Physics & Radbio

[Mr RADical]

Anyone else really enjoy the Holiday Card sent out by the ABR today?

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Members don't see this ad.

 

[deleted947887]

Just want to reiterate how disgusting this field is.

 

[thecarbonionangle]

2/10 on card. missing Wallner, Kachnic and Giaccia in elf hats wishing all of you happy holidays. What a thoughtful field!!

 

[Tony&lisa]

I didn't see it. What did it say?

 

[trainee]

anyone willing to share hall notes/summaries?

 

[smith2009]

LK=Sarah Sanders

Bumpity bump

 

[KHE88]

anyone willing to share hall notes/summaries?

Not at one of the programs where residents memorize the test questions and pass them on to the next years class? Sucks for you!

The ABR doesn't care that people are cheating to pass this exam. What ever happened to their promise to look into differences in candidate performance on new vs. recycled questions at large vs. small program?

The reality is that small programs are cheating too. I've gotten names of a few of them.

If you graduated from a program that used recalls/had a recall system or know of such programs, please PM me. The recall story is the only way we can really hurt the ABR, and they deserve it because they engendered this. Using recycled questions on exams is totally unacceptable and needs to stop, period.

If you have databases of old questions, post them anonymously. The ABR is not honest, and this is the only way to force them to create an honest test. A couple of names have been dropped to me, but no hard evidence yet. How many of our peers are banking on using recall databases this time around? The ABR isn't the only one that doesn't want these questions made public I'm sure.

F'ing pathetic all around.

 

[Fpg1245]

https://www.google.com/amp/s/www.ws...-do-enough-graduates-pass-the-bar-11547391600

Wasn’t there an issue a few years ago with new law schools opening up flooding the market with these grads? I read it and immediately thought of ROs predicament.

 

[Tony&lisa]

Hey guys,
So its January and I haven't heard anything from the ABR in terms of a new study giude, early test options, ANYTHING that we heard they might be considering. Has anyone heard any updates? ARRO, anything from your end?

 

[XRTWarrior]

Hey guys,
So its January and I haven't heard anything from the ABR in terms of a new study giude, early test options, ANYTHING that we heard they might be considering. Has anyone heard any updates? ARRO, anything from your end?

Yes, it seems that the ABR updated pass rate statistics just this week (ABR) for a test that was given over 6 months ago. But hey, at least they stopped reporting pooled rates to conceal "little blips" from year to year. Hopefully a study guide may be available by 2024? Also, they promised a detailed analysis of banked and new questions that Dr. Kachnic did not include in her ARRO presentation because it would be "too complex for us to understand". I'm not going to hold my breath on that one.

 

[evilbooyaa]

@ARRO official 2018 would appreciate your outlook to the above question as it has been 6 months since day 0 now without significant movement.

 

[radoncresident59]

Looks like ARRO posted the most recent ABR letter. From the letter:
"Candidate performance on “used” versus “unused” items was psychometrically valid and reproducible, and in several instances, performance of failed candidates was actually better on the 2018 exam than the 2017 administration"

...are they finally admitting that the exam was harder and that 2018 candidates actually did better than 2017 candidates on the pool of questions that was in common between the two tests? Meaning the new questions were more difficult/is the reason for the higher fail rate? Even though the rest of the letter does not seem like ABR is admitting guilt, this is pretty damning

 

[RO28]

Looks like ARRO posted the most recent ABR letter. From the letter:
"Candidate performance on “used” versus “unused” items was psychometrically valid and reproducible, and in several instances, performance of failed candidates was actually better on the 2018 exam than the 2017 administration"

...are they finally admitting that the exam was harder and that 2018 candidates actually did better than 2017 candidates on the pool of questions that was in common between the two tests? Meaning the new questions were more difficult/is the reason for the higher fail rate? Even though the rest of the letter does not seem like ABR is admitting guilt, this is pretty damning

Could you please link the letter? I don’t see it on ARROs website

 

[Mandelin Rain]

Sounds like they were trying to prove that those that failed didn't fail due to lack of recalls.

 

[evilbooyaa]

Could you please link the letter? I don’t see it on ARROs website

 

[deleted947887]

A well-known northeast chair wanted cheap labor. That's why the exam rates were higher this year. He got that times three.

Looks like ARRO posted the most recent ABR letter. From the letter:
"Candidate performance on “used” versus “unused” items was psychometrically valid and reproducible, and in several instances, performance of failed candidates was actually better on the 2018 exam than the 2017 administration"

...are they finally admitting that the exam was harder and that 2018 candidates actually did better than 2017 candidates on the pool of questions that was in common between the two tests? Meaning the new questions were more difficult/is the reason for the higher fail rate? Even though the rest of the letter does not seem like ABR is admitting guilt, this is pretty damning

 

[RO2019]

Sounds like they were trying to prove that those that failed didn't fail due to lack of recalls.

this has been clear from the start, but yes good to see that fact.

this was never a recall issue.

it was a 'the 2018 test was much harder' issue

 

[taserlaser]

this has been clear from the start, but yes good to see that fact.

this was never a recall issue.

it was a 'the 2018 test was much harder' issue

It is the simplest and most obvious reason, despite all the stats and analysis. The new ones hadn’t lower Angoff scores, but probably weren’t low enough.

 

[taserlaser]

I should also add something else to the discussion: from my Canadian colleagues up North, I have heard that the ABR has reached out to the directors in Canada to try and understand why their pass rate was abysmal this year. I’m not sure what the historical rates of passing are (and Canadians aren’t any slouches either), but it sounds like 11 of them wrote this year, and only 2 passed radbio, and 5 passed physics. Ouch.

 

[Tony&lisa]

And it is absolutely stunning that the ABR is still assuming absolutely no responsibility for this massive screw-up

 

[Mandelin Rain]

Don't hold your breath.

 

[deleted947887]

Change Board Recertification

RICO added.

 

[it'sjustme]

With the 2019 physics and rad bio boards approaching, I was wondering if anyone was willing to share their study schedule/resources? Is everyone still planning on using Hall/Khan and ASTRO rad bio/Raphex exams or adding new materials to the mix given last year's scores?

 

[Tony&lisa]

I tried this about a month ago without response, but ARRO, any updates? So far we've vented and mouthed off in this echo chamber, mentioned all kinds of ideas, ARRO did end up putting out that impressive article and met with ABR representatives at ASTRO, but to this point, nothing has actually changed! The authoritarian leaders on top haven't done anything to give an inch or to help in any way, anyone who failed one of the test still feels completely screwed and with no guidance for what to do now, and 2 doctors, one of whom is probably riddled in conflict of interest, are still dictating our futures. ARRO, as our elected voice, is there anything being done to help this class of residents?

 

[RO28]

I should also add I have directly emailed one of the members on ARRO’s executive committee after your post a month ago and haven’t heard anything back personally either. I’m really, really disappointed in how this is turning out, but I can’t say I’m surprised.

 

[evilbooyaa]

Perhaps tagging them directly will help @ARRO official 2018

 

[Tony&lisa]

Thanks, I didn't know how to do that.

 

[KHE88]

The committee met last year in February according to their website, so I would imagine they are meeting now or have already met. If they produce a study guide like they indicated they would, I would be surprised if it will be specific enough to be that helpful. I imagine what facts are subjectively deemed "minimal clinical competence" will still be a tightly held secret (both by the ABR with the recall-generating programs lagging shortly behind).

No way around it. To get comfortably out of the fail-zone (if that's even possible, I don't know) where you won't fail by randomness or a few bad guesses (still waiting on those stats, ABR, as to the distribution of test takers right around the cut score), you have to spend months studying for this with every resource you can get your hands on to try and hit every low yield point. Of course, if you're cheating with recalls, that safety margin you need and the extra effort you have to put in is going to be less.

It's so gross how the ABR has just gotten away with this. I hoped we would have seen them called out in the literature for this. Nothing.
But hey, ABR, if you want to make it up to us, can you make 2020 the year you eliminate orals? We all know it's (rightfully) coming, and we'll call it even. Or you can just eliminate them in 2021 to reinforce how much you really despise our class in particular.

 

[radbioistheworst]

I spoke with an ARRO rep recently and was told there will be a 2019 ASTRO study guide released in April (pretty awesome how they just didn’t have one last year). There will also be an updated list of topics, apparently with more detail, and a list of references used to make the exam questions

 

[Mandelin Rain]

Study Guide:
1. Entirety of Radiation Biology
2. Entirety of Molecular Biology
3. Entirety of Cellular Biology
4. Entirety of Cancer Biology
5. Entirety of Immunology

Nail those 5 simple topics and you're probably set.

 

[ARRO]

Hi everyone - Thank you for your patience regarding the slow trickle of information and updates. We are planning to post an update in next week's ARROgram. We'd like to circle back around with ADROP and ABR, but if anything finalizes before our ARROgram is published we will post it here. What @radbioistheworst said is, to the best of our knowledge, correct. In addition, some further developments may be underway about which we hope to have more information soon.

As you've probably predicted, not every problem is going to be solved this year. We know that the progress we want to see is not going to be achieved as quickly as we (and you) would like, but we've honestly been heartened by the number of hard-working people who have engaged with us on this issue and spent a considerable amount of time trying to help affect change.

Please know that we will continue to passionately advocate on your behalf.

- ARRO Executive Committee

 

[nkmiami]

Study Guide:
1. Entirety of Radiation Biology
2. Entirety of Molecular Biology
3. Entirety of Cellular Biology
4. Entirety of Cancer Biology
5. Entirety of Immunology

Nail those 5 simple topics and you're probably set.

yes, residents should definitely study stuff about cancer and radiation.

 

[evilbooyaa]

Study Guide:
1. Entirety of Radiation Biology
2. Entirety of Molecular Biology
3. Entirety of Cellular Biology
4. Entirety of Cancer Biology
5. Entirety of Immunology

Nail those 5 simple topics and you're probably set.

Obtain PhDs in Cancer Biology and Immunology at minimum, probably Radiation Biology as well just to be safe.

 

[Mandelin Rain]

Obtain PhDs in Cancer Biology and Immunology at minimum, probably Radiation Biology as well just to be safe.

Do you really only want to be minimally competent?

 

[ARRO]

This afternoon, the ABR posted the updated study guides on their website (see attached).

They also sent a letter with the following to representatives of ARRO, ADROP, SCAROP, and ASTRO:

It is critical that the various constituencies involved in the process understand the purpose of the guides and a clarification:
1. Topics have been categorized and divided in a more granular fashion that should focus preparation better, and will certainly allow for improved understanding and usefulness of performance reporting.
2. References have been carefully selected to be highly useful to residents and candidates in exam preparation, and primary and secondary references will serve as the sources of a majority of exam items
3. It must be understood that the basic nature of science is fluid, and that in any given year, exam items may be added and not specifically referenced in the study guide. The number of such items would be limited.

 

[KHE88]

3. It must be understood that the basic nature of science is fluid, and that in any given year, exam items may be added and not specifically referenced in the study guide. The number of such items would be limited.

This last point is unacceptable, in my opinion. The scope is vague and it gives them an out for allowing creep of inappropriate questions in the exam. People shouldn't be failing exams of "minimal competence" because they got 1 or 2 new unreferenced questions wrong.

It should be the burden of the test makers to ensure that test questions can be answered from study resources. If the primary study resources are determined to be out of date and it is deemed imperative for a test of "minimal competence" to include a contemporaneous novel question, then at least the secondary resource list should be updated prior to the exam. In other words, the test content should lag the resource list, not lead it. An honest review of test content would ensure that 100% of questions can be answered definitively from reference materials.

So, no I'm sorry. I disagree with the ABR's assertion that "it must be understood." Says who? That's a rather bold thing to say. No, that's not understood. Sure, "science is fluid," but platitudes like that don't justify adding questions to an exam testing minimal competence that are not found in the most recent revisions of multiple comprehensive seminal textbooks in the field. And they undermine their own argument by going on the defensive that "the number of items would be limited." If it's truly about science being fluid, then so what if 100% of the questions are not in Hall or Joiner? Why is it ok for 5% to be out there, but not ok for 100%? Why are they defending that a few unreferenced questions are ok in a high stakes exam like this? That number should be exactly zero. Furthermore, what defines "limited"? 5%? 10%? 25%? Can't they see the problem with this subjectivity?

I am disappointed that they were not willing to implement a hard policy against including questions that cannot be answered from the complete resource list. If they want to add a question that is outside of the scope of Hall and Joiner, fine. I would argue that for an exam of "minimal competence," THREE primary textbooks should well assess for this, but regardless, fine -- if they really want to add a new question, then they should update the secondary resource list with a specific citation to cover it. And efforts should be made to keep the volume of this list reasonable and exclude redundant references.

This is a decent start, but my recommendation to representatives of the 4 groups this letter was sent to would be to strongly object to the language used in point #3 and push the ABR to implement a policy that has them review every question and ensure that it can be answered from listed resources and if not, either throw it out or update the reference list. At the very minimum make it a non-scored experimental question.

The second point I would like to make is that none of this addresses the primary problem with last year's test, which was the absurd difficulty of large numbers of the questions, which any reasonable person would be able to identify as well beyond "minimal competence" for safe clinical practice. It is still possible to produce a test full of irrelevant minutiae, which in some cases essentially boiled down to trivia like simply not getting the letters and numbers in three-letter-acronym combinations mixed up, all of which can technically be found in Hall or Joiner. The ABR has yet to comment or offer concessions on the problem with inappropriate question difficulty other than offering explanations like "clinicians approved of the clinical relevance of all questions" (paraphrased) despite overwhelming feedback suggesting strong disagreement with this assertion in the setting of a statistically improbable increase in failure rates.

At the end of the day, nobody is policing the ABR, they are accountable to no one, they essentially have a monopoly in the board certification business, and they may just say, "why is it our responsibility to tell the students and instructors what we are going to test? You should be able to figure out what's important yourself." And we can't do anything about that. But if they want to engender faith in the system, prove they are not taking advantage of their monopoly status, and demonstrate value of the board examination process, a good faith effort to communicate with residency programs exactly what they define as minimal competence is necessary.

 

[taserlaser]

Thanks for sharing this. I wonder how much of the cancer biology is covered on the med onc exam, ha!

This afternoon, the ABR posted the updated study guides on their website (see attached).

They also sent a letter with the following to representatives of ARRO, ADROP, SCAROP, and ASTRO:

It is critical that the various constituencies involved in the process understand the purpose of the guides and a clarification:
1. Topics have been categorized and divided in a more granular fashion that should focus preparation better, and will certainly allow for improved understanding and usefulness of performance reporting.
2. References have been carefully selected to be highly useful to residents and candidates in exam preparation, and primary and secondary references will serve as the sources of a majority of exam items
3. It must be understood that the basic nature of science is fluid, and that in any given year, exam items may be added and not specifically referenced in the study guide. The number of such items would be limited.

 

[RickyScott]

From Paul Wallner complaining about small programs months before the exam through this response, it is so clear that physics and bio exams are being used as ptretext to address residency expansion.

 

[Chartreuse Wombat]

Mediocre. No blueprint. No percentage of questions on the subjects listed. No indication that the Board thinks some subjects are more important. Weasel language alluded to above they basically says they can ask whatever they want; including material not listed on the study guide. This is antithetical to what a study guide should be. Is this really the best the Board can do?

 

[Chartreuse Wombat]

Thanks for sharing this. I wonder how much of the cancer biology is covered on the med onc exam, ha!

Taken from the ABIM website. For the fellowship examination in medical oncology, approximately 12-15% of the questions are devoted to cancer biology, genetics and tumor biology. At present 5.5 hours of test time is devoted to Medical Physics and Radiation Cancer Biology. This is greater than 50% of the test time. Is RadOnc that different?

 

[Gfunk6]

I read through the Rad Bio study guide.

WHERE'S THE TAQMAN???

 

[thecarbonionangle]

Calling this a “study guide” is insulting. Its a blank outline, pure mediocrity. here read these books and papers and you might be fine...... maybe. This is Embarassing. Well good luck folks!

 

[RadOncG]

This is a rubric not a study guide. It took them 6 months to make a rubric? Love our leadership. Wonder how many meetings this took?

@ARRO Please let the ABR know that your constituents would appreciate the study guide. What is attached is a useless joke.

 

[fiji128]

I took and passed the Rad/Bio exam a few years back. The outline seems to be about the same to what would've been previously tested except for these two sections.

IV Cancer Biology. sections (c) Mechanisms of cancer development seems much more extensive and (d) Cancer genetics/genomics also seems much more extensive. for example "TET2 mutations in AML" no idea what that is.

IX Combined Modality Therapy. sections (c) Immune Therapeutics. Not even a testable topic a few years back but obviously at the forefront today.

I would seriously question how well rad bio is being taught at many residency programs. In my residency, we essentially had no useful rad bio instruction and if you wanted to prepare for the test, the topics in the outline had to be essentially self learned. Why the ABR or whoever just don't post online lectures from instructors that know and cover these topics well that can also be remotely viewed so all residents are on the same page is an open question this day in age.

 

[scarbrtj]

Thanks for sharing this. I wonder how much of the cancer biology is covered on the med onc exam, ha!

Practically none of course. Which makes med oncs so stupid, rad oncs sooooo smart. *patting collective selves on back*
If med oncs did it the rad onc way, they would have questions like "calculate the magnetic moment present at the NH3 portion of the cisplatin molecule" or "which of the following industrial vats is used in the first synthesis steps for adriamycin"... you know, clinically important stuff...

 

[MadamCurie]

Wellllllll...it is an improvement, however I'm not sure it's going to solve all the world's problems. I still have a few quibbles though, in particular the ABR's insistence that this constitutes a "study guide". An outline is not a study guide!

• No relative "weights" for each topic vis-a-vis the exam, and related, no recommendation for all us incompetent educators as to how many lecture-hours should be devoted to each topic.

• Adding secondary references = good, even though a few are outdated (particularly the one about mechanisms of cell death).

• Mentioning alpha-beta ratios under the heading of "models of cell survival" only reinforces the INCORRECT notion that alpha-beta ratios used clinically are derived from cell survival curve parameters.

• And for the love of all that is sacred, it's the "4 (or 5) R's of Radiotherapy" not "of radiobiology" and definitely not "of fractionation". </pet peeve>

The biggest bit of good news? Adding the Joiner & van der Kogel textbook as a primary reference, which I have long maintained is superior to Hall & Giaccia.

 

[scarbrtj]

Dear ABR,

Compared to something like this for radiation oncology residents in another country, your study guides are inferior, unhelpful, and not informationally adequate in order to produce good radiation oncologists. Make America, specifically the American Board of Radiology, great again.

 

[scarbrtj]

Wellllllll...it is an improvement, however I'm not sure it's going to solve all the world's problems. I still have a few quibbles though, in particular the ABR's insistence that this constitutes a "study guide". An outline is not a study guide!

• No relative "weights" for each topic vis-a-vis the exam, and related, no recommendation for all us incompetent educators as to how many lecture-hours should be devoted to each topic.

• Adding secondary references = good, even though a few are outdated (particularly the one about mechanisms of cell death).

• Mentioning alpha-beta ratios under the heading of "models of cell survival" only reinforces the INCORRECT notion that alpha-beta ratios used clinically are derived from cell survival curve parameters.

• And for the love of all that is sacred, it's the "4 (or 5) R's of Radiotherapy" not "of radiobiology" and definitely not "of fractionation". </pet peeve>

The biggest bit of good news? Adding the Joiner & van der Kogel textbook as a primary reference, which I have long maintained is superior to Hall & Giaccia.

Pedantic, and nit-picky, but you are correct. It is so much better to be correct than incorrect, especially when death is on the line! Er, especially when making a board-certified physician is on the line. Like Twain said: What gets us into trouble is not what we don’t know, it’s what we know for sure that just ain’t so. The ABR knows a lot of stuff for sure it seems.

 

[Mandelin Rain]

I'm glad the ABR has decided to focus on certifying only competent bench scientists, during this moment in history where there is no money or jobs for bench scientists in radiation oncology.

Good on you ABR.

 

[multitudes]

ARRO, thank you for working on this. I have to believe that you're stuck between a rock and a hard place, trying to appease/be cordial with the leadership of ABR, ASTRO, and your own institutions. It's probably difficult to offer much push back. You are in an unenviable position, and I'm sure you didn't think you'd be stuck with all of this nonsense when you ran for your positions.

However, these study guides are a true disappointment. The radiobiology exam lists examples of pathways to know (which is admittedly potentially helpful), and is now 5 pages instead of 2 pages. Oh well, I thought, I'll just make sure to read (and re-read) all the sources of questions. The authors go on to suggest that primary source materials include an entire cancer biology textbook. An entire biology book!

The physics guideline seems relatively unchanged, with the addition of a few sources, but then again, this test wasn't the total out-of-left-field production that radiobiology was.

In short, I had been hopeful there would be some real guidance and a chance at a reasonable and fair exam, but these outlines paint a broader picture with numerous textbooks worth of information, without any real guidance on what is emphasized. While PGY4 and unfortunate PGY5s could be pursuing research or preparing for clinical boards, they instead have the unique opportunity to buy a collection of textbooks and try to read them all in a few short months.