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At some of the low end programs, the attendings are stealing masks from residents.
Stay safe
Jokes, just to be clear
At some of the low end programs, the attendings are stealing masks from residents.
Stay safe
Aren't the oral exams still given in hotel rooms?. It has been our custom to thoroughly clean every station and public area after an exam administration. Those efforts will only increase."
Behind the Tucson Greyhound stationAren't the oral exams still given in hotel rooms?
do these centers have private booths?What are the odds that the oral boards will be in person? Probably low in my opinion, the same people who decided to make ASTRO digital are some of the same people who are part of the ABR.
A digital oral boards is very doable. Use the same testing sites that we took our clinicals and rad bio. Have them set up computers with cameras in private booths. Done.
What are the odds that the oral boards will be in person? Probably low in my opinion, the same people who decided to make ASTRO digital are some of the same people who are part of the ABR.
A digital oral boards is very doable. Use the same testing sites that we took our clinicals and rad bio. Have them set up computers with cameras in private booths. Done.
What are the odds that the oral boards will be in person? Probably low in my opinion, the same people who decided to make ASTRO digital are some of the same people who are part of the ABR.
A digital oral boards is very doable. Use the same testing sites that we took our clinicals and rad bio. Have them set up computers with cameras in private booths. Done.
Taking it from Pearson won't work... all written exams have been postponed with no re-scheduled date as of yet.
I'm very skeptical that online ASTRO means online board exams.
Online board exams would be awesome. I’m more on the cynical side though, and worried there won’t be the infrastructure unless there’s an agreement made that each program proctors their own students, which I would find very unlikely. I also think a fall sitting for oral boards unlikely/a big Covid risk for everyone involved, between flying and congregating all in one place. Everyone is going to have masks available? Who’s going to supply them? I am just not sure how they’ll do this well.
This assumes those testing centers will even be open/amenable to this as well - which is unclear, considering decisions about written quals have yet to be made.
Knowing ABR workings a bit, I'm a bit skeptical that they'll be able to procure and commission a professional online platform on that short of a notice. Just DYO'ing oral boards by Zoom would not work.
This whole thing is so stupid.
Do you all remember when we took USMLE step 3?
They had this portion of the test that had a virtual case simulator.
There is ZERO reason why rad onc can't do this.
Create a test to be administered at Pearson that simply has a comprehensive written exam followed by a case simulator. Give the thing multiple times a year. Logitically EASY. Get more people certified and into their MOC scam.
DONE. ABR still gets their monies (with likely higher profit margin) and pretends to certify us as competent (with likely higher degree of confidence).
The in-person exam is a subjective archaic relic and needs to die a quick, painful death.
This whole thing is so stupid.
Do you all remember when we took USMLE step 3?
They had this portion of the test that had a virtual case simulator.
There is ZERO reason why rad onc can't do this.
Create a test to be administered at Pearson that simply has a comprehensive written exam followed by a case simulator. Give the thing multiple times a year. Logitically EASY. Get more people certified and into their MOC scam.
DONE. ABR still gets their monies (with likely higher profit margin) and pretends to certify us as competent (with likely higher degree of confidence).
The in-person exam is a subjective archaic relic and needs to die a quick, painful death.
Step 3-style virtual cases exercise is doable. It'll will take ABR awhile to build it and to refine it. It will not be available in Fall 2020. So, they are in a bind.
“There is something about a bureaucrat that does not like a poem”, said Gore Vidal. The ABR would not get paid for a poem, the crux of the issue.Crazy proposal:
End 4 board exams.
Have a single Step 3-esque written exam to be taken either at the end of residency or first year attending.
Include some radbio and physics pearls - i.e. how does radiation kill a cell? What happens to surface dose with increasing energy of electrons compared to photons? NEVER EVER EVER ASK AGAIN ABOUT SIGNALING PATHWAYS FOR A MINIMUM CLINICAL COMPETENCY EXAM OSTENSIBLY IN PLACE TO ENSURE PUBLIC SAFETY.
Problem solved.
“There is something about a bureaucrat that does not like a poem”, said Gore Vidal. The ABR would not get paid for a poem, the crux of the issue.
if you ever get a call from ABR saying “im from the ABR and i am here to help” You must run. We must run.
like Christopher Mcdougall said “Every morning in Africa, a gazelle wakes up, it knows it must outrun the fastest lion or it will be killed. Every morning in Africa, a lion wakes up. It knows it must run faster than the slowest gazelle, or it will starve. It doesn't matter whether you're the lion or a gazelle-when the sun comes up, you'd better be running.”
Lee WR, Amdur RJ. A Call for Change in the ABR Initial Certification Examination in Radiation Oncology. Int J Radiat Oncol Biol Phys. 2019;104(1):17‐20. doi:10.1016/j.ijrobp.2018.12.046Crazy proposal:
End 4 board exams.
Have a single Step 3-esque written exam to be taken either at the end of residency or first year attending.
Include some radbio and physics pearls - i.e. how does radiation kill a cell? What happens to surface dose with increasing energy of electrons compared to photons? NEVER EVER EVER ASK AGAIN ABOUT SIGNALING PATHWAYS FOR A MINIMUM CLINICAL COMPETENCY EXAM OSTENSIBLY IN PLACE TO ENSURE PUBLIC SAFETY.
Problem solved.
Lee WR, Amdur RJ. A Call for Change in the ABR Initial Certification Examination in Radiation Oncology. Int J Radiat Oncol Biol Phys. 2019;104(1):17‐20. doi:10.1016/j.ijrobp.2018.12.046
Lee WR, Amdur RJ. A Call for Change in the ABR Initial Certification Examination in Radiation Oncology. Int J Radiat Oncol Biol Phys. 2019;104(1):17‐20. doi:10.1016/j.ijrobp.2018.12.046
Separate issue but was mildly against program expansion back then and refused to increase the complement in the department where I was PD. Now the case for overtraining is a slam-dunk (can i use that phrase? pretty sure scarb will ding me for it). As i have said before the number to watch is US Seniors ranking RO and that number is falling off a cliff.what was your take on the Shah Editorial at the time, and has it changed since?
Lee WR, Amdur RJ. A Call for Change in the ABR Initial Certification Examination in Radiation Oncology. Int J Radiat Oncol Biol Phys. 2019;104(1):17‐20. doi:10.1016/j.ijrobp.2018.12.046
You mean the FMGs and the folks with a pulse like Wallner that matched in the 70s and 80s?While I completely agree, this was essentially dismissed by Wallner/Kachnic and the other ABR shills: https://www.redjournal.org/article/S0360-3016(19)30181-6/fulltext
The ABR has no interest in 'collaborating' as decreasing the number of exams will bring to light the reality of the ridiculousness of paying for 4 board exams on 3 separate days, and if those costs are added together for the purposes of one exam (as @elementaryschooleconomics suggests cheekily) will shine actual light on the situation and will bring pitchforks from more than just SDN and parts of twitter to their doorstep.
My favorite was the gaslighting line towards the end in their response:
"Practicing radiation oncologists owe a great debt of gratitude to the foresight of our founders, who elevated RO to a well-respected specialty in the house of medicine. Future generations of radiation oncologists should expect nothing less from us. "
I think we should separate and form ABRO. We'll have to buy the twitter account from that person though.
While I completely agree, this was essentially dismissed by Wallner/Kachnic and the other ABR shills: https://www.redjournal.org/article/S0360-3016(19)30181-6/fulltext
The ABR has no interest in 'collaborating' as decreasing the number of exams will bring to light the reality of the ridiculousness of paying for 4 board exams on 3 separate days, and if those costs are added together for the purposes of one exam (as @elementaryschooleconomics suggests cheekily) will shine actual light on the situation and will bring pitchforks from more than just SDN and parts of twitter to their doorstep.
My favorite was the gaslighting line towards the end in their response:
"Practicing radiation oncologists owe a great debt of gratitude to the foresight of our founders, who elevated RO to a well-respected specialty in the house of medicine. Future generations of radiation oncologists should expect nothing less from us. "
I think we should separate and form ABRO. We'll have to buy the twitter account from that person though.
The ABR gaslighting in general is just tremendous - and we are uniquely susceptible. As one of (if not the) smallest specialties you can match into directly after medical school, we have very little lobbying power from a sheer numbers perspective. The "keep your head down and get through it or get crushed" mentality is strong in RadOnc. This is why we're stuck with 4 board exams, two of which are essentially basic science.
In comparison, look at the USMLE Step I exam. Arguably, the "most important" exam in all of medicine for several decades, FINALLY made Pass/Fail. I would argue this was accomplished due to the sheer strength and number of voices. I think eliminating basic science board exams for a clinical specialty is much less controversial than making Step I Pass/Fail. If the 2018 Debacle followed by the COVID-19 pandemic doesn't force the ABR to examine the need and utility of making clinicians take the equivalent of poorly-designed PhD-candidate qualifying exams...literally nothing will.
While the oral boards are slightly harder to argue against (since those are somewhat common at least in the surgical world), I find the "implicit bias" concerns extremely compelling. To be honest, knowing some of the people in charge of this field - I find an "explicit bias" also compelling. It's disappointing that it took a global pandemic for this conversation to finally be elevated to the level that it has. However, I expect the ABR (and other senior leadership) to really dig their heels in about oral boards, while very similar arguments that were used against the USMLE Step I can be almost uniformly be applied here (bias, expense, utility, etc).
At the end of the day, I'm mostly left wondering about the real efficacy of the ABR. When I was in medical school, I essentially took "board certification" for granted. OF COURSE that was a good and righteous thing, necessary to practice medicine in America. I obviously can't speak for other specialties but - as it pertains to the ABR and Radiation Oncology - where is the evidence? Ostensibly, board certification through the ABR is supposed to protect the public from quacks and thieves. Is the current design successful in that? What's stopping us from examining the data?
What if we took a cohort of practicing RadOncs recently out of residency. It is my understanding you can practice as an attending with the "board eligible" moniker for at least 4 years after residency (assuming the 5 year clock of passing board exams starts at the end of PGY4). You could separate this group into three cohorts, randomly - those who passed all exams on the first attempt, those who failed exams but eventually passed them, and those who never passed all exams (probably a pretty small group). You could collect a representative sample of their case outcomes - toxicities, local recurrence, death - and then compare across the three groups. If the board exams do what they're supposed to do, I would hypothesize that the outcomes for those who passed all their exams on the first attempt should be better than the other two groups.
If the outcomes are roughly equivalent (as I suspect they are) - the current boarding system is not accomplishing what it should be. There should ALWAYS be barriers to protect the public - accredited residency, board certification, etc - but that DOES NOT MEAN we need to settle for a backwards system established through legacy.
Whether you agree with me or not on these specific points is immaterial - the only question we should be asking is "in America, is the current system in place to train and maintain the workforce of Radiation Oncologists operating in the most effective way possible?". Any answer other than "yes" means we are doing a disservice to our patients and society at large, and need to do better. We don't accept stagnation in our treatment regimens - why are we accepting stagnation in ourselves?
Medicine itself is in the middle of a big fight over this issue. When the dust settles the question will be if anybody did anything about it or like you said followed "keep head down" mentality which for whatever reason is a big majority of our field to my frustration. We seem to attract some really catfish like tortoises with no bite. For those who have not been following Dr. Paul Teirstein and his leadership of NBPAS, I really recommend you watch these videos. In one he debates the ABIM and in the other our very own ABR president Dr. Valerie Jackson. He exposes the corruption by being direct, honest, respectful. We cannot equivocate about these issues.
MOC Debate National Board of Physicians and Surgeons
MOC Debate National Board of Physicians and Surgeonsnbpas.org
In another thread, I linked again the ongoing lawsuit against the ABR which has been re-filed. There are ongoing lawsuits against ABIM and neuro/psych boards as well. There are ways to donate to these efforts if you google it. Anybody with means can contribute anonymously.
I'm tired of putting my head down. Are YOU?
These are great links - I had no idea about this guy!
I remember first hearing about people who were taking issue with the structure of MOC when I was in medical school and at the time couldn't fathom why anyone would do that. I'm so disappointed with how naive I was back then. There definitely seems to be growing momentum (at least in the Social Media sphere) of people questioning the structure of testing and board certification in Medicine...I guess I find myself in that camp now.
Heads up!
A slightly bigger cohort than us, hmm...
Sent from my iPhone using SDN
A slightly bigger cohort than us, hmm...
Sent from my iPhone using SDN
ABR could simply rent ABS's exact same method for what we need to do.
*EDIT* - Reading the twitter thread, this appears to be for the ABS's WRITTEN exam, not their oral exam.
Somewhat less exciting, but perhaps could be used for rad bio/physics/clinical writtens.
oh it's the written?
talk about BUZZ KILL
If a surgeon decides to do something, they get it done. I'd take a surgeon any day over a rad onc as a team-mate going into battle
if a rad onc decides to do something, first think of 10 reasons why it can't be done. Then have committees and committees to discuss why it cannot be done, and in the end get nothing done!
Sounds like admin!
I would never take a "cut first, think later" (which is their means to "getting it done" as mentioned above) individual as a teammate. ACOSOG and other surgical cooperative groups have no less bureaucracy than rad onc cooperative groups. Self-flagellation gets us nowhere.If a surgeon decides to do something, they get it done. I'd take a surgeon any day over a rad onc as a team-mate going into battle
if a rad onc decides to do something, first think of 10 reasons why it can't be done. Then have committees and committees to discuss why it cannot be done, and in the end get nothing done!
I would never take a "cut first, think later" (which is their means to "getting it done" as mentioned above) individual as a teammate. ACOSOG and other surgical cooperative groups have no less bureaucracy than rad onc cooperative groups. Self-flagellation gets us nowhere.
I would never take a "cut first, think later" (which is their means to "getting it done" as mentioned above) individual as a teammate. ACOSOG and other surgical cooperative groups have no less bureaucracy than rad onc cooperative groups. Self-flagellation gets us nowhere.
Maybe you should start supporting them more? Who does your port/pegs for H&N? In big academic centers, sometimes it just ends up with IR, but out in the real world, those are easy, quick cases that help surgeons survive.disagree. would take surgeon any day. They also would not take us because most surgeons don’t respect rad oncs. We just draw circles and do what they tell us. We are the catfish at tumor board, and we love their crumbs that trickle down. We bend the knee. The truth hurts, i know, but it has got to be said, folks!
Maybe you should start supporting them more? Who does your port/pegs for H&N? In big academic centers, sometimes it just ends up with IR, but out in the real world, those are easy, quick cases that help surgeons survive.