2024 Pathology boards pass rates

[ChicagoPath]

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[PathNeuroIMorFM]

Some of these are a lot lower than I'd expect. Can anyone chime in on why most pass rates aren't at least 90%? And retesters also don't perform well?

I imagine if you make it to residency you must be some degree of smart, motivated, etc. so I'm wondering why residents might struggle so much to pass, especially on the AP side.

 

[ChicagoPath]

Some of these are a lot lower than I'd expect. Can anyone chime in on why most pass rates aren't at least 90%? And retesters also don't perform well?

I imagine if you make it to residency you must be some degree of smart, motivated, etc. so I'm wondering why residents might struggle so much to pass, especially on the AP side.

What I find surprising is a whopping 135 people repeating AP. I attribute that to weaker candidates who get into path and training programs with weak didactics. If your program doesn’t have weekly unknown sessions or weekly slide conferences then you are in one of these weaker programs.

Don’t really know what else can be causing the low pass rates.

 

[SunBakedTrash]

Hopefully they really are making the exam more difficult. If you are not baseline proficient after 4 years, your program has failed you. It shouldn’t take 2-3 fellowships to fix that.

I also wonder if they are rewriting/modernizing questions? I finished residency in 2012 and there were still people (mostly surg path fellows from crap programs) using or saying they used remembrances effectively. Some of those microscope slides looked 30 years old.

 

[ScubaV]

Retesters generally don't perform well because whatever issue caused them to fail in the first place is usually not easily solvable. Poor training can't be redone and bad study habits or test-taking skills are hard to impossible to correct this late in your long schooling career. Most of those who subsequently pass probably had a temporary issue or went from barely failing to barely passing.

 

[pathres9999]

Whew, I feel for those that fail but ultimately could be good for job market in the long run. Maybe it'll also put more pressure on certain training programs. That AP pass rate seems to be trending down, hopefully it's because the test is harder and not that we are recruiting weaker physicians.

 

[pathres9999]

What I find surprising is a whopping 135 people repeating AP. I attribute that to weaker candidates who get into path and training programs with weak didactics. If your program doesn’t have weekly unknown sessions or weekly slide conferences then you are in one of these weaker programs.

Don’t really know what else can be causing the low pass rates.

I agree it's got to be weak candidates. Out of AP and CP, AP is the easier of the two and I think easiest to prepare for and more important for practice. The fail rate is pretty high, which is not what I'd call reassuring for the state of our professions training standards.

 

[HeyDalaron]

I can think of two reasons right now.

The first is that a high number of programs utilize residents as cheap labor for specimen grossing in lieu of paying PAs, without teaching them pathology, or having the appropriate volume and complexity of cases to prepare them. No amount of studying or 're-taking' the exam would result in success.

The second is that there are a lot of FMGs in pathology, whose educational credentials are difficult or impossible to verify. A relatively recent scandal involving over 800 Nepal-based test-takers having their USMLE scores invalidated due to cheating illustrates this point, and I do not think it should be considered controversial to talk about it.

 

[octopusprime]

Programs are loathe to give up residency spots, whether due to a dearth of volume & complexity or due to the need for grossing monkeys. But if there are programs that have routine higher-than-avg fail rates, I would hope the GME office would take note.

 

[Alteran]

In my era, which I don't think was too long ago, it was an overall pass rate of 90%. That it has dropped this much in about a decade I think speaks to the degradation of our field.

I believe this stems from a self perpetuating cycle that will be hard to break. Our field hasn't classically been associated with high-achievers and that perception also hasn't improved over time. My understanding is that Pathology is the default backup specialty for medical students trying to match into something even moderately competitive because they know we'll take anyone with a pulse. When this is coupled with at least 30% of the Pathology programs in the US being subpar, it isn't difficult to see why the current pass rates are what they are. As the applicant pool degenerates, the programs circle down the drain and the converse is also true.

These pass rates are really a barometer of how our field is doing and the quality of our future colleagues (which is to say not good) and our leadership should really take a hard look at the future applicant pool and work force (which they won't).

 

[mike-sheree]

As I recall in the 80s, it was a lot lower than it is now.

 

[PathNeuroIMorFM]

Also curious if better board score means better at their work.

Similar article about medicine performance and step 3 score (although written by NBME administrators, so major conflict of interest here):

The Associations Between United States Medical Licensing... : Academic Medicine

le for a process seeking to provide patients with safe and effective health care. Method This was a retrospective cohort study of 196,881 hospitalizations in Pennsylvania over a 3-year period (January 1, 2017 to December 31, 2019) for 5 primary diagnoses: heart failure, acute myocardial...

journals.lww.com

 

[KeratinPearls]

Hopefully they really are making the exam more difficult. If you are not baseline proficient after 4 years, your program has failed you. It shouldn’t take 2-3 fellowships to fix that.

You would think after 4 years a program can get a resident to pass the boards. What have these residents been doing for four years? Socializing and gossiping in the resident's room? Surfing Instagram all day?

What have the attendings been doing? Too busy to even teach (which Ive seen) or even worse dont even teach?

Where is the oversight by our leadership? Do we not have any standards in regards to programs that consistently produce graduates that fail or even drop CP to become AP only board certified? Does quantity trump quality?

These people fail and then fail again. What do they do without a job? Become a PA? You also have to question their diagnostic/practical skills as well. Groups are wary of who they hire for this reason. Poor diagnostic skills, etc.

As an aside, these people who fail AP boards should get into strong AP surgpath fellowship programs with good teaching and weekly unknown conferences, etc. I think that should help.

 

[Alteran]

What have the attendings been doing?

That is a very good question. For a resident or fellow to qualify for the board exam, it is my understanding that the program director has to attest that the resident/fellow has met the minimum educational and training qualifications to sit for the boards. It is as much a failure of the faculty as the resident for a resident to matriculate without the skill set to pass boards or successfully practice. How else could a resident get to 4th year having neither the knowledge to pass boards or skill set to successfully practice independently if not for the faculty just blindly promoting them up for failure.

 

[mike-sheree]

I have NEVER heard of a program director NOT attesting to the ability and readiness of one of their residents to sit for the boards. That would just reflect poorly on the program. And it would also point out that the candidate should never have been allowed to get to that situation.

 

[KeratinPearls]

Attendings should be held accountable for training their residents so they are HIGHLY COMPETENT when they practice and not treat them as a courier service. I’ve seen this happen and it’s despicable. Basically using residents to carry their slides with little to no teaching. These are the people that will go on to diagnose patient biopsies. There needs to be a high standard in training residents and not using them as technicians, personal secretaries or gross monkeys.

Posted on Reddit.

“What to do when your attendings especially the program director treat you like you are dumb and only makes you do scutwork like file cases pull cases organize cases deliver slides to her office etc and never let you do anything like order IHC or ever discuss difficult cases with you? The only times she ever tried to teach us the basic things that even a medical student should know. I am super annoyed and usually I try to be professional and hide it but the other day I think I acted annoyed and she could maybe tell”

“I empathize with this. I had a newer faculty member at my fellowship program ask me to do this stuff a lot, and our offices were on different floors. Granted she only did it during weeks I was on her service, but I felt it was a ****ty move. My fellowship director was good about advocating for me. I think it’s fair this late in fellowship to say you need to maximize your time doing physician tasks so you won’t always be free to be an errand boy/girl.”

 

[ScubaV]

Ideally only attendings who want to teach or are at least willing to put in a decent effort should work at an academic program with residents.

In reality, there's a lot of people who want to live in a certain area or want a more relaxed pace of work and their only options are academic institutions. Or they're an antisocial personality who only likes the research side of academia.

I don't want to be involved in teaching so I specifically only applied to jobs that didn't have residents. But with private groups dwindling and consolidation everywhere, chances are higher that you'll be forced to deal with students and residents at least some of the time, even if it's not a path residency or not at the mothership campus.

 

[coroner]

Some of these are a lot lower than I'd expect. Can anyone chime in on why most pass rates aren't at least 90%?

Don’t really know what else can be causing the low pass rates.

In my era, which I don't think was too long ago, it was an overall pass rate of 90%. That it has dropped this much in about a decade I think speaks to the degradation of our field.

The pass rate is not significantly lower than in recent years. For AP it's 86%. Even 10-15 yrs ago, AP ranged from the high 80s-low 90s. If you focus on the 76% pass rate for AP which is due to the re-testers and not reflective of the pass rate for first-time test takers, then of course it seems a lot worse. But, it's basically unchanged in the last 10-15 yrs.

The one thing I will say is AP & CP flipped i.e. 10-15 yrs ago, the CP pass rate lower than AP, and most people would say significantly harder. In recent years the CP pass rate has slightly exceeded that of AP which is surprising to me.

As I recall in the 80s, it was a lot lower than it is now.

Yep. I never saw the stats, but one of my former attendings who took boards in the early 1980's said the CP pass rate was about half...