So that during tumor boards, you can sound smarter than the 10 other rad oncs kissing the rings of the med oncs.
It really is bizarre. I love all these practice questions asking me to know the PFS differences in the arms of trials started in the 1980s.
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Don't be disrespectful. You owe our founders who have elevated your status in the house of medicine.
Such a pity!
Man, I have experienced so many variations of this scenario.
Bone broken?
Something else I've noticed:
Any meta-analysis is 5% OS.
I think this is the problem right here (not that I disagree with you in any way).
jamanetwork.com
While this is a good hard and fast rule, the problem is that the answer choices don't really help. For instance if the correct answer is low risk, the choices are usually:
We have such an exam. It’s called the oral exam. The format can be intimidating but most of the examiners are very reasonable and keep it to real world scenarios. Why are we still doing both? That is a great question. We should either fix the written and dump the orals or just dump the written exam in my opinion.I think this is the problem right here (not that I disagree with you in any way).
I have heard variations of these two statements from many faculty over the years:
1) "Just do it, it's how you earn your seat at the table"
2) "The way the exams are written are done so because asking trivia is easy to write, not because they demonstrate your aptitude as a physician"
These statements are always followed up with essentially throwing hands up in the air, saying no one will do anything about it, that by the time someone gets to a point in their career that they CAN do something about it, they no longer want to or even if they do, they don't have the time because they will not be adequately reimbursed either financially or with prestige.
The other point that's often left unsaid: if you took these exams 30+ years ago, as many of our leaders did, the amount of general knowledge required was nowhere near what we need to have today. Examples of this have been published:
Changes in Length and Complexity of Clinical Practice Guidelines in Oncology, 1996-2019
This cross-sectional study calculates the increase in clinical cancer knowledge represented in the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines from 1996 to 2019.
"Between 1996 and 2019, the mean (SD) page count of NCCN Guidelines increased from 26 (4.2) to 198 (30.0) pages, a 762% absolute increase overall and a mean increase of 7.5 pages annually (Figure 1). Mean (SD) references cited increased from 28 (16.8) to 856 (146.3), a 3057% increase overall and a mean increase of 36 references annually (Figure 2). Similar increases were seen across all cancer types studied. The mean (SD) number of decision paths increased from 30 (8.5) to 111 (49.5), a 370% absolute increase. Trends in page count and references cited were best fit by exponential regression (R2 = 0.99 for both). Using the best-fit models, projections for mean page count and references cited in 2025 would be 355 pages and 1954 references per disease site guideline."
At what point will this break down? We need to seriously consider moving towards testing candidates in a way that is more reflective of real-world practice if the ABR wants to achieve its goal of "certifying minimally competent physicians who can practice medicine safely".
These pedantic quests we're asked to complete are of increasingly questionable value to us, and to society.
I do IN THEORY like that we are tested heavily, like tradiational Ph.D. programs. We can confidently let patients and our peers know that our process is very rigorous. I feel we truly earn our post-doctorate certification, by mastering not only the big concepts, but minutiae as well. As specialists. I don't think it's out of bounds to know the minutiae of our own craft.
They will turn it from MC to matching and probably include more picture questions
It depends on who you mean by they. The exam is administered by the ABR who don't administer these exams for free. Does the pass rate mean anything to them? What would their incentive to change be?
I would imagine senior leadership of individual programs. The ACGME requires an average first-time pass rate of 60% averaged over 5 years I believe. In RadOnc programs with 1-3 residents a year, that's a slim margin of error.
It wasn't that close when I took the clinical exam. The trials were random on the test, but it was obvious if you read the trial.
So in this scenario the ABR could
I think the logic goes something like this...
There is definitely some year to year variation on these things. On my physics boards I barely needed a calculator and finished in less than half the allotted time. The next year apparently there was so much math people were barely finishing. I’d say I got the better draw on that one 😀
They tricked me on my physics boards. I had several equation-based questions in the first ~dozen or so questions, then the next ~75 were mostly concepts. I thought I was in the clear...then the last dozen were equation-based and left me questioning everything.
