CNN story about cheating on radiology boards

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Pediatrics has the PREP curriculum which includes a monthly magazine with review articles, a book of "content specifications" (i.e. the key learning points of a given area) and PREP question banks which are meant to study for the boards (these were not really "board-style" in that they tend to be lengthier than the real thing. The prime learning value in these was the explanations of answers right and wrong, which was helpful for how the boards might want you to get to an answer). Each year I was in residency I got a new edition of all the above. This comes through the AAP. There is no other "recall bank" that I am aware of.
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pgg said:
... If there's anything shocking about the whole thing, it's how long it's taken for it all to blow up.

The ABR is sure deserving of plenty of blame, but I'm still left shaking my head and wondering what all these radiologists thought was going to happen.
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not shocking at all. The ABR didn't have a problem with this practice until CNN did.
 
Law2Doc said:
For the inservice a lot of the absite question books are essentially recalls though.
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I'm not specifically familiar with the absite question books you're referring to, but every published review question book for every specialty has "questions" that are "essentially" the same as what appear on the exam. That's the point. There are only so many ways to construct a question about a specific topic; no Board can copyright "what is the treatment for X complication from Y treatment of Z disease process."

For example, Hall has published a book of ~1000 anesthesia board-style questions based on the subject outline published by the American Board of Anesthesiology, actual released old ABA exams, and (probably) remembered topics from actual test takers.

Creating original material is not the same thing as copying the Board's exams, so I don't quite get where you conclude that the existence of commercially published review books is a defense of an exam recall scheme.

You're working awfully hard to pretend there's absolutely nothing the least bit shady about residents teaming up to divide-and-conquer memorize portions of an exam, after explicitly agreeing not to do so, for the purpose of compiling extensive databases of actual exam questions, known to reappear year after year on the specialty board exam.

So far the defenses I've heard are
a) everybody's doing it!
b) but the ABR must've known and been OK with it!
c) the radiology written test is too hard to pass otherwise!
All of which may be true, but completely oblique to the point.

And maybe you're not surprised by any of this, but I just don't believe that anyone participating in this kind of scheme (per A above, presumably "everybody") never considered or worried that it might come back to bite them, even if they smirked or rolled their eyes when signing the "I will not purposely memorize and share the questions on this exam" legal boilerplate.

I absolutely believe the ABR knew about the recall schemes and looked the other way. I guess the root of my surprise here is that so many people didn't recognize or believe that it was inevitable that eventually the ABR would get publicly cornered into not being able to ignore it any more. And that when the day came, the people left holding the bag, looking bad, and facing consequences would be the residents doing the recalling.

Short version: Did you guys really not think this day was coming?
 
interesting post, ppg. but it remains to be seen if there are any real repercussions, for either test takers or the ABR. i've not heard any stories elsewhere on this topic, so perhaps there won't be.
 
mlw03 said:
interesting post, ppg. but it remains to be seen if there are any real repercussions, for either test takers or the ABR. i've not heard any stories elsewhere on this topic, so perhaps there won't be.
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If you surf the web there is fairly significant outcry throughout the field of radiology against the statements of the ABR reps, including multiple petitions for their removal. I'm thinking the only repercussions, if any, will be to throw these guys out in the street for pretty much calling many generations of radiologists cheaters. They sold out their entire constituency.
 
pgg said:
So far the defenses I've heard are
a) everybody's doing it!
b) but the ABR must've known and been OK with it!
c) the radiology written test is too hard to pass otherwise!
All of which may be true, but completely oblique to the point.
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Actually, the best one is:

If it's cheating to have seen the previous years' questions, how is it that anyone who fails is ever allowed to re-write?
 
I don't recall the exact wording of the agreement I signed when taking the written rad boards, it being some 19 yrs ago, but I remember the discussion about recalls with attendings, including a past president of theACR, and a member of the ABR, and the gist of it was that you agree not to provide verbatim questions and answers to those taking that year's test.

Recalls in my residency were in the form of "they asked about this-know it", even though some took the form of questions, none was verbatim, and in no way could you possibly simply memorize a question and provided answer. Our bank of questions and topics was 100s if not 1000s, and were traded with all other residencies, all of which did the same. We all made a point of taking a select packet of recalls to the AFIP, as did other residencies, for trades, and the Kinko's by Walter Reed did a fine business. My father is a rad, and talked about their recall sessions in 1971. The ABR obviously has full knowledge of the general practice. In this form, this is in no way cheating, but effective study.

As for those who say they wouldn't ask a rad resident about an anesthetic drug, or what antibiotic to use for a particular infection, of course they would and do...it's the ABR. Many of the "solutions" denoted above are valid, but the bottom line is that it is unreasonable and irrational to expect anyone to go into a board exam without a reasonable empirical idea of what to expect.
 
I don't recall the exact wording of the agreement I signed when taking the written rad boards, it being some 19 yrs ago, but I remember the discussion about recalls with attendings, including a past president of theACR, and a member of the ABR, and the gist of it was that you agree not to provide verbatim questions and answers to those taking that year's test.

Recalls in my residency were in the form of "they asked about this-know it", even though some took the form of questions, none was verbatim, and in no way could you possibly simply memorize a question and provided answer. Our bank of questions and topics was 100s if not 1000s, and were traded with all other residencies, all of which did the same. We all made a point of taking a select packet of recalls to the AFIP, as did other residencies, for trades, and the Kinko's by Walter Reed did a fine business. My father is a rad, and talked about their recall sessions in 1971. The ABR obviously has full knowledge of the general practice. In this form, this is in no way cheating, but effective study.

As for those who say they wouldn't ask a rad resident about an anesthetic drug, or what antibiotic to use for a particular infection, of course they would and do...it's the ABR. Many of the "solutions" denoted above are valid, but the bottom line is that it is unreasonable and irrational to expect anyone to go into a board exam without a reasonable empirical idea of what to expect.
 
dukerad: Do you distinguish between "they asked about this - know it" versus organized memorizing of exact questions and answer options? the former is what i had in pathology (which is ok, in my opinion), while i consider the latter crossing a line into the domain of cheating.
 
Buzz Me As far as I know, surgery doesn't have a "recall" bank of questions for the written boards either.

The general surgeons I,ve talked to describe exactly the same practice among many residencies.
 
I do consider assigning individuals to specifically commit to memory question x through y with verbatim answers for the express purpose of reproducing the exam crossing a line, and is the activity that my understanding of the test agreement forbids.
 
mlw03 said:
dukerad: Do you distinguish between "they asked about this - know it" versus organized memorizing of exact questions and answer options? the former is what i had in pathology (which is ok, in my opinion), while i consider the latter crossing a line into the domain of cheating.
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If you look at it hard enough you will find these two scenarios are the same. In my opinion it should be dealt with by exposing the old exams to everyone.

What is the bottom line for the broads? Do they like to be ambiguous? Do they enjoy failing candidates? Are they testing the required knowledge and skills to practice that specialty, hence decide the competency? What is their reason of existence? I am trying to understand their job and not dismissing them.:poke:
 
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pgg said:
You're working awfully hard to pretend there's absolutely nothing the least bit shady about residents teaming up to divide-and-conquer memorize portions of an exam, after explicitly agreeing not to do so, for the purpose of compiling extensive databases of actual exam questions, known to reappear year after year on the specialty board exam.


Short version: Did you guys really not think this day was coming?
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While Im sure that happened in some instances, it was a small minority. I certainly never witnessed nor participated in any scheme to memorize specific questions.

Which is why radiologists are so pissed, the CNN story and the ABR in it's incompetent answer made it seem as though every radiologist was involved in some conspiracy to memorize exam questions. Just simply not true.
 
I just don't see it that way. I agree it's a slippery slope in a sense, but as a pathologist I've been taught to think about diagnostic thresholds. As in, are these cells atypical or do they cross the line into malignant? I'm glad folks are thinking about and discussing this. I do not think they are the same scenarios for a few reasons. 1) the organized effort to divide up the exam into memorizable portions and 2) memorizing the exact wording of the questions and the answer choices.

so while I agree there is value in releasing old exams, i differ in my interpretation of what's occurring. I'd counter by asking you to explain why you feel the scenarios are the same.

MD forever said:
If you look at it hard enough you will find these two scenarios are the same. In my opinion it should be dealt with by exposing the old exams to everyone.

What is the bottom line if these broads? Do they like to be ambiguous? Do they enjoy failing candidates? Are they testing the required knowledge and skills to practice that specialty, hence decide the competency? What is their reason of existence? I am trying to understand their job and not dismissing them.:poke:
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Two guys went to the move theater, one illegally video taped the move, the other just go home and told the story from his memory. You are the great grand mother of any of these guys, will you be excited to bye ticket for this move!

One faculty member who is newly graduated and passed the Boards, while teaching his/her residents come across data being extensively tested and from his/ her memory tried to explore and cover details because there were very interested residents who barraged him/ her with further inquires and questions.

Take the different companies out there in the market and how they being rated, true business life, If you know this company being classified by exam takers as low exam yield, will you spend your bucks on that company?

Do you think those companies who always maintained high acuity because of chance?

Speaking of diagnostic threshold, Patients with colon adenoma, why need to be followed extensively before turning into malignancy. Will it never transform to malignancy or it just about when?. Same thing for diabetes and impaired glucose.
 
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MD forever said:
Two guys went to the move theater, one illegally video taped the move, the other just go home and told the story from his memory. You are the great grand mother of any of these guys, will you be excited to bye ticket for this move!

One faculty member who is newly graduated and passed the Boards, while teaching his/her residents come across data being extensively tested and from his/ her memory tried to explore and cover details because there were very interested residents who barraged him/ her with further inquires and questions.

Take the different companies out there in the market and how they being rated, true business life, If you know this company being classified by exam takers as low exam yield, will you spend your bucks on that company?

Do you think those companies who always maintained high acuity because of chance?

Speaking of diagnostic threshold, Patients with colon adenoma, why need to be followed extensively before turning into malignancy. Will it never transform to malignancy or it just about when?. Same thing for diabetes and impaired glucose.
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What...the...hell?

My great grandmother is going to get diabetes and colon cancer because my cousin videotaped a movie?
 
dukerad said:
Buzz Me As far as I know, surgery doesn't have a "recall" bank of questions for the written boards either.

The general surgeons I,ve talked to describe exactly the same practice among many residencies.
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I believe they were less strict/aggressive about this type of thing 5-10 years ago (probably because the internet can disseminate the info much farther and faster than it could be in the past, when it was only by word of mouth and xeroxed notes) than they are now.

The ABS sends out emails and statements stating clearly that anyone who takes the ABS QE/CE who discloses exam (written or oral) questions or topics or distributes them will have disciplinary action and are likely to lose their BC/BE status permanently. They are very clear on this, and that they can and will look for patterns among people from the same program as well. I got multiple paranoia-inducing communications from ABS about this throughout the BC process. It's just not worth the risk of getting caught with illegal material.
 
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gutonc said:
What...the...hell?
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Together we can stop Bullying.

"A bully is a victim of ------- him/herself " Is that true?

If you know better you do----------:cool:
 
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Smurfette said:
I believe they were less strict/aggressive about this type of thing 5-10 years ago (probably because the internet can disseminate the info much farther and faster than it could be in the past, when it was only by word of mouth and xeroxed notes) than they are now.
.
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That is correct, I would like to add, remember during that time there was no Wikileaks. The idea of trying to control the information belong to era of human history, when there were only two super powers dominated the world. Today the genie is already out from the bottle.There is no use no one can stop it now. So better share these exams to everybody.
 
Cheating is whatever the test administrator says it is. If there are no rules to break, then it's not cheating. The verbiage matters. Some teachers/professors/etc. encourage discussing pop quizzes and exams, perhaps because they want their students to learn the information for subsequent exams and perhaps because they write new exams every semester. Others rigorously guard their exams and their limited bank of questions and consider a wide myriad of things "cheating". I don't know exactly what the radiology contracts/policies all say regarding the issue, and I don't recall what I had to sign or click through for pathology.. merely that the topic was addressed somehow. Strictly speaking, I think the wording matters.

I also think one could argue the validity of any of the board exams to accomplish their stated goal, which is usually something along the lines of assuring a minimum level of competency in that discipline, when for the most part all they do is ensure one is able to answer a certain limited number of questions correctly. But it's about the most reasonable way we have to document one's ability to "do what it takes" to obtain board certification, and may be a reasonable -predictor- of minimum competency if not necessarily an independent gauge.

As for having any specialty board generate an entirely new exam every year -- it can be astonishingly difficult to get people who intentionally sign up for exam committees (i.e., people who presumably -want- to) to each submit even half a dozen new questions every year. It sounds easy, but in practice it just ain't. This is one reason why board exams tend to "lag" behind cutting edge practice -- it just takes that long to slowly replace outdated questions. Furthermore, if a new exam was written every year, the already common complaint of "But I don't know what kind of things are going to be on the boards!" I think would magnify exponentially, because -nobody- knows what's going to be on the next year's boards, and indeed it could be dramatically different in style, content, and/or difficulty from the previous, which doesn't sound exactly fair.

What I see in this thread suggests that most specialties use some form of either formal study source or informal remembrances/qbanks. As I'm not aware of a particular failing of any of those "affected" specialties, then it sounds as if the system -- imperfect as it may be -- is accomplishing its primary end. That being the case, I would be cautious in suggesting any sweeping "reforms" to same -- though some agreement between contract/policies and actual practice within a given specialty would be preferred.
 
MD forever said:
That is correct, I would like to add, remember during that time there was no Wikileaks. The idea of trying to control the information belong to era of human history, when there were only two super powers dominated the world. Today the genie is already out from the bottle.There is no use no one can stop it now. So better share these exams to everybody.
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I think he's posting verbal Rorschach tests. I think here he is talking about the history of steroid use for the treatment of sepsis.

FWIW, Emergency Medicine's semi-official written board prep sounds similar to peds and surgery (with PEER instead of PREP or ABSITE). We sign agreements not to divulge test questions and are threatened with loss of board status (or never getting to sit for the board if caught reproducing in-service questions). We're also warned not to discuss the material tested on the oral boards under same penalty.

That being said, the EM boards seem to have become significantly more clinical than used to be the case (looking at old review material vs. current), with far fewer "what is the biochemical pathway" questions.
 
ketamine said:
This problem was created by the laziness of the medical boards. Is the subject area so limited that the medical boards can’t create a new exam every year?

Board exams should be published, soon after they are administered. All old exams for the last 7 to 10 years should be available for purchase by anyone. This will quickly stop the process of “cheating by remembering questions” but more importantly exams would be open. Bad questions could be debated and eliminated, thus improving the quality of the exam.

Exams published soon after they are administered are the only way to assure that the process is fair, honest, and transparent. Open exams will allow the public to be to be confidence of the system. Publishing exams will allow residents and attending to debate the contents of the exam, and thus the relevance of the exam.
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Agreed. Exams should be written anew each year, or there should be such a vast question bank that if you actually knew all the answers, it would only be because you knew all the material by the time you finished.
 
valkener said:
I'm pretty sure Kaplan et al would get sued by the AAMC if they would publish 1:1 exact questions and materials by the testmakers. I think there is an important distinction to make here, but I don't want to repeat myself.

I also think it's almost an invitation to cheat to use the same tests again and again, but it's still not an excuse imo, especially if these are 1:1 - especially if the test is unrealistically hard.
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I had essentially identical questions on the USMLE as UWorld.
 
TheProwler said:
... or there should be such a vast question bank that if you actually knew all the answers, it would only be because you knew all the material by the time you finished.
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In radiology if this has been going on since at least the 80s as suggested elsewhere, that's 200 questions a year for 30 years (ie 6000 questions floating around). That's bigger than any qbank you'll find elsewhere.
 
Law2Doc said:
In radiology if this has been going on since at least the 80s as suggested elsewhere, that's 200 questions a year for 30 years (ie 6000 questions floating around). That's bigger than any qbank you'll find elsewhere.
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Except that they reuse half of them each year
 
I really am not seeing why there are those that have difficulty in drawing a distinction between commerically available test prep question banks and the use of "recalls" in radiology. I think it's safe to say that those who use the commercial qbanks do so under the assumption that the questions were independently developed by the test/board prep company, and not purloined from past administrations of the examination. Having that knowledge, I think, makes all the difference. I cannot see how anyone could say it is not a form of cheating if the questions were never intended for release by the ABR.

It is not my intent to pass judgement on those who have used the recalls. I believe anyone who has been through medical school and residency and has had to endure the endless gauntlet of licensing exams has an appreciation for their proclivity towards the esoteric. If anything, I think the CNN program reflected badly on the ABR more than anything else. Not just because they denied having knowledge of something they must have been aware of but also because their exam seems to lack clinical relevance.

Board exams should possess the validity to ensure a minimal level of competence considered necessary to practice within the field which one would assume a board-eligible candidate who had successfully completed a 4-year radiology program would possess. If the case, as stated by one of the residents they interviewed, is that a significant proportion of candidates would fail without use of the recalls, then the problem is most likely not the residents or program but the exam itself. The ABR should take this opportunity to revamp the board exam so that it accurately reflects current clinical practice.

Interestingly, not much of the discussion on this thread has surrounded the "real" ethical breach mentioned in the CNN special regarding the 140 physicians who had their ABIM certification revoked. The following quote was taken from the ABIM press release regarding the issue:

“Sharing test questions from memory is a serious problem that threatens the integrity of all standardized testing. Test takers need to know that this kind of ‘brain dumping’ is grossly unethical,” said Dr. Cassel. “Ethics are critical to the practice of medicine and are the foundation of a successful doctor-patient relationship. We will not tolerate unethical behavior from physicians seeking board certification.”

That's a pretty unequivocal denunciation of the practice of recalling test questions, and one that I don't think any amount of arguing over semantics is going to change.
 
wooster201106 said:
I really am not seeing why there are those that have difficulty in drawing a distinction between commerically available test prep question banks and the use of "recalls" in radiology. I think it's safe to say that those who use the commercial qbanks do so under the assumption that the questions were independently developed by the test/board prep company, and not purloined from past administrations of the examination...
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Here's the problem with your statement. First, some of us have seen exact duplicates of questions on qbanks and on the USMLE. That means either the companies are obtaining recalls or the USMLE is stealing from the prep companies. Second, a lot of people have known folks who were debriefed on what was on various standardized tests by test prep folks over the years. It happens. Third, prep courses have been known over the years to send in people to sit for tests expressly for the purpose of obtaining questions. Probably not specialty boards since you have to clear too many hurdles first, but certainly other standardized tests we all have taken over the years. Finally, if you really are still have trouble believing this is going on, as noted earlier in this thread, the Arora prep course was sued just over a year ago for pretty much exactly the same thing by the Internal Medicine board for blatantly having it's students provide them with questions after each test. They got caught because they were more blatant about it, advertised the fact, and the case was more or less meant as a warning shot for all of the other, bigger, test prep courses out there that everybody knows were doing similar things. Most of the Arora case has been quietly settled with all the participants involved, although there is one doctor with ongoing litigation against the ABIM working it's way through the courts to date.

So at any rate we know for a certainty that there are companies using or which have used questions which were not " independently developed", perhaps mixed in with their own variations on existing questions. we know this because one company got caught and was made an example of about a year ago. that ship has sailed. You cant make that argument with a straight face, any more. There's a court case in the federal courts of Pennsylvania that proves otherwise, that this has in fact been going on.

So you can still argue this was or wasn't cheating, but you can't really make the distinction that using test prep materials is akin to using independently developed stuff. The only difference is that you are paying for it, you don't know for sure where the questions came from, and you perhaps dont personally know the person who violated their nondisclosure agreement to get you these questions. Maybe that makes you sleep better, but I still think it's the "It's not cheating on your wife if it's a prostitute "phenomena. Ethically the ground is just as just as muddy.

I think the real issue isn't whether or not this goes on, because it does. The question is whether studying old tests is cheating, or studying. If you have a question bank of 4000 old test questions, regardless of how it was obtained, and you are working through it to prepare for a 200 question test, most of which will be novel questions, are you studying or cheating. I mean you aren't memorizing that the answer to question 2416 is "a", and 2417 is "b". You are trying to learn what tidbit they thought was important to know about interstitial lung disease on a prior test. Isnt this how people have studied for every single standardized test in their entire professional life?
 
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Law2Doc said:
Here's the problem with your statement. First, some of us have seen exact duplicates of questions on qbanks and on the USMLE...Second, a lot of people have known folks who were debriefed on what was on various standardized tests by test prep folks over the years. It happens. Third, prep courses have been known over the years to send in people to sit for tests expressly for the purpose of obtaining questions...So at any rate we know for a certainty that there are companies using or which have used questions which were not " independently developed", perhaps mixed in with their own variations on existing questions. we know this because one company got caught and was made an example of about a year ago. that ship has sailed. You cant make that argument with a straight face, any more...

So you can still argue this was or wasn't cheating, but you can't really make the distinction that using test prep materials is akin to using independently developed stuff. The only difference is that you are paying for it, you don't know for sure where the questions came from, and you perhaps dont personally know the person who violated their nondisclosure agreement to get you these questions. Maybe that makes you sleep better, but I still think it's the "It's not cheating on your wife if it's a prostitute "phenomena. Ethically the ground is just as just as muddy.
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I don't deny that the practice exists. I never claimed it didn't and I am aware of some of the instances that have happened. However, a lot of what you mentioned sounds like hearsay. If the popular commercially available qbanks bore enough similarity to their actual respective exams, I'm sure there would be no hesitation to file a lawsuit for copyright-infringement. I don't know for sure where the qbank questions come from, but I doubt you do either. To presume all commercial qbanks have elements that were obtained fraudulently without any proof would be presumptuous and irresponsible. I understand your position but the argument that the use of recalls is fundamentally the same as using commercial qbanks is one with which I cannot agree.

The question is whether studying old tests is cheating, or studying. If you have a question bank of 4000 old test questions, regardless of how it was obtained, and you are working through it to prepare for a 200 question test, most of which will be novel questions, are you studying or cheating. I mean you aren't memorizing that the answer to question 2416 is "a", and 2417 is "b". You are trying to learn what tidbit they thought was important to know about interstitial lung disease on a prior test. Isnt this how people have studied for every single standardized test in their entire professional life
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Why can't it be both? If I provide you with questions phrased in a similar way or context to how they appeared on the actual exam, but not the actual answers, you would still have to review that topic to answer the question correctly on future exams. In that case, you would still have to study, but, I would have essentially provided you with a blueprint of the topics covered and, most importantly, the context in which they are tested. You would have been given an unfair advantage over someone who did not have the topics pared down and were not as able to narrow their focus while preparing for the actual exam.

You might argue that commercial qbanks may be able to do the same thing, but what are the odds they will match the accuracy of "recalls" with the same frequency and consistency when it comes to the real deal. You could easily argue that the few that do match are due to pure coincidence. Having to study, rather than just having to memorize an answer because you weren't provided the questions and answers verbatim, doesn't mean it is not a form of cheating if you knew exactly what to study.
 
Law2Doc said:
If you have a question bank of 4000 old test questions, regardless of how it was obtained, and you are working through it to prepare for a 200 question test, most of which will be novel questions, are you studying or cheating. I mean you aren't memorizing that the answer to question 2416 is "a", and 2417 is "b". You are trying to learn what tidbit they thought was important to know about interstitial lung disease on a prior test. Isnt this how people have studied for every single standardized test in their entire professional life?
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I'd call it effective studying and not the slightest bit unethical.

You of all people though, with your lawyerly background :), surely recognize that activities exist that most everyone would regard as morally or ethically OK, yet still run afoul of rules and contracts. Even if sometimes those contracts are only "voluntary" in the loosest sense of the word, like the ones we sign to take board exams.

And that at least, is the source of my incredularity over this particular issue. Every radiology resident who contributed to these qbanks surely understood that there was risk (however low) in ignoring the ABR's rules (however silly).

Risk isn't just a word though, and here we are ...
 
Everyone that is talking about the unethical behavior of those taking the exams and knowing what questions will be on the test keeps failing to answer this question:

If you fail, why are you allowed to take the test again? You've seen all the questions, you'll remember many of them, and you will use that knowledge to take the test next time. If they are allowed to take the exam, the policy is de facto violated every time a candidate is allowed to re-take an exam. But, they are allowed to re-take the exam. So, they don't really care about the policy and their ridiculous responses ("OH MY GOD! RESIDENTS ARE USING RECALLS! WE HAD NO IDEA!!") are just window dressing and media crap.

Those people not in radiology or radiation oncology (i.e. under the ABR's jurisdiction) have no idea what they are talking about. Look at the information that the ABR provides about the radiation oncology exams: http://www.theabr.org/ic-ro-study.

There is not one practice question, a link to practice questions, old exam question releases, or anything of the sort that the ABR provides. The oral exam lists every malignancy known, yet those that have taken the exam know that adrenal cancer, ovarian cancer, fallopian tube cancer, and many others are never tested. In fact, if faculty didn't do mock exams with us (based on exams that they have given to other examinees) for the residents, the oral boards would be an utter disaster - the pass rate would be around 20%. But, no one is going to bust on the chair of GU oncology at Harvard or the the leading breast cancer specialist wherever for giving mock exams to residents, even though that by definition is a "recall" and should be illegal. However, since there are no materials given to the residents, no release of old cases, no videos developed by the ABR to show how a case is presented, even the most ethical oncologists in the country are forced to violate the ABR's insane policy (that they don't even believe in, because they allow doctors to re-take the exact same exam) to make sure that more than 1 out of 5 graduating residents are able to get board certified.

This whole thing is such a farce. To have people from other specialties say otherwise is sanctimonious bullcrap. MKSAP is recalls. ABSITE is recalls. QBank is recalls. There is a book for the surgery rotation and shelf exam called "Surgical Recall" that has sold 10s of thousands of copies. You can call it otherwise, and pretend it's different because a company provides it and makes money off of it, but it's the same thing.

The radiologists are being given a bum rap. These are the students and residents that got into medical school, did extremely well during their classes and rotations, rocked the boards, and got into one of the hardest residencies to get into. 99% of them use recalls and that doesn't mean 99% of them are cheaters, unethical, or anything of the sort. They were STUDYING for an exam that has no material that one can study from. It's so easy to call 99% of an entire specialty cheaters, but I dare you to question a board certified diagnostic radiologist on his/her ethics and morality to their face or question their interpretation of images, because you think they wrongly passed a test they should have failed. Seriously, question one of their reads, and then bring up the fact that they likely cheated on their exam so they probably have no idea what they are talking about.
 
I'm thinking that people suggesting a new exam be written every year have not administered many standardized tests. If you want to change a colon to a semicolon in an answer stem it takes 2 months and 3 ad hoc committees.
 
very interesting discussion here.. cardiology fellow here. It bothers me to think that ABR's tests were not up to the mark for so many years. I am sure radiology residents pay hefty fees to take the examination. Testing esoteric facts 1/50 times or so to distinguish those who have good rote memory is okay. But if such questions accounted for a significant chunk, then I think the exam shd have been revamped a long time ago. It might be helpful for them to use test-making metrics that ABIM uses. The exam blueprints on ABIM website for test takers are also helpful.
We did not use recall in my internal medicine residency. During rotations and didactics it was emphasized what the important topics were. So when I prepared, I ensured that I had read the important and high yield topics from a review book( as i was doing a busy fellowship). Why can't taking radiology exams be as simple as this and more standardized?? Come one... with so many 99ers in a specialty, I am sure they wd have at least figured test design by now :)
 
SimulD said:
Everyone that is talking about the unethical behavior of those taking the exams and knowing what questions will be on the test keeps failing to answer this question:

If you fail, why are you allowed to take the test again? You've seen all the questions, you'll remember many of them, and you will use that knowledge to take the test next time. If they are allowed to take the exam, the policy is de facto violated every time a candidate is allowed to re-take an exam. But, they are allowed to re-take the exam. So, they don't really care about the policy and their ridiculous responses ("OH MY GOD! RESIDENTS ARE USING RECALLS! WE HAD NO IDEA!!") are just window dressing and media crap.

Those people not in radiology or radiation oncology (i.e. under the ABR's jurisdiction) have no idea what they are talking about. Look at the information that the ABR provides about the radiation oncology exams: http://www.theabr.org/ic-ro-study.

There is not one practice question, a link to practice questions, old exam question releases, or anything of the sort that the ABR provides. The oral exam lists every malignancy known, yet those that have taken the exam know that adrenal cancer, ovarian cancer, fallopian tube cancer, and many others are never tested. In fact, if faculty didn't do mock exams with us (based on exams that they have given to other examinees) for the residents, the oral boards would be an utter disaster - the pass rate would be around 20%. But, no one is going to bust on the chair of GU oncology at Harvard or the the leading breast cancer specialist wherever for giving mock exams to residents, even though that by definition is a "recall" and should be illegal. However, since there are no materials given to the residents, no release of old cases, no videos developed by the ABR to show how a case is presented, even the most ethical oncologists in the country are forced to violate the ABR's insane policy (that they don't even believe in, because they allow doctors to re-take the exact same exam) to make sure that more than 1 out of 5 graduating residents are able to get board certified.

This whole thing is such a farce. To have people from other specialties say otherwise is sanctimonious bullcrap. MKSAP is recalls. ABSITE is recalls. QBank is recalls. There is a book for the surgery rotation and shelf exam called "Surgical Recall" that has sold 10s of thousands of copies. You can call it otherwise, and pretend it's different because a company provides it and makes money off of it, but it's the same thing.

The radiologists are being given a bum rap. These are the students and residents that got into medical school, did extremely well during their classes and rotations, rocked the boards, and got into one of the hardest residencies to get into. 99% of them use recalls and that doesn't mean 99% of them are cheaters, unethical, or anything of the sort. They were STUDYING for an exam that has no material that one can study from. It's so easy to call 99% of an entire specialty cheaters, but I dare you to question a board certified diagnostic radiologist on his/her ethics and morality to their face or question their interpretation of images, because you think they wrongly passed a test they should have failed. Seriously, question one of their reads, and then bring up the fact that they likely cheated on their exam so they probably have no idea what they are talking about.
Click to expand...

I dont think that MKSAP is based on recall. However, it is designed by many people who know people who sit on exam writing committees (the academic 'mafia'). And to be honest for each disease in medicine, there are only so many different ways that you can develop a test question that will perform well. They rarely ask what the diagnosis is. Usually the questions expect test takers to pick a diagnostic option or select treatment option.

The questions on MKSAP are in fact a level or two above what one may find on the boards, and they tend to be longer than the ones on the boards. I honestly felt that I wasted too much time on MKSAP.
 
EPADHA said:
very interesting discussion here.. cardiology fellow here. It bothers me to think that ABR's tests were not up to the mark for so many years. I am sure radiology residents pay hefty fees to take the examination. Testing esoteric facts 1/50 times or so to distinguish those who have good rote memory is okay. But if such questions accounted for a significant chunk, then I think the exam shd have been revamped a long time ago. It might be helpful for them to use test-making metrics that ABIM uses. The exam blueprints on ABIM website for test takers are also helpful.
We did not use recall in my internal medicine residency. During rotations and didactics it was emphasized what the important topics were. So when I prepared, I ensured that I had read the important and high yield topics from a review book( as i was doing a busy fellowship). Why can't taking radiology exams be as simple as this and more standardized?? Come one... with so many 99ers in a specialty, I am sure they wd have at least figured test design by now :)
Click to expand...

The ABIM is currently still involved in litigation stemming from the Arora case a year ago precisely because they have been similarly lazy as the ABR, and continued to reuse a substantial percentage of test questions over and over again, so I'm not sure that's the shining example you want to hang your hat on. During rotations and didactics, how do you think your faculty knew what topics were the "important" ones? And that review book you used, how did it manage to luck onto the topics that were highest yield? This is all a form of recall. Somebody passed on info as to what kind of stuff was on the exam. It might not be verbatim, but the agreements boards make you sign cover this more generalized sharing of information equally draconianly. Whenever a faculty member giving a lecture says "this is important for the boards", by the terms of the board agreements, he is behaving unethically and you are technically "cheating". I think the problem is that to prepare for a test where there are no officially sanctioned study guides, and the scope is potentially infinite, the only thing you can study are the topics previously tested. You have no way of knowing what will appear on your test, or if you will see any repeat questions at all, and by that very fact you really don't meet any accepted definition of cheating. It's up to the boards to generate fair tests, not to put up roadblocks so that people can't prepare for them. The goal should be a test that tests for a certain level of expected knowledge, and if the residency programs do their jobs 100% should be able to pass. If boards are playing hide the ball thats problematic. Everyone should have access to what the board considers important. Protecting the integrity of the test by labeling generations of professional as cheaters isn't exactly a wise approach.
 
I think CNN has realized that they can make this a weekly story by working it's way through all the specialties. I'm not sure why the notion that doctors are merely cheaters who don't know squat is so appealing to the public, but it is.
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I think its a great way to make doctors look bad so that the upcoming reimbursement cuts will be agreed upon by the general public.
 
Substance said:
I think its a great way to make doctors look bad so that the upcoming reimbursement cuts will be agreed upon by the general public.
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Sure, but it's not the government or insurance companies who are pushing this story, it's CNN. They have decided that people tune in when you promo that their doctor may be a cheater. I think it's really an idea that the public wants to latch onto -- that any bozo could be a doctor, that they are no smarter than the average grocery bag boy, just someone who cheated their way to the top. I'm not sure why this is an appealing notion.
 
Law2Doc said:
Sure, but it's not the government or insurance companies who are pushing this story, it's CNN. They have decided that people tune in when you promo that their doctor may be a cheater. I think it's really an idea that the public wants to latch onto -- that any bozo could be a doctor, that they are no smarter than the average grocery bag boy, just someone who cheated their way to the top. I'm not sure why this is an appealing notion.
Click to expand...
The average person doesn't like the notion that people with more money than them just put in more hard work than them. This way, they can believe that the people with more money than them just cheated to get there. Now Average Person is more ethical than the cheating doctors rather than lazier than the hard-working doctors.
 
Law2Doc said:
I'm not sure why the notion that doctors are merely cheaters who don't know squat is so appealing to the public, but it is.
Click to expand...

Really?

This ain't the 1950s - doctors aren't held in the high regard they used to be.

When it comes to healthcare, its the hardworking, overworked, in-touch, sensitive, caring, tired (but not dangerously over-tired), working class (+/- single mom), no-nonsense, practical, common-sense, slang-speakin' NURSES that the public adores because they selflessly protect patients from those greedy, over-educated, insensitive, golf-addicted, BMW/Mercedes/Porsche-driving, impatient conversation-cut-offing DOCTORS.

We may not be hated like lawyers are, but doctor schadenfreude is a proven news headline winner.
 
pgg said:
Really?

This ain't the 1950s - doctors aren't held in the high regard they used to be.

When it comes to healthcare, its the hardworking, overworked, in-touch, sensitive, caring, tired (but not dangerously over-tired), working class (+/- single mom), no-nonsense, practical, common-sense, slang-speakin' NURSES that the public adores because they selflessly protect patients from those greedy, over-educated, insensitive, golf-addicted, BMW/Mercedes/Porsche-driving, impatient conversation-cut-offing DOCTORS.

We may not be hated like lawyers are, but doctor schadenfreude is a proven news headline winner.
Click to expand...

It's not an issue of whether the public holds a doctor in high regard, that eroded long ago. it's an issue of the other extreme, the public wanting to feel superior to their doctor, like it vindicates their own lack of success. I think that's different. And new.

FWIW, lawyers in some ways actually get more respect these days -- a story about cheating would never hurt lawyers because people want their lawyers to be unscrupulous.
 
Law2Doc said:
It's not an issue of whether the public holds a doctor in high regard, that eroded long ago. it's an issue of the other extreme, the public wanting to feel superior to their doctor, like it vindicates their own lack of success. I think that's different. And new.
Click to expand...

Could be ... interesting point.

Law2Doc said:
FWIW, lawyers in some ways actually get more respect these days -- a story about cheating would never hurt lawyers because people want their lawyers to be unscrupulous.
Click to expand...

Heh, awesome. :)
 
pgg said:
Really?

This ain't the 1950s - doctors aren't held in the high regard they used to be.

When it comes to healthcare, its the hardworking, overworked, in-touch, sensitive, caring, tired (but not dangerously over-tired), working class (+/- single mom), no-nonsense, practical, common-sense, slang-speakin' NURSES that the public adores because they selflessly protect patients from those greedy, over-educated, insensitive, golf-addicted, BMW/Mercedes/Porsche-driving, impatient conversation-cut-offing DOCTORS.

We may not be hated like lawyers are, but doctor schadenfreude is a proven news headline winner.
Click to expand...

Funny thing is that, at least at my academic institution, on the whole, the nurses are the ones driving the nicer cars. Sure...the full/endowed chair professors are rollin' in sweet rides. But everybody else is driving a 7-10 year old Volvo/Subaru/Mazda.

You wan to find the nicest cars on campus, follow the night shift nurses back to their cars @ 7:30am.
 
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