many, many, many more people feel like they failed than actually fail. It is not fair but it is a consolidating exercise. I agree, studying for peds is ridiculous, but anyone who can get themselves to remember tx and workup of Wilm's, neuro, and rhabdo even for a day gets props from me. I don't consider any of my board certified colleagues who bracketed my training by 10 years to be dumb.

I actually hope that the board gauntlet scares a few people away in these times.

Knowing chemo is fine. Radoncs should be running the tumor boards. We got to do something.

 

[seper]

A few years ago i heard of someone failing breast because they gave ddAC taxol and herceptin instead of THCP for a her2+ tumor. We don’t even give chemo. This chemo is not even concurrent. Even if concurrent we still would not give it.
Is our children learning? That is the question!

If you "fail", no one tells you why. The candidate was likely incorrect in assessing her/his own performance.
People do condition the breast section relatively frequently (as opposed to say, GU). But that would not be due to taxol

 

[evilbooyaa]

If you "fail", no one tells you why. The candidate was likely incorrect in assessing her/his own performance.
People do condition the breast section relatively frequently (as opposed to say, GU). But that would not be due to taxol

He *failed* b/c of the Adriamycin. Combination with Herceptin is generally a no-no due to concern of overlapping cardiotoxicity risks in contemporary MO practice.

But I agree with you on the point - he more likely failed because he accepted a MHD of 8Gy on a left heart plan without consider breath hold.

But that's the beauty of it, it's all subjective as to "why" somebody failed. I wish the folks who got failed would get feedback as to WHY they failed/conditioned.

 

[Lamount]

He *failed* b/c of the Adriamycin. Combination with Herceptin is generally a no-no due to concern of overlapping cardiotoxicity risks in contemporary MO practice.

But I agree with you on the point - he more likely failed because he accepted a MHD of 8Gy on a left heart plan without consider breath hold.

But that's the beauty of it, it's all subjective as to "why" somebody failed. I wish the folks who got failed would get feedback as to WHY they failed/conditioned.

Second this. I was specifically warned not to recommend this combo on boards. I was told Her+Dox and not giving neoadjuvant chemo on inflammatory breast cancer were insta-fail for breast. Every disease site has a handful of these.

 

[deleted1111261]

He *failed* b/c of the Adriamycin. Combination with Herceptin is generally a no-no due to concern of overlapping cardiotoxicity risks in contemporary MO practice.

But I agree with you on the point - he more likely failed because he accepted a MHD of 8Gy on a left heart plan without consider breath hold.

But that's the beauty of it, it's all subjective as to "why" somebody failed. I wish the folks who got failed would get feedback as to WHY they failed/conditioned.

Is this a documented toxicity or theoretical? It makes sense, I just didn’t know it was actually a thing.

 

[evilbooyaa]

Is this a documented toxicity or theoretical? It makes sense, I just didn’t know it was actually a thing.

Documented - metastatic breast cancer: Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2 - PubMed

"The most important adverse event was cardiac dysfunction of New York Heart Association class III or IV, which occurred in 27 percent of the group given an anthracycline, cyclophosphamide, and trastuzumab; 8 percent of the group given an anthracycline and cyclophosphamide alone; 13 percent of the group given paclitaxel and trastuzumab; and 1 percent of the group given paclitaxel alone. "

Same situation in adjuvant breast cancer: https://www.nejm.org/doi/full/10.1056/nejmoa0910383
"At study entry, cardiac risk factors were well balanced among the three study groups (Table 4). At the time of this analysis, the incidence of congestive heart failure in the two trastuzumab-containing regimens was higher in the group receiving AC-T plus trastuzumab (2.0%) than in the AC-T group (0.7%) or the TCH group (0.4%); the incidence with AC-T plus trastuzumab as compared with TCH was increased by a factor of 5. The difference in rates of congestive heart failure between the two trastuzumab-containing regimens significantly favored TCH over AC-T plus trastuzumab (P<0.001). In addition, a significant difference in sustained, subclinical loss of mean LVEF (defined as >10% relative loss) was observed in the group receiving AC-T plus trastuzumab, as compared with the TCH group (18.6% vs. 9.4%, P<0.001), with a rate of 11.2% in the AC-T group. Although the cardiac dysfunction associated with trastuzumab after the use of adjuvant anthracyclines has been reported to be relatively transient,22-26 in this study, the subclinical toxic effect persisted for several years (Figure 2). Of 194 of the 1042 patients (19%) who had a relative reduction in LVEF of more than 10% in the group receiving AC-T plus trastuzumab, the decrease persisted for at least 4 years after randomization in 33% of the patients. Of note, 23 of 1073 patients (2.1%) who were assigned to receive AC-T plus trastuzumab never received trastuzumab because the LVEF declined to an unacceptable level after the initial anthracycline treatment. Consequently, these HER2-positive women received no targeted therapy after receiving anthracycline therapy."

 

[deleted1111261]

thanks!!

 

[Wildcat321]

Second this. I was specifically warned not to recommend this combo on boards. I was told Her+Dox and not giving neoadjuvant chemo on inflammatory breast cancer were insta-fail for breast. Every disease site has a handful of these.

Mind sharing any other insta-fails?

 

[evilbooyaa]

thanks!!

Beriwal would be disappointed you didn't know that data already, lol. Still can't believe he reads SDN. I wonder if he did his entire career or if it was a post-job transition way to stay up to date/have some entertainment.

 

[deleted1111261]

Beriwal would be disappointed you didn't know that data already, lol. Still can't believe he reads SDN. I wonder if he did his entire career or if it was a post-job transition way to stay up to date/have some entertainment.

Well, his residents cut and paste stuff and send. And when I say something outrageous, they usually send to him to mock me.

 

[Chartreuse Wombat]

Mind sharing any other insta-fails?

GU examiner for several years here. Hard to fail GU (I failed two people of more than 100 examinees)

1) 60 Gy for seminoma...started with 2cm RP node when examinee said 36 Gy...increased to 5 then 8cm...asked twice..60 Gy (rationale was that IMRT makes it possible). The right answer was chemo at some point (3-4cm range)
2) Examinee couldn't answer any questions about androgen deprivation therapy. RAtionale was that "urology does that". Couldn't provide a name of a drug, dose or common side effects

 

[Lamount]

Mind sharing any other insta-fails?

Off hand, here are some I remember…

18 x 3 for central lung tumors.

APR in anal after residual nodule at 6 weeks

Biopsying Wilms

…and I would guess letting cord, brainstem, OC, ON, brachial plexus, small bowel or stomach exceed constraints.

if there are data that something yields significantly worse outcomes or is harmful, there is a good chance it can cause you to fail.

 

[Ray D. Ayshun]

GU examiner for several years here. Hard to fail GU (I failed two people of more than 100 examinees)

1) 60 Gy for seminoma...started with 2cm RP node when examinee said 36 Gy...increased to 5 then 8cm...asked twice..60 Gy (rationale was that IMRT makes it possible). The right answer was chemo at some point (3-4cm range)
2) Examinee couldn't answer any questions about androgen deprivation therapy. RAtionale was that "urology does that". Couldn't provide a name of a drug, dose or common side effects

on top of better local control, 60 Gy only requires 5 fx as opposed to 15-18, so better for patient convenience..

 

[TheWallnerus]

He *failed* b/c of the Adriamycin. Combination with Herceptin is generally a no-no due to concern of overlapping cardiotoxicity risks in contemporary MO practice.

But I agree with you on the point - he more likely failed because he accepted a MHD of 8Gy on a left heart plan without consider breath hold.

But that's the beauty of it, it's all subjective as to "why" somebody failed. I wish the folks who got failed would get feedback as to WHY they failed/conditioned.

Second this. I was specifically warned not to recommend this combo on boards. I was told Her+Dox and not giving neoadjuvant chemo on inflammatory breast cancer were insta-fail for breast. Every disease site has a handful of these.

It consoles me that the med onc fails their oral boards if they don’t know cord tolerance or can’t calculate the wavelength of a 6 MeV photon.

 

[Lamount]

It consoles me that me med onc fails their oral boards if they don’t know cord tolerance or can’t calculate the wavelength of a 6 MeV photon.

I’d settle for them not telling patients I will treat them the same day I meet them (not referencing my normal referral med oncs, who are excellent)

 

[dieABRdie]

Mind sharing any other insta-fails?

Treating a pregnant woman

 

[RadOncDoc21]

Treating a pregnant woman

What about a pregnant male? It is 2021! 😉

 

[medgator]

Mind sharing any other insta-fails?

Csi setup not feathering junction iirc

 

[DoctwoB]

GU examiner for several years here. Hard to fail GU (I failed two people of more than 100 examinees)

1) 60 Gy for seminoma...started with 2cm RP node when examinee said 36 Gy...increased to 5 then 8cm...asked twice..60 Gy (rationale was that IMRT makes it possible). The right answer was chemo at some point (3-4cm range)
2) Examinee couldn't answer any questions about androgen deprivation therapy. RAtionale was that "urology does that". Couldn't provide a name of a drug, dose or common side effects

Everyone knows the dose of leuprolide. 3 month or 4 month.

 

[medgator]

Everyone knows the dose of leuprolide. 3 month or 4 month.

6 month formulation as well

 

[elementaryschooleconomics]

2) Examinee couldn't answer any questions about androgen deprivation therapy. RAtionale was that "urology does that". Couldn't provide a name of a drug, dose or common side effects

That's hilarious, how do you make it to orals without having to fight the ADT scheduling and prior auth battle at least a dozen times? Both in residency and in practice, I can't get away with trying to give someone ADT without me signing at least three forms...few things are etched into my mind like ADT names, dosing, and schedules.

 

[medgator]

That's hilarious, how do you make it to orals without having to fight the ADT scheduling and prior auth battle at least a dozen times? Both in residency and in practice, I can't get away with trying to give someone ADT without me signing at least three forms...few things are etched into my mind like ADT names, dosing, and schedules.

If only ADT reimbursement had remained disgustingly high..... Then rad oncs may have never been roped into giving it

As someone who trained after the turn of the century, we never had to give adt nor place fiducials in residency. Was a complete 180 when i got out into real world. Had one urologist flat out tell me it wasn't worth his time to give it anymore

 

[thecarbonionangle]

He *failed* b/c of the Adriamycin. Combination with Herceptin is generally a no-no due to concern of overlapping cardiotoxicity risks in contemporary MO practice.

Surprised people did not know this. Goes to show how irrelevant it is for our field which does not give chemo and multiple BC rad oncs are unaware of it… Its a real story which happened to someone who competently treated the disease yet the ABR decided it warranted failing them a few years ago. My point is the ABR boards are useless and one stupid mistake can lead to a failure in a setting which does not even come close to reality. I really do not get the fascination with this useless ritual from people in our field.

 

[deleted1111261]

Surprised people did not know this. Goes to show how irrelevant it is for our field which does not give chemo and multiple BC rad oncs are unaware of it… Its a real story which happened to someone who competently treated the disease yet the ABR decided it warranted failing them a few years ago. My point is the ABR boards are useless and one stupid mistake can lead to a failure in a setting which does not even come close to reality. I really do not get the fascination with this useless ritual from people in our field.

💯
Though I should know this, why should an RO fail for the chemo regimen??