Clinical Written 2022

[chemsmith]

I thought it sucked. I feel like I studied my ass off for nothing. I thought the complaint that "half the exam is sarcoma and genetics" was a meme, but it wasn't. It was real life. Thoughts?

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[thecarbonionangle]

Im sorry, im sure you did fine. If not you will likely eventually pass. Ok good news out of way.

Wait until you look for a job. There will be a lot of “i studied my ass off for nothing” thoughts then too. Very sad stuff.

 

[chemsmith]

Thanks, you are likely right , but I can't help but worry. Physics and radbio seemed way easier by comparison. And I have already had the job finding experience, fortunately I got some decent offers.

 

[thecarbonionangle]

Thanks, you are likely right , but I can't help but worry. Physics and radbio seemed way easier by comparison. And I have already had the job finding experience, fortunately I got some decent offers.

Thats good to hear congrats. Post your job finding experience when you get a chance. Always good to have more n , positive or negative

 

[Baws]

Boards to me felt like a case review of vulvar cancer and peds; I passed (years ago). Try not to think about it. Most people do fine.

 

[ramsesthenice]

I thought it sucked. I feel like I studied my ass off for nothing. I thought the complaint that "half the exam is sarcoma and genetics" was a meme, but it wasn't. It was real life. Thoughts?

Totally normal. In the words of Bruce Hornsby “That’s just the way it is, some things will never change.” The upside is, you are basically done getting hazed.

 

[thecarbonionangle]

Totally normal. In the words of Bruce Hornsby “That’s just the way it is, some things will never change.” The upside is, you are basically done getting hazed.

Really? Orals wasnt hazing? When i took it i totally hated it and it felt exactly like hazing

 

[ramsesthenice]

Really? Orals wasnt hazing? When i took it i totally hated it and it felt exactly like hazing

Sorry to hear that but no, not at all for me. It happens but unlike all of the Step, In Service, and written exams, it is possible to have a fair oral exam and walk out feeling confident. That’s why I said “basically done” as opposed to “done”. At most, you have 1 more after 8 or so years of taking tests that you are acing if you can get 60-70% of the questions right after months of prep. All I can say is OLA. There are useful assessment tools in the world.

 

[elementaryschooleconomics]

Boards to me felt like a case review of vulvar cancer and peds; I passed (years ago). Try not to think about it. Most people do fine.

Ahaha I had like zero peds and an avalanche of vaginal cancer.

High yield!

 

[TheWallnerus]

Ahaha I had like zero peds and an avalanche of vaginal cancer.

High yield!

'Avalanche of Vaginal Cancer' is my favorite Missy Elliott track

 

[thecarbonionangle]

Sorry to hear that but no, not at all for me. It happens but unlike all of the Step, In Service, and written exams, it is possible to have a fair oral exam and walk out feeling confident. That’s why I said “basically done” as opposed to “done”. At most, you have 1 more after 8 or so years of taking tests that you are acing if you can get 60-70% of the questions right after months of prep. All I can say is OLA. There are useful assessment tools in the world.

Of course it is possible to walk out “confident” out of a test which we all studied for tons. Just like one could feel confident that one can eat an entire can of dip or chug half a fifth of whiskey during a hazing ritual while someone pisses on you. Im obviously not a fan of oral boards and i have stated this in the past. Our refusal to modify our boards isn’t helping us. Medical oncologists themselves look up chemo doses and take one test. The amount of time and stress we had to go through just to get A job is absolutely ridiculous.

 

[medgator]

Of course it is possible to walk out “confident” out of a test which we all studied for tons. Just like one could feel confident that one can eat an entire can of dip or chug half a fifth of whiskey during a hazing ritual while someone pisses on you. Im obviously not a fan of oral boards and i have stated this in the past. Our refusal to modify our boards isn’t helping us. Medical oncologists themselves look up chemo doses and take one test. The amount of time and stress we had to go through just to get A job is absolutely ridiculous.

Sorry carbon, with the beer goggles that PDs and chairs are putting on now when it comes to matching folks, oral boards have become more important than ever.

 

[thecarbonionangle]

Sorry carbon, with the beer goggles that PDs and chairs are putting on now when it comes to matching folks, oral boards have become more important than ever.

i get your argument. How about we close bad residencies with bad actors and improve education? The four board exams could easily he combined into a hybrid focusing on clinical skills.

 

[deleted1111261]

The eating the whole can of dip and drinking a fifth of whiskey while someone pees on you sounds too vivid and cliche to be a hypothetical. You okay, carbon?

 

[thecarbonionangle]

The eating the whole can of dip and drinking a fifth of whiskey while someone pees on you sounds too vivid and cliche to be a hypothetical. You okay, carbon?

I have friends who experienced this kind of nonsense in frats yes

 

[elementaryschooleconomics]

Sorry carbon, with the beer goggles that PDs and chairs are putting on now when it comes to matching folks, oral boards have become more important than ever.

I know we're all pretty well stationed in our opinion camps regarding oral boards.

Just to preface, I'm on the side of "either overhaul them into modernity or abolish them completely".

I think @medgator's opinion is a popular one. For those of you who feel like oral boards is a stalwart champion of quality:

I take it you have never, in your entire career, met a "bad" board-certified RadOnc? Meaning, reflecting on literally every board-certified Radiation Oncologist you have ever known or worked with: you would be comfortable with every last one of them treating you or your loved ones?

For me, the answer to that question is a resounding "no". There are currently practicing RadOncs who terrify me because I have personally seen their contouring, treatment planning, side effect management, and follow-ups (or obituaries).

More importantly: there has literally never been a shred of evidence that the board certification process accomplishes anything other than lining the pockets of the ABR with more cash. Furthermore, the evidence that board certification in any specialty means anything is incredibly weak, or component or not.

As per usual, EM is running alongside us in a parallel universe of problems. EM and RadOnc are 2 of the 8 non-surgical specialties that still have an oral exam component. This was written last year - "Quarantine the Oral Boards".

There are only two realities here:

1) The ABR is right, despite literally zero evidence, and 85% of medical specialties are wrong: oral boards are necessary.

2) The ABR is wrong, has produced zero evidence supporting its current process, and 85% of medical specialties are right: oral boards are not necessary.

I think the weight of the evidence is pretty clear.

 

[thecarbonionangle]

Radiology got rid of oral boards. Same arguments used to be made. Yes i know IR has them. When ABIM got rid of their oral boards, they analized that only predictor of you passing was who examined you. I have made this argument before but a lot of the origins of these sort of similar things in society often have sexist, racist, classist roots for one last “lets lay eyes on you” ritual before we let you be part of the country club. Except our field ain’t at the country club no more, we at the wendys, and wendys dollar menu so don’t get too excited folks.

 

[thecarbonionangle]

i think EM is in a similar situation to us. Let us explore: it used to be that gen surg, Fam med and surgery ran ERs. These docs had their ability to be PCPs, gen surg/crit care, and hospitalists as a back up. Then they created a new field and the boom and greed ruined it. Unemployed ER docs cannot for most part be hospitalists. They are in a slightly better situation compared to us because now you can do crit care fellowship from ER. We in other hand have no back up and no useful fellowship or training pathways to expand our scope.

 

[Baws]

Radiology got rid of oral boards. Same arguments used to be made. Yes i know IR has them. When ABIM got rid of their oral boards, they analized that only predictor of you passing was who examined you. I have made this argument before but a lot of the origins of these sort of similar things in society often have sexist, racist, classist roots for one last “lets lay eyes on you” ritual before we let you be part of the country club. Except our field ain’t at the country club no more, we at the wendys, and wendys dollar menu so don’t get too excited folks.

This is exactly it; it's a test of how white you are. Nothing else. Otherwise they would have changed it to be like Step 3 cases.

 

[TheWallnerus]

Medical oncologists themselves look up chemo doses and take one test.

Well chemo is safer than radiation! So the chemo guys need less testing. That's why the govt lets a nurse practitioner supervise chemo in a freestanding, but lets a janitor supervise the radiation in a hospital. IT ALL MAKES SENSE.

The eating the whole can of dip and drinking a fifth of whiskey while someone pees on you sounds too vivid and cliche to be a hypothetical. You okay, carbon?

I have friends who experienced this kind of nonsense in frats yes

I once had to eat a whole can of dip, drink a fifth of whiskey, eat tuna fish, AND smoke a cig while someone peed on me. Ah memories.

 

[medgator]

I know we're all pretty well stationed in our opinion camps regarding oral boards.

Just to preface, I'm on the side of "either overhaul them into modernity or abolish them completely".

I think @medgator's opinion is a popular one. For those of you who feel like oral boards is a stalwart champion of quality:

I take it you have never, in your entire career, met a "bad" board-certified RadOnc? Meaning, reflecting on literally every board-certified Radiation Oncologist you have ever known or worked with: you would be comfortable with every last one of them treating you or your loved ones?

For me, the answer to that question is a resounding "no". There are currently practicing RadOncs who terrify me because I have personally seen their contouring, treatment planning, side effect management, and follow-ups (or obituaries).

More importantly: there has literally never been a shred of evidence that the board certification process accomplishes anything other than lining the pockets of the ABR with more cash. Furthermore, the evidence that board certification in any specialty means anything is incredibly weak, or component or not.

As per usual, EM is running alongside us in a parallel universe of problems. EM and RadOnc are 2 of the 8 non-surgical specialties that still have an oral exam component. This was written last year - "Quarantine the Oral Boards".

View attachment 354633

There are only two realities here:

1) The ABR is right, despite literally zero evidence, and 85% of medical specialties are wrong: oral boards are necessary.

2) The ABR is wrong, has produced zero evidence supporting its current process, and 85% of medical specialties are right: oral boards are not necessary.

I think the weight of the evidence is pretty clear.

Definitely met some dummies that somehow made it through boards, but also know a few who didn't specifically because of them. Not sure it is ideal but given what the hellpits are doing these days, i stand by my take

 

[elementaryschooleconomics]

Definitely met some dummies that somehow made it through boards, but also know a few who didn't specifically because of them. Not sure it is ideal but given what the hellpits are doing these days, i stand by my take

Yeah to be clear I don't think I really "disagree" with you.

This conversation always seems to be pitched in two scenarios: keep things the same or obliterate board exams. (Not saying that's happening here, just how this usually goes).

I definitely don't want to abolish board exams, even though the evidence is weak. I think we could do a SIGNIFICANTLY better job than our current 4-exam process, and I don't know why this isn't happening.

(kidding - I know exactly why nothing has changed)

 

[jondunn]

I’m of two minds - and they are conflicting. ESE is totally right that BC means nothing to me in evaluating a colleague. It’s the lowest bar one can set. Nearly Everyone becomes BC if they want to be.

On the other hand, I’m not sure it should be totally removed. Conflicting thoughts on it

It’s way harder to get into Med school and pass steps than pass oral boards. If you’ve made it past the first parts, is really really hard not to do the latter

 

[medgator]

It’s way harder to get into Med school and pass steps than pass oral boards. If you’ve made it past the first parts, is really really hard not to do the latter

Really? Have you met a ross or SGU grad lately?

 

[deleted1116990]

Nearly Everyone becomes BC if they want to be.

Dude...

 

[jondunn]

Dude...

Yes?

 

[ramsesthenice]

Of course it is possible to walk out “confident” out of a test which we all studied for tons. Just like one could feel confident that one can eat an entire can of dip or chug half a fifth of whiskey during a hazing ritual while someone pisses on you. Im obviously not a fan of oral boards and i have stated this in the past. Our refusal to modify our boards isn’t helping us. Medical oncologists themselves look up chemo doses and take one test. The amount of time and stress we had to go through just to get A job is absolutely ridiculous.

I know we're all pretty well stationed in our opinion camps regarding oral boards.

Just to preface, I'm on the side of "either overhaul them into modernity or abolish them completely".

I think @medgator's opinion is a popular one. For those of you who feel like oral boards is a stalwart champion of quality:

I take it you have never, in your entire career, met a "bad" board-certified RadOnc? Meaning, reflecting on literally every board-certified Radiation Oncologist you have ever known or worked with: you would be comfortable with every last one of them treating you or your loved ones?

For me, the answer to that question is a resounding "no". There are currently practicing RadOncs who terrify me because I have personally seen their contouring, treatment planning, side effect management, and follow-ups (or obituaries).

More importantly: there has literally never been a shred of evidence that the board certification process accomplishes anything other than lining the pockets of the ABR with more cash. Furthermore, the evidence that board certification in any specialty means anything is incredibly weak, or component or not.

As per usual, EM is running alongside us in a parallel universe of problems. EM and RadOnc are 2 of the 8 non-surgical specialties that still have an oral exam component. This was written last year - "Quarantine the Oral Boards".

View attachment 354633

There are only two realities here:

1) The ABR is right, despite literally zero evidence, and 85% of medical specialties are wrong: oral boards are necessary.

2) The ABR is wrong, has produced zero evidence supporting its current process, and 85% of medical specialties are right: oral boards are not necessary.

I think the weight of the evidence is pretty clear.

Yes, people fall into different camps but I don't think anyone here doesn't think boards shouldn't be significantly revamped. I think there are fruitful discussions to be had about the oral vs written format but regardless of the format we can all completely agree the goal of these tests is supposed to be to determine competence and heavily slanting them towards the rare and esoteric is not valuable. Tests of competence should not require intense cramming. In fact, they should ideally be something that you CANT cram for. But I digress.

 

[elementaryschooleconomics]

Tests of competence should not require intense cramming. In fact, they should ideally be something that you CANT cram for. But I digress.

What's crazy is the ABR already not only knows all of this, they've actually already taken action about it.

1) Though there's a whole separate saga involving the "recall scandal", the Diagnostic Radiology side of the ABR abolished oral boards a decade ago, remaking their written exams in the process.

2) The RadOnc side of the ABR, with the current version of the OLA, clearly knows how to make questions that those already in practice should be able to answer with their day-to-day knowledge.

I know there are grumbles about OLA being "too easy", but really, that's what it probably should feel like, we're just so used to being hazed by exams our whole career. Questions should be something that seem very straightforward to a competent, practicing Radiation Oncologist, but you couldn't pluck a random Cardiologist off the street and have them still get the question right.

So yeah, maybe everyone reading this message board knows the QUANTEC spinal cord dose constraint and would roll their eyes if it was on an exam...but would any non-RadOnc physician be able to answer that off the top of their head? I doubt it.

 

[deleted1111261]

What's crazy is the ABR already not only knows all of this, they've actually already taken action about it.

1) Though there's a whole separate saga involving the "recall scandal", the Diagnostic Radiology side of the ABR abolished oral boards a decade ago, remaking their written exams in the process.

2) The RadOnc side of the ABR, with the current version of the OLA, clearly knows how to make questions that those already in practice should be able to answer with their day-to-day knowledge.

I know there are grumbles about OLA being "too easy", but really, that's what it probably should feel like, we're just so used to being hazed by exams our whole career. Questions should be something that seem very straightforward to a competent, practicing Radiation Oncologist, but you couldn't pluck a random Cardiologist off the street and have them still get the question right.

So yeah, maybe everyone reading this message board knows the QUANTEC spinal cord dose constraint and would roll their eyes if it was on an exam...but would any non-RadOnc physician be able to answer that off the top of their head? I doubt it.

Yes. Exactly.

I know varying opinions about oral exam exist, but if tweaked a bit more - maybe modules, maybe no actual examiner - I think there’s a way to do a comprehensive exam.

 

[Chartreuse Wombat]

Yes. Exactly.

I know varying opinions about oral exam exist, but if tweaked a bit more - maybe modules, maybe no actual examiner - I think there’s a way to do a comprehensive exam.

All remote. Routine cases. Scripted questions. Recorded. AI would be able to weed out the "right answers" and any borderline answers would be judged by multiple raters. Simple, fair and efficient.

 

[RadRadRad]

Legitimate question
If majority of people here think that we have too many radoncs
And agree that the standards for admission to residency have markedly decreased (less aoa, lower step scores, etc)

Then shouldn’t we want the board certification process to be as rigorous as possible? For our patients sake and our own?

Perhaps the exams need to be altered…but elimination of the hardest part (oral boards) seems to play into the hands of the expansionist chairpeople

I have previously heard that the failure rate for medical physicists is like 50%…

 

[elementaryschooleconomics]

AI would be able to weed out the "right answers" and any borderline answers would be judged by multiple raters.

"Blunt dissection of the avascular plane"

"Low ligation of the spermatic cord"

"Xeloda 7 days a week during radiation"

"Temodar Monday-Friday during radiation"

"It might be Wilms - let's biopsy to be sure"

 

[Chartreuse Wombat]

"Blunt dissection of the avascular plane"

"Low ligation of the spermatic cord"

"Xeloda 7 days a week during radiation"

"Temodar Monday-Friday during radiation"

"It might be Wilms - let's biopsy to be sure"

"AFP >15000 but pathologist says seminoma"

"Vascular mass in the nasal cavity of a 14 year old-biopsy immediately"

 

[elementaryschooleconomics]

Legitimate question
If majority of people here think that we have too many radoncs
And agree that the standards for admission to residency have markedly decreased (less aoa, lower step scores, etc)

Then shouldn’t we want the board certification process to be as rigorous as possible? For our patients sake and our own?

Perhaps the exams need to be altered…but elimination of the hardest part (oral boards) seems to play into the hands of the expansionist chairpeople

I have previously heard that the failure rate for medical physicists is like 50%…

There's a HUGE difference between "rigor" and "hard for the sake of hard".

I can easily design an exam to fail 75% of the people taking it. But passing that exam doesn't separate "good" from "bad".

That's the core of the issue, for me. The ABR has literally never, in its entire history, produced a shred of evidence that their board certification process means ANYTHING. There is literally not the faintest whiff of support for the statement: "board certification through the ABR in Radiation Oncology produces safer/more competent physicians".

Actually, the fact that you can't even finish the certification process till at least 1 year of practicing independently anecdotally supports the null hypothesis, that is, board certified physicians are no different than non-board certified physicians. Every year, there are now at least 200 RadOncs practicing for 12 months without certification. With COVID-induced delays, this number doubled for almost a full year recently.

I haven't heard any issues with safety or efficacy. Maybe we need long term follow up?

Because of the nature of medical education and training, we're conditioned to BELIEVE that this process is necessary and "good". That all of our sacrifice and effort was "worth it". But...perhaps it wasn't. Perhaps it isn't.

The burden is on the ABR and the other specialty boards to prove their value to US, not the other way around.

 

[RSAOaky]

Legitimate question
If majority of people here think that we have too many radoncs
And agree that the standards for admission to residency have markedly decreased (less aoa, lower step scores, etc)

Then shouldn’t we want the board certification process to be as rigorous as possible? For our patients sake and our own?

We should not be punishing trainees to compensate for poor leadership decisions. As much as we rail on Boomer radoncs who have made their money at our expense, to attempt to maintain our current job market by punishing those that come after us would be no better.

 

[TheWallnerus]

Legitimate question
If majority of people here think that we have too many radoncs
And agree that the standards for admission to residency have markedly decreased (less aoa, lower step scores, etc)

Then shouldn’t we want the board certification process to be as rigorous as possible? For our patients sake and our own?

Perhaps the exams need to be altered…but elimination of the hardest part (oral boards) seems to play into the hands of the expansionist chairpeople

I have previously heard that the failure rate for medical physicists is like 50%…

If this stat is true then it appears board difficulty and/or failure rates don't (significantly) prevent the growth of new specialists

To wit, growth in ABMS diplomates 2002-2022:

#1: Rad onc (up 147%)
#2: Emergency med (up 143%)
#3: PMR (up 124%)
#4: Therapeutic med phys (up 106%)
...
#22: Urology (up 32%)
...
last place: Thoracic surg (down 2%)