Anyone have a copy of the retracted PRO article by UF and Duke program directors about ABR exam?

[emt409]

The article was released, and then when we requested our librarians obtain it thru interlibrary loan, they told us it had been retracted.

Sure enough:

http://www.practicalradonc.org/article/S1879-8500(18)30080-8/fulltext

---

Members don't see this ad.

 

[RadOncMegatron]

Hmmm... so curious as to what it said now...

 

[Chartreuse Wombat]

If you follow the link the paper is temporarily removed. This is very different than a retraction. I am surprised that a librarian would make this mistake.

 

[Mandelin Rain]

Temporary removal strikes me as editors didn't read what they should have read until it was published and then said, "Oh ****." Or, powerful friends/colleagues of said editors read article and said, "Oh, ****." Thus leading to the "Temporary Removal" that will likely lead to a watered down version of the original, spun to a different, more diplomatic conclusion.

 

[emt409]

Temporary removal strikes me as editors didn't read what they should have read until it was published and then said, "Oh ****." Or, powerful friends/colleagues of said editors read article and said, "Oh, ****." Thus leading to the "Temporary Removal" that will likely lead to a watered down version of the original, spun to a different, more diplomatic conclusion.

This was my thought as well...

ABR: Hey program directors, we don't like your article...simmer down a bit or your dues are going up again!

 

[radiaterMike]

except the editor is one of the authors. More likely than not an error was caught that needs to be corrected. FWIW the figures are still online

 

[Irradi8or]

Interestingly, if you go to the bottom of the temporary removal PDF, and scroll to the bottom, they've left in a figure...

 

[Chartreuse Wombat]

Temporary removal strikes me as editors didn't read what they should have read until it was published and then said, "Oh ****." Or, powerful friends/colleagues of said editors read article and said, "Oh, ****." Thus leading to the "Temporary Removal" that will likely lead to a watered down version of the original, spun to a different, more diplomatic conclusion.

That's quite a set of assumptions.

 

[scarbrtj]

Grade (USMLE steps) inflation without knowledge/skills inflation, the figures seem to show. Ours is a day in which everybody is apparently above average.

 

[evilbooyaa]

Grade (USMLE steps) inflation without knowledge/skills inflation, the figures seem to show. Ours is a day in which everybody is apparently above average.

It's hard to show continued benefit when you have a binary test (and not a range of scores) compared to a test with a range of scores.

I'm not sure what the bolded is about, but the average has improved because the materials and knowledge of how to do well on USMLE exams has become much more streamlined and common knowledge.

Students are still putting the work in - it's not like the USMLE is increasing the average for the sake of it. It's not like getting a 240 has become inherently easier (or that there's LESS material now than there was 10years ago, lol) than it was 10 years ago.

I'm not sure if your thoughts are "lol millenials grade inflation, back in my day the test was so hard we all got 210 on it" or what exactly your thoughts are.

Remember the old adage - 2 weeks for Step 1, 2 days for Step 2, #2 pencil for Step 3? Wonder if any medical student still abides by that old-school mantra now.

 

[kristofer]

The commentary on twitter about this was that the paper questioned the utility of board examinations given excellent pass rates and high quality training pool, and that the focus of residency training on board prep was detrimental to the practical learning experience of residency as residents are focused on memorizing minutiae and historical trial data recall. Yeah, I could see where that would ruffle a few delicate feathers.

 

[kristofer]

Grade (USMLE steps) inflation without knowledge/skills inflation, the figures seem to show. Ours is a day in which everybody is apparently above average.

The reason that the USMLE scores are higher is that med school has become hypercompetitive. My mentors in med school could not remember their step scores. These days, most students are preparing for step 1 their first semester of med school, and I would guess most could still tell you their MCAT and USMLE scores when they are on their deathbeds. A test prep cottage industry has sprung up catering to the hypercompetitive nature, partially due to increased numbers of medical students without a corresponding increase in residency positions. See above about the historical 2 weeks/2 days/#2 pencil. I never heard that. When I was in school it was 2 months/2 weeks/ 2 days. Students study much longer for the USMLE now and have access to study materials and question banks that have driven scores higher. It's not a matter of the tests becoming easier and everyone getting a high score.

 

[Chartreuse Wombat]

The USMLE scores appear to be for the matched radiation oncology cohort rather than the entire group of US medical students. This is consistent with PDs focusing on Step 1 for ranking purposes as has been observed in other specialties.

 

[thecarbonionangle]

What do you guys think about the boards for our specialty? My opinion, in my obviously limited experience as a resident, is that the physics and rad bio course are littered with irrelevant stuff which is not clinically applicable. Physicists admit this to me privately more so than the rad bio guys. Radiobiology as a field has a long way to go and it has been wrong about things (the whole debate of HDR vs LDR in cervix, SBRT not "suppposed" to work, etc). Why do we emphasize it so much, and put faith on them? What about the clinical written? From my experience the in-service is a wasteland of trivia, heard some similar themes about the clinical written.

Lastly, what is your thinking about the oral boards? setting aside the dreadful location, most all specialties have gotten rid of them. Most recently, radiology got rid of them. All of these specialties still manage to produce clinically competent physicians. Is there any movement in rad onc to get rid of them at all?

 

[thecarbonionangle]

There is no question the USMLE is harder than it was previously. The amount of information has largely increased over the past decades. What has changed is the way to do well has dramatically improved and people just know the formula to do well. We could have a whole debate on the merits of standardized testing....I personally I am not a fan, but I see it never completely going away. I do hope for a way to move away from it and de-emphasizing minutia and focusing on understanding concepts. There is too much money in the standardized testing complex (PSAT, SAT/ACT, MCAT, GMAT, LSAT, USMLE1-3, etc etc). These are powerful interests. Then come all the boards which stand to make money. The IM board tried to increase testing and already BC docs rebelled and won. At some point, physicians have to stand up to some of these things and demand common sense testing. The amount of money involved in the USMLE is absolute theft. I remember paying for my step 2 CK and CS and feeling like i wanted to vomit. It was incredibly expensive and I was spending money i did not have.

 

[OTN]

Bio boards were completely, totally worthless, with zero relevance to clinical practice. Physics boards at least force you to study Kahn which does help you have more intelligent conversations with your physicists. Written clinical boards are usually rather poorly written, but at least they try and focus on worthwhile information. The ABIM got rid of oral boards after they discovered the only variable associated with someone passing or failing was who their examiner was, but I’m not holding my breath for any changes in our field.

 

[thecarbonionangle]

what gives you so little hope things will change specifically? Same issues as the expansion issue? lack of true leadership?. It really is a shame such a widely recognized issue is not addressed at all.

 

[medgator]

I think RO will get rid of their boards when surgery and its subspecialties do. The mindset in RO is more akin to surg rather than diagnostic radiology, even if both fall under the ABR

 

[seper]

Our boards do keep some completely hopeless types from being board certified on time, which probably have helped a patient or 2.
The only change I would personally do is to fold Bio+Phys into Clinical Writtens.

 

[Corgi4Prez]

This is a good 2013 NEJM Editorial that looks at the value of Step 2 CS in an interesting way if you are interested.

The Step 2 Clinical Skills Exam — A Poor Value Proposition, Elmer Philip Lehman, IV, M.D., M.P.P., and Jason Ross Guercio, M.D., M.B.A., N Engl J Med 2013; 368:889-891, DOI: 10.1056/NEJMp1213760

 

[RadOncMegatron]

I think there is some utility to our boards. They forced me to learn a lot - the oral boards especially. Truth be told, I learned a lot and feel like I am a better oncologist due to oral board training.

Step 2 CS or Step 3 on the other hand...

 

[MadamCurie]

...Radiobiology as a field has a long way to go and it has been wrong about things (the whole debate of HDR vs LDR in cervix, SBRT not "suppposed" to work, etc). Why do we emphasize it so much, and put faith on them?...

Like the medical profession has never been wrong about things?

And in terms of the specific examples you provided, true, in theory HDR brachy and SBRT/extreme hypofractionation were not supposed to work...and wouldn't have were it not for improvements in dose conformality that allowed the exclusion of most normal tissue from the radiation field. That, and the fact that careful guidelines and dose constraints have also been introduced in an attempt to avoid pushing the envelope too far.

 

[thecarbonionangle]

Like the medical profession has never been wrong about things?

And in terms of the specific examples you provided, true, in theory HDR brachy and SBRT/extreme hypofractionation were not supposed to work...and wouldn't have were it not for improvements in dose conformality that allowed the exclusion of most normal tissue from the radiation field. That, and the fact that careful guidelines and dose constraints have also been introduced in an attempt to avoid pushing the envelope too far.

So if "in theory" (whatever that means) these things were "not supposed to work", then what does this mean? could this mean that a lot of what the "experts" are teaching us, testing us on, is in fact WRONG and that our understanding of it is minimal? There is no other field where people are still learning things that are in fact DISPROVEN by observation. I guess people gotta remain employed.

 

[nkmiami]

Like the medical profession has never been wrong about things?

And in terms of the specific examples you provided, true, in theory HDR brachy and SBRT/extreme hypofractionation were not supposed to work...and wouldn't have were it not for improvements in dose conformality that allowed the exclusion of most normal tissue from the radiation field. That, and the fact that careful guidelines and dose constraints have also been introduced in an attempt to avoid pushing the envelope too far.

i wouldnt put it that way, having been in the field at the time. I would say that radiobiology raised concerns about hdr/ hypofractionation that were allayed by clinical experience, with small, and specific targets. No one was really saying "this is not supposed to work, more like-" lets proceed with cation" How quickly we proceed/expand targets was really the debate. We have always known that some small targets can take extreme ablative doses- like 80GY trigmeninal root entry zone, which first was done probably before i was born. Gamma knife was invented before the mri?

 

[emt409]

i wouldnt put it that way, having been in the field at the time. I would say that radiobiology raised concerns about hdr/ hypofractionation that were allayed by clinical experience, with small, and specific targets. No one was really saying "this is not supposed to work, more like-" lets proceed with cation" How quickly we proceed/expand targets was really the debate. We have always known that some small targets can take extreme ablative doses- like 80GY trigmeninal root entry zone, which first was done probably before i was born. Gamma knife was invented before the mri?

Yes, radiosurgery was invented long before MRI. First radiosurgery was actually done with orthovoltage kv units. That obviously didn't work well, so the next was protons, but in the 50s, proton beam technology was not very versatile, so GK was invented. People talk about 80Gy to DREZ being crazy, but 200Gy bilateral anterior capsulotomies were being done before even those.

 

[seper]

RadBio people definitely got it wrong with the biological equivalence of HDR fractionation schemes. A few large fractions appear to work extremely well.

 

[radiaterMike]

the article is still unavailable, though a commentary on it was just published ....

http://www.practicalradonc.org/article/S1879-8500(18)30122-X/pdf

 

[Neuronix]

the article is still unavailable, though a commentary on it was just published ....

http://www.practicalradonc.org/article/S1879-8500(18)30122-X/pdf

The commentary is now also under "TEMPORARY REMOVAL"

 

[medgator]

The commentary is now also under "TEMPORARY REMOVAL"

Thankfully the SDN community was able to bring a spotlight to it before that happened.... although, like I said, this is a big nothingburger compared to the job market woes, but it certainly does give a glimpse into the leadership of the field