ABP: Idiot residents that need a code red

[Kunu]

Below is a letter submitted by an anonymous resident to the ABP re: use of remembrances as study material for the primary certification exam.

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Hello,

I am currently studying for the up and coming pathology board examination. I received the statement pasted below a few months ago, and thus resolved to not use any board remembrances in my personal study/preparation for the board examination.

After attending a few board review courses, I have become acutely aware that I am in the great minority of participants who will not be engaging in the seemingly universal practice of reviewing board remembrances. (especially since instructors highly recommended we peruse such material prior to the exam as it will greatly help our overall score.)

If indeed it is cheating to review remembrances, which is how I interpret the statement below, I am well aware that my decision to not use them will put me at a significant disadvantage compared to my peers. That hardly seems fair in my estimation, and seems to discriminate against those of us who choose to maintain the highest standards of personal integrity (which is the standard I presume the board expects of its test-takers).

I have pasted the statement from the ABP board below. Please let me know if my interpretation is correct. If the use of remembrances is NOT cheating, please let me know as I greatly desire to pass the up and coming board exam. If it is indeed cheating, I would like to know how those of us who choose not to cheat on the exam can be rewarded rather than penalized. I imagine there is a statistical manner by which candidates who memorized board remembrances can be identified.

I would greatly appreciate a response.

Sincerest regards,

Board candidate 2013.
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Dear letter writer: Get off your high horse little Miss/Mr honest abe alright? First of all I will say that neither programs nor faculty should provide, facilitate access to or encourage the use of formal material and lists of questions and answers to candidates preparing to sit for the path certification exams. That would be on the record. Off the record, if it happens then so be it. The exam is stupid, esoteric, and does not as it has been given gauge competence to practice pathology. All of us who have taken this test know this. Further the cost of these exams is outrageous and exploitive on behalf of the ABP on candidates for who this is the only path for certification to be able to make a living to feed their families. Actually remembering specific questions is NOT going to help someone pass this test if they are otherwise incompetent. Being alerted to the array of ignorant and irrelevant minutia covered WILL. And as many others, I was not privileged with the potential to attend "multiple review courses" as the jackass that wrote this letter was afforded. This to me is equally as unfair an advantage. So what constitutes inappropriate or unfair? Some faculty teaching globally sucks at a given place while other residents enjoy a well formed curriculum and commitment to education. So when I teach, should I be censored when covering an organ system to mention board relevant hotspots along the way?

How should this issue be settled? I know how it should NOT be handled. Writing sissified letters to the ABP because a candidate is wetting the bed over their own personal marginal ability and lack of self-confidence is not of help to anyone including the letter writer. All I can say is grow a pair. Study your a%* off and dont cheat during the exam. Its a hard test so just suck it and do your best with what you have. That is all.

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[longlakeboy]

If the ABP were transparent about anything regarding the boards - topics, what type of questions there are, how it's graded - nobody would use remembrances.

Nobody used them for the USMLE Step exams. Why? Because those tests have actual review materials available that in some way reflect what's actually on the exam (sorry Lefkowitch), and the scoring system is well established.

Stopping them from being made is unenforceable anyway, so they're going to continue to exist. The ABP has created this situation - if they don't like it, tough. Remembrances are valuable because of how ridiculous the test is and how secretive they are about it.

 

[malchik]

The exam is stupid, esoteric, and does not as it has been given gauge competence to practice pathology. . . . Actually remembering specific questions is NOT going to help someone pass this test if they are otherwise incompetent. .

Do you think the test measures competence or not?

 

[Kunu]

Do you think the test measures competence or not?

If you are completely incompetent you will fail whether you use remembrances or not.
Most people I know who were just misses to passing were competent for clinical practice but were not great test takers.
Ive also worked with so called "elite" place trained people who are supposedly smart and can answer questions on tests but who do as little work as possible and turf half their workload to internal consults to solve their cases for them because they lack judgement/ workplace common-sense competence.

 

[mlw03]

How did you become aware of this letter?

 

[2121115]

Below is a letter submitted by an anonymous resident to the ABP re: use of remembrances as study material for the primary certification exam.

-----------------------------------------------------------
Hello,

I am currently studying for the up and coming pathology board examination. I received the statement pasted below a few months ago, and thus resolved to not use any board remembrances in my personal study/preparation for the board examination.

After attending a few board review courses, I have become acutely aware that I am in the great minority of participants who will not be engaging in the seemingly universal practice of reviewing board remembrances. (especially since instructors highly recommended we peruse such material prior to the exam as it will greatly help our overall score.)

If indeed it is cheating to review remembrances, which is how I interpret the statement below, I am well aware that my decision to not use them will put me at a significant disadvantage compared to my peers. That hardly seems fair in my estimation, and seems to discriminate against those of us who choose to maintain the highest standards of personal integrity (which is the standard I presume the board expects of its test-takers).

I have pasted the statement from the ABP board below. Please let me know if my interpretation is correct. If the use of remembrances is NOT cheating, please let me know as I greatly desire to pass the up and coming board exam. If it is indeed cheating, I would like to know how those of us who choose not to cheat on the exam can be rewarded rather than penalized. I imagine there is a statistical manner by which candidates who memorized board remembrances can be identified.

I would greatly appreciate a response.

Sincerest regards,

Board candidate 2013.
---------------------------------------------------------------------------------------------------------------

Dear letter writer: Get off your high horse little Miss/Mr honest abe alright? First of all I will say that neither programs nor faculty should provide, facilitate access to or encourage the use of formal material and lists of questions and answers to candidates preparing to sit for the path certification exams. That would be on the record. Off the record, if it happens then so be it. The exam is stupid, esoteric, and does not as it has been given gauge competence to practice pathology. All of us who have taken this test know this. Further the cost of these exams is outrageous and exploitive on behalf of the ABP on candidates for who this is the only path for certification to be able to make a living to feed their families. Actually remembering specific questions is NOT going to help someone pass this test if they are otherwise incompetent. Being alerted to the array of ignorant and irrelevant minutia covered WILL. And as many others, I was not privileged with the potential to attend "multiple review courses" as the jackass that wrote this letter was afforded. This to me is equally as unfair an advantage. So what constitutes inappropriate or unfair? Some faculty teaching globally sucks at a given place while other residents enjoy a well formed curriculum and commitment to education. So when I teach, should I be censored when covering an organ system to mention board relevant hotspots along the way?

How should this issue be settled? I know how it should NOT be handled. Writing sissified letters to the ABP because a candidate is wetting the bed over their own personal marginal ability and lack of self-confidence is not of help to anyone including the letter writer. All I can say is grow a pair. Study your a%* off and dont cheat during the exam. Its a hard test so just suck it and do your best with what you have. That is all.

It was a resident in your program wasn't it?

 

[thebouque]

In the car they found a letter to the ABP, but they didn't say who wrote it. Come to think about it, his name was... it was you.

 

[Kunu]

How did you become aware of this letter?

The ABP sent it to the training programs to reinforce their prohibition of using remembrances.

 

[KCShaw]

I'm still befuddled that the exam is digital yet scoring reportedly requires a manual transfer to a different computer system. Embarrassingly shameful at best, but closer to willful incompetence given the completely unnecessary risk and financial burden, and also not advertised.

As for the alleged initial letter/writer, well, people try to manipulate the system all the way around. Doesn't mean they always think or care about the consequences beyond their dreamy hopes. One of the things I've learned over the years is that when you choose a battle, or sometimes even ask a question, you have to be able to live with the outcome/clarification -- which may not be the one you expected or wanted. I've also learned that some things are worth ignoring.

 

[Scania]

I've also learned that some things are worth ignoring.

Most things in residency are, excluding gross negligence (pun intended) or sexual harassment or murder or some heinous act like using a Pilot finepoint slide marking pen for every-day note-taking purposes...
Being compelled to defend oneself / fellow residents should be weighed along with the consequences. I know lots of people that have been burned by speaking their mind / complaining / going against the grain...

Also better to ask forgiveness than permission.

 

[yaah]

I think it's an even bigger issue in radiology. Remember this story? http://www.cnn.com/2012/01/13/health/prescription-for-cheating
Is there anybody in medicine who thought this whistle blower wasn't full of himself? Anybody know if anything came out of this for the next exam cycle?

The letter writer is a bit condescending.

Board remembrances are a problem for the ABP but the problem of course is that there is a fine line between true "remembrances" and informed review of pertinent topics. I took an MCAT review course in college and it was the same thing. Kaplan hired people specifically who scored highly on the MCAT to teach the course, because they knew how to score well. If you don't cross the line to talking about specific questions, is it a violation? It's hard to know. How about a topic? Can you say "the boards showed a pap smear slide"? "The boards asked a question about lobular breast CA ipox?" Or is it only a problem if you relate the specific question?

 

[Kilgoretrout 65]

The letter I saw said you could say something like "there was a lot of non-neoplastic lung" but you couldn't say "I saw a slide with UIP". The problem with remembrances is that the first test taker could have been flat out wrong. If the ABP vary their tests enough getting the knowledge that "there was tons of wet heme" on the board doesn't help you when on your test there are 10 gross images of testicular tumors.

 

[Johnny Sunshine]

It would be nice if the ABP were not so secretive with their scoring methods, learning points tested, and so on. It would also be nice if more of the questions asked were clinically relevant... 😛

But all of that would only restrict their options, and require more work on their end, so I doubt it will change.

They can just throw a bunch of questions together and rely on the scoring algorithms to beat some sort of sense out of the resulting mash. Not only does this simplify things on their end, but it gives them control and a way to "guide the field"...since they don't have the balls/power to actually cut the number of residency spots. The current system suits their purposes just fine, so I doubt they'll change.

If this is some misguided attempt to "restrict access to the field", it is a poor way to go about it. Far better would be to restrict access to residencies, by limiting spots and raising standards. But then, path departments and their hospitals would loose free grossing labor.

 

[KLPM]

Not as big of an issue but my medical school recently issued a lengthy 2 page declaration of how wrong it is for students to remember questions from our exams. The problem is that students in my year usually get together and each remember a question from the exam and then post-exam collate their remembrances into a single document. The faculty caught on and needless to say was not pleased.

 

[deleted314957]

I suggest they are a bunch of hippocrites because I'm sure they all did it.

 

[zao275]

Betsy Bennett (former Executive VP of ABP; current EVP is Rebecca Johnson) spoke about this at CAP Residents Forum last Fall. She said that what ABP forbids is verbatim re-creation of actual questions with corresponding answer choices that appeared on a Board exam. They feel this is a violation of copyright. She said they do not care if you discuss topics or even exact entities that showed up on the boards (paraphrasing her, she said something like "I don't care if you go back to your residency program and tell your co-residents that there was a pilocytic astrocytoma on the boards"). Her discussion helped clarify some things in my opinion, although as evidenced by this thread, this is still a hot topic with much controversy (and likely will be for a long time into the future).

 

[KCShaw]

Interesting. I'm no lawyer, but could copyright law even apply? I thought nonprofit educational use was generally excluded -- not that a judge would necessarily buy that as a valid defense in this kind of situation. Easier to just have everyone sign agreement to whatever it is you intend than try to apply that, I would have thought...and actually I thought they did that. Just not one of the things I remember from taking the boards. Heh.

 

[TMZ2007]

Betsy Bennett (former Executive VP of ABP; current EVP is Rebecca Johnson) spoke about this at CAP Residents Forum last Fall. She said that what ABP forbids is verbatim re-creation of actual questions with corresponding answer choices that appeared on a Board exam. They feel this is a violation of copyright. She said they do not care if you discuss topics or even exact entities that showed up on the boards (paraphrasing her, she said something like "I don't care if you go back to your residency program and tell your co-residents that there was a pilocytic astrocytoma on the boards"). Her discussion helped clarify some things in my opinion, although as evidenced by this thread, this is still a hot topic with much controversy (and likely will be for a long time into the future).

Do you have this bolded part in writing someplace? The (non) guidance commentary article from the Archives that has just been pre-released seems to say that anything more specific than "I had a lot of breast and not too much heme" is strictly forbidden.

Most of the special materials are just listings of entities or one-line summaries of concepts, but some of them are like "glass slide: some differential, didn't know which was right" (which basically is the whole question, I guess).

I guess the trick is to rename all your special materials as "study guides" so that no one will suspect you...?

 

[pathstudent]

Is it impossible to have new questions/slides every year? If it is possible, then problem solved.

 

[zao275]

No I don't have it written, TMZ2007. But there were about 200 witnesses! ;-) In all honesty, the actually pledge that board-takers sign is much more strict and basically says you can't discuss anything at all about the contents of the exam. But that brings up hard questions. If I know entity X is on the boards, and I tell my residents "Hey, this entity is REALLY important" is that cheating? How can I even teach pathology at all in that case? It becomes an impossibly gray area in that case. And I think that's why Betsy was saying the main thing they care about is question reproduction more than mentions of entities or topics. I have known her for several years now after my involvement in Residents Forum, and she seems pretty fair and reasonable to me (although I think many residents in the past have viewed her as the face of the big bad ABP). She always dutifully showed up when invited to RF town hall meetings and happily let residents complain and rake her over the coals about the evils of the Boards. I was always pretty impressed by that.

KCShaw: I thought of that same thing. I am no copyright lawyer, but I was doubtful that approach would legally fly. But the bigger worry than going to court is the worry of losing one's board certificate I think.

 

[KCShaw]

Which is one of the problems of boards -- they don't appear to really answer to anyone, and frankly could jerk one's board certificate and leave that person with little recourse. In a way it's kind of telling that those they most directly influence can rake them over the coals, so to speak, without apparent effect. I'm not saying I have an ideal solution to that, but there has to be more than just recognition that people's careers are being regulated without having much/any? real influence over the process or people controlling it and questionable to insufficient data to say that what's being done is beneficial to anyone other than those who've created jobs for themselves out of it. Kinda drifting from the original topic onto MOC/recert, but this is among the reasons some individuals have taken to paying certification mills -- same result of being able to say "I'm board certified (please ignore the fact that hardly anyone in the field recognizes this board)" without all the hassle.. it's kinda a common thread in the forensic setting these days, and it would be no stretch for an upstart group to collect enough physicians to claim clout. Which highlights the concerns of existing boards colluding with state licensing bodies, etc., to prevent competition (in the name of "safe" regulation, for the health of voting patients, of course). At any rate, I don't think this broad topic is an insignificant one.

Someone asked about creating new questions -- great in theory, but surprisingly difficult in practice. Even large committees who try to spread the workload around and get everyone to submit 10 new questions every few months or year seem to have a hard time actually getting decent new questions. If you happen to have a couple of prolific question writers, you find tendencies developing in the question style & content, and unintentional bias creeps in. Basically, it's just not as easy as it sounds. Most board exam committees are constantly trying to increase their question banks, eliminate out-of-date questions and add new but not too new information as it comes down the pipe.

 

[zao275]

I think it actually might be kind of good to create Board questions based on cutting edge brand new stuff. It would encourage more reading of the current literature, and would also provide residents with guidance on what to study (read AJSP, Modern Path, Archives, etc). Maybe that would be too hard. KCShaw is right that it is very tough for question writing committees to create questions that are agreed upon by all AND statistically validated. Dr. Weiss (my mentor) in on the ABP and she has mentioned that difficulty.

 

[pathstudent]

I think it actually might be kind of good to create Board questions based on cutting edge brand new stuff. It would encourage more reading of the current literature, and would also provide residents with guidance on what to study (read AJSP, Modern Path, Archives, etc). Maybe that would be too hard. KCShaw is right that it is very tough for question writing committees to create questions that are agreed upon by all AND statistically validated. Dr. Weiss (my mentor) in on the ABP and she has mentioned that difficulty.

Have the statisitically validated that MOC, SAMs and recertification decreases morbidity and mortality of the US population?

Didn't think so.

It didn't stop them from doing that.

 

[KCShaw]

Supposedly the AMA House of Delegates will be voting on a number of resolutions addressing MOC/recertification, transparency of specialty boards (such as finances), and so on at the AMA meeting this June. Since it appears it's only accessible to logged in current members (who can also offer comments, etc. regarding them prior to the meeting) I'm reluctant to re-post exact wording, but in summary they do in fact bring up these points -- lack of evidence to support MOC in general -and- how it's specifically handled by each specialty board, lack of financial transparency of specialty boards, discrimination by organizations such as state licensing boards, hospital credentialing committees, insurance companies, etc. based on lack of participation in corporate (ABMS) schemes, and so on.

Doesn't mean there's any teeth behind these in and of themselves, but change just needs a critical mass.