ABR written prep 2019

[deleted605854]

Hi everyone,

Long time lurker. Haven't posted much. I'm one of the folks who unfortunately failed both physics and radbio last year. I'd appreciate some advice.

I've been studying non-stop since January using the usual suspects:

Radbio: Hall, in house radbio course from my residency program. I'm going to start reading Joiner. Are the Rabex exams worth it? Any other recommendations beside a 900 page cancer biology textbook? There's no way I can finish that.

Physics: McDermott and Raphex. Is reading Khan worth it? Anything else?

Clinical written: Rad onc question based review. Essentials of clinical radiation oncology. Rad onc questions.

I'm feeling lost. Don't know if this will be enough. After last year's exam, I think my confidence in exam taking has been shattered.

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[Sheldor]

I'll let others speak to Rad Bio/Physics who have taken it post-last years kerfuffle. (That said, I think that doing as many practice questions as possible is always good, so I would do Rabex.)

For clinical written I think you nailed the correct resources. Read both books carefully and do all the questions and you'll be good to go! I was impressed with how those two books complement each other. There is obviously overlap, but a lot of little factoids that are in one but not the other.

I know its overwhelming, but just remember that at least with clinical written every minute you study is just making you a better Rad Onc!

 

[multitudes]

I’m a triple tester this year. Hooray. Obviously I have no insight into what works but here’s my plan:

RadBio: Hall, Joiner, residency-sponsored review, radoncquestions, old RABEX questions.

Physics: Caggiano, McDermott, RAPHEX (lots)

Clinical: Debating Essentials of RO (Cleveland Clinic) vs Absolute Clinical Radiation Oncology as my go-to handbook; the former is more thorough but not sure if I like the format as much as the latter. I’ll follow that with the RO Question-Based Review. I’ve also completed ~80% of radoncquestions.com (my percentage peer score is abysmal). After I finish it, I’ll reset and use it to self-assess for clinical in mid-June.

 

[Mandelin Rain]

Just get you hands on some good recalls. 50% of the tests right there. Zing! (but no, really, that estimate is legit)

Seriously though, wonder what the pass rates would look like if the ABR just out of the blue went to all new questions one year.

 

[scarbrtj]

Many, many years ago, when I finished residency, I was "one of those" who did a residency in two places. I transferred mid-stream from one place to another. In the first place, we had didactics from doddering old (one in physics, one in rad bio) dudes, no "recalls," no library of old inservice exams, etc. Once I transferred to the new, bigger place I could then feast from the cornucopia of inside baseball available there and many, many more teachers. Not the least of which was they had outside guys come in (for which they paid a pretty penny I'm sure) to "teach to the boards" on physics and rad bio. Incredibly information-rich "cheat sheets" they provided were worth their weight in californium. And these were like three-day courses. And I say all that to say this: In an effectively taught multiple-day course by an excellent teacher, you can learn all you need to know to pass the physics boards. And this goes for rad bio, too. By my logic, therefore, if 2/3 of the writtens are rad bio and physics, you can learn 66.7% of all you need to know to become a board certified rad onc in multiple-day courses taught by two teachers. Yikes. Never really thought about it this way before, but I think I might be not wrong.

 

[thecarbonionangle]

Dont you know? ABR has new comprehensive “study guide” all you need. Just read all these books and articles. You’ll be fine. Squeeze that in along learning how to be a rad onc to be “minimally competent”. You dont know Taqman? sucks for you!

 

[xrthopeful]

100% honest advice for physics is to just do as many Raphex tests as you have time for and then do them again.

 

[deleted605854]

I've just finished my Canadian written board exam, (two days, 3 hours each) short answer questions are a lot tougher than MCQs IMO. All I can say is, wow. This tops the ABR situation by leaps and bounds. I can't say this has done my confidence any favors. Oh well, the oral exam is in 2 weeks. Eye on the prize.

 

[scarbrtj]

I've just finished my Canadian written board exam, (two days, 3 hours each) short answer questions are a lot tougher than MCQs IMO. All I can say is, wow. This tops the ABR situation by leaps and bounds. I can't say this has done my confidence any favors. Oh well, the oral exam is in 2 weeks. Eye on the prize.

Might be interesting to others to point out differences in Canadian and U.S. board exams. In Canada is it MCQs and essay qu's too all in your "first round"? Do you have any oral exams like we do in "round two" or is it oral and written "round one"? Or is just essay exams in "round two"?

 

[deleted605854]

Might be interesting to others to point out differences in Canadian and U.S. board exams. In Canada is it MCQs and essay qu's too all in your "first round"? Do you have any oral exams like we do in "round two" or is it oral and written "round one"? Or is just essay exams in "round two"?

All the components take place in one round. So here's how it goes (everything that I'm saying now is public knowledge and here is the link http://www.royalcollege.ca/rcsite/documents/ibd/radiation_oncology_examinfo_e.pdf . I am not breaking any confidentiality rules):

Comprehensive Radiation Oncology exam by the Royal College of Physicians and Surgeons of Canada. Any PGY5s training in an accredited radiation oncology program in Canada can register for it quite easily. For US applicants it's possible but I believe there's much more paperwork involved and they have to make sure that you've ticked off all the required boxes (I personally know some people from the US who've taken it in the previous 3 years, the paperwork does take sometime but it gets done).

For the written component there's Paper 1 and Paper 2. Both are Short answer question papers. There's no MCQs whatsoever in the Canadian royal college exam. Even our in-house exams are all short answers. Paper 1 is basically clinical cases with the usual questions on workup, management and some trivia. It's 3 hours long and you'll need those 3 hours. Paper 2 is the "basic sciences" paper. Basically questions on Anatomy, radiobiology, cancer biology, physics, systemic therapy, statistics, ethics plus some other miscellaneous Canada specific things. It's a pen and paper exam. The exam is usually held in an assembly hall or hotel conference room in one of the major cities in Canada. You're put in with other specialties who do have MCQ exams. You can hear them scratching their bubbles while you write your answers furiously.

The oral component is 2.5 weeks after the written. No one is held back from taking the oral exam even if they've failed the written. This year it'll be April 16 and April 17, 2019. Held in the Royal College in Ottawa. My day of reckoning is soon I suppose.

Oral exam Day 1
5 Clinical cases, each 12 minutes long. You don't know what case you're getting in advance. Could be something bread and butter that you've prepped well or it could be something rare that you haven't seen in residency. General questions about cases and their management. Some stations may also have images and they'll ask you to interpret them.

Oral exam Day 2 (yes, there's a day 2!)
"The candidate will be examined at approximately five stations for approximately 20 minutes each. Typically the candidate will be provided with material to evaluate and then engage in a discussion with one examiner. The stations typically include topics such as: target volumes definition, critical organ identification, normal tissue tolerance, dosimetry, radiotherapy planning techniques, palliative radiotherapy and skin cancer radiotherapy." So you basically have some time to prep for the case and then the examiner will ask you questions relating to the case. Again, could be something you've seen or not seen in residency. With the last two points, palliative radiotherapy and skin cancer radiotherapy are a big thing in Canada with huge emphasis on teaching those in residency. And you may be given a highly complex case scenario in those areas without fancy tools to help you.

And that's it! The results are released exactly two weeks after the oral exam concludes. If you fail one component you fail the whole thing and you have to re-take the whole thing again the following year. There are no mid year exams. We are not told if we've passed the written or not before stepping into the oral exam. So someone could be taking the oral exam with no chance of obtaining a passing grade.

Not passing the exam from the first attempt is heavily stigmatized and makes the difficult Canadian job market near impossible with regards to job prospects. Not passing the exam means no full license and without that you can't practice as an attending. I have known people who've lost attending job positions because of this exam. It's rare to get an attending job without a fellowship these days but I've seen some people who've managed that. Oh, some fellowship programs will also revoke your fellowship offer if you don't pass the Royal College exam. So there's that.

 

[scarbrtj]

All the components take place in one round. So here's how it goes (everything that I'm saying now is public knowledge and here is the link http://www.royalcollege.ca/rcsite/documents/ibd/radiation_oncology_examinfo_e.pdf . I am not breaking any confidentiality rules):

Comprehensive Radiation Oncology exam by the Royal College of Physicians and Surgeons of Canada. Any PGY5s training in an accredited radiation oncology program in Canada can register for it quite easily. For US applicants it's possible but I believe there's much more paperwork involved and they have to make sure that you've ticked off all the required boxes (I personally know some people from the US who've taken it in the previous 3 years, the paperwork does take sometime but it gets done).

For the written component there's Paper 1 and Paper 2. Both are Short answer question papers. There's no MCQs whatsoever in the Canadian royal college exam. Even our in-house exams are all short answers. Paper 1 is basically clinical cases with the usual questions on workup, management and some trivia. It's 3 hours long and you'll need those 3 hours. Paper 2 is the "basic sciences" paper. Basically questions on Anatomy, radiobiology, cancer biology, physics, systemic therapy, statistics, ethics plus some other miscellaneous Canada specific things. It's a pen and paper exam. The exam is usually held in an assembly hall or hotel conference room in one of the major cities in Canada. You're put in with other specialties who do have MCQ exams. You can hear them scratching their bubbles while you write your answers furiously.

The oral component is 2.5 weeks after the written. No one is held back from taking the oral exam even if they've failed the written. This year it'll be April 16 and April 17, 2019. Held in the Royal College in Ottawa. My day of reckoning is soon I suppose.

Oral exam Day 1
5 Clinical cases, each 12 minutes long. You don't know what case you're getting in advance. Could be something bread and butter that you've prepped well or it could be something rare that you haven't seen in residency. General questions about cases and their management. Some stations may also have images and they'll ask you to interpret them.

Oral exam Day 2 (yes, there's a day 2!)
"The candidate will be examined at approximately five stations for approximately 20 minutes each. Typically the candidate will be provided with material to evaluate and then engage in a discussion with one examiner. The stations typically include topics such as: target volumes definition, critical organ identification, normal tissue tolerance, dosimetry, radiotherapy planning techniques, palliative radiotherapy and skin cancer radiotherapy." So you basically have some time to prep for the case and then the examiner will ask you questions relating to the case. Again, could be something you've seen or not seen in residency. With the last two points, palliative radiotherapy and skin cancer radiotherapy are a big thing in Canada with huge emphasis on teaching those in residency. And you may be given a highly complex case scenario in those areas without fancy tools to help you.

And that's it! The results are released exactly two weeks after the oral exam concludes. If you fail one component you fail the whole thing and you have to re-take the whole thing again the following year. There are no mid year exams. We are not told if we've passed the written or not before stepping into the oral exam. So someone could be taking the oral exam with no chance of obtaining a passing grade.

Not passing the exam from the first attempt is heavily stigmatized and makes the difficult Canadian job market near impossible with regards to job prospects. Not passing the exam means no full license and without that you can't practice as an attending. I have known people who've lost attending job positions because of this exam. It's rare to get an attending job without a fellowship these days but I've seen some people who've managed that. Oh, some fellowship programs will also revoke your fellowship offer if you don't pass the Royal College exam. So there's that.

Thanks. I find this stuff interesting. Clearly in the U.S. we have forged a bit different pathway to board certification. The Canadian way and RANZCR way seem more similar.

 

[deleted605854]

Looks like "The biology of cancer" book is no longer listed as a primary reference.

ABR

Study Guide for Radiation and Cancer Biology Last verified on June 3, 2022 Download this study guide in printable .pdf format This exam tests your knowledge of the principles of radiation and cancer biology underlying the practice of radiation oncology. Included are questions on the general...

www.theabr.org

 

[Chartreuse Wombat]

The Weinberg book is still on the pdf that i just downloaded.

 

[GapCalc]

ABR

They probably didn’t update the PDF. The web page doesn’t list the textbook anymore.

 

[PointA]

They changed an important primary reference just a few months before the exam? Haven't residents already been studying for a couple months now? and many may have already purchased that book. If ABR is this disorganized, they should not be in charge of the exam.

 

[CaesarRO]

ABR

They probably didn’t update the PDF. The web page doesn’t list the textbook anymore.

It's still listed as a secondary reference (bottom of the list)

 

[scarbrtj]

Maybe they just want residents to learn the biology of cancer.
Not the textbook "The Biology of Cancer" per se, but the biology of cancer. In its entirety. This renders any references, or mistakes or typos thereof appertaining etc, moot. Just learn the biology of cancer, piece of cake.

 

[it'sjustme]

This might be impossible to determine given last year's physics/rad bio scoring, but is there a target raw percentage correct for Raphex and ASTRO Radiation Biology tests that correlates with passing?

 

[scarbrtj]

Eric Hall, interviewed by ASTRO circa 2002 (essentially saying "refresher courses" should teach residents all they need to know about radiobiology... but what does Eric Hall know?):

Question: Let me ask you, then, how you think we can improve training programs from here on out in respect specifically to radiation biology?

Dr. Hall: I think that the notion of insisting that there be a radiobiologist, or at least a basic scientist, in every department has been very good for the employment of radiation biologists, but I'm not sure it's done as much for training and I'm not sure it's been as good for training as people thought it would be when it was set up. Because it has had one very negative impact, which is that is has discouraged to the point of elimination the more central courses. Now, this is very parochial for me to say this, but whereas in the days of yore, in Edith Quimby’s day, essentially all the residents in the New York were taught physics by her. And then for quite a few years all the radiobiology in the New York area was taught in the course at Columbia. Nowadays that can't happen because the chairman of each department can't send residents to another department because that implies that you don't have the facilities. So very often residents get much poorer teaching because they've got somebody at home. Very often that person hardly speaks English and doesn't know any biology anyway, but they have to give the course. So I think that's been, in many ways it's not worked out as well as it might have. And that takes me back to what I said earlier, that I think ASTRO has missed the boat in not providing better teaching in physics as well as in radiation biology. Well, physics is not so bad because you've got to have competent physicists for the treatment planning. But you don't have to have competent biologists. All he's got to be is a biologist and many are not very competent and many don't speak English very well.

Question: ASTRO has some good courses . . .

Dr. Hall: Yeah, I think that there appears to be no connection. For example, there's a radiobiology committee in ASTRO. I've never been on it, but there is a radiobiology committee and there's a refresher course committee, but there doesn't seem to be any connection between these. And this came up again at the ABR meeting that we had that the radiobiology committee got no input into the refresher courses. And while I don't think for a minute that that ought to be the central role in refresher courses, not at all, not at all, not at all. But, with the number of refresher courses there are, they could be sufficient for residents to get their course. Now, the residents from Mass General, residents from UCLA and Stanford get all their teaching perfectly adequately at home, but there are many residents from smaller programs around the country that could have a much better course at ASTRO than they get in their own institution.

 

[metallica81788]

How do you guys think the new RadONC question radbio/phys qbank prepares us for this battering ram ABR train coming our way? Any info or like educated guesses on this? Anybody with knowledge/power about the test content can comment? Very nervous about poor resources and guidance available to us. Feel very blind going into this in a few months...and worried about the failures.

I went through the RadBio/Physics questions last year multiple times in prep for the exam. While they were useful in building core knowledge, they were not of the difficulty or in-depth level of questions on both tests. Liken it to the difficulty of RadBio/Physics questions on the inservice - useful but basic. If I had any of those questions on my test I may have jumped for joy. Not sure how they've improved/changed this year with the increase in content.

 

[RadOnc2019]

I am writing the physics and radiobiology exam and I was wondering what kind of calculator on the market closely resembles Pearson VUE software interface calculator? thanks in advance!