CNN story about cheating on radiology boards

[mlw03]

http://www.cnn.com/2012/01/13/health/prescription-for-cheating/index.html?hpt=hp_c2

and this is a response from the ABR: http://www.theabr.org/sites/all/themes/abr-media/pdf/ABR Exam Security Information from Becker.pdf

Discuss.

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[smq123]

Moving to Radiology.

 

[drizzt3117]

They're changing the boards starting with the current pgy-3 class, so should be a non-issue.

 

[mlw03]

I put this in the general forum because I do not think this is something unique to radiology. Pathology residents speak of "rememberances" which are not exact questions like talked about in this case, but do refer to particular pathologic entities tested on slides. But this is more overt, in my opinion, and I'm surprised that it seems to have been going on for so long, leading me to believe the ABR had to know about it. Please consider returning this to the general forum, because I bet similar stuff is occurring in other specialties, and I think the perspective of other residents beyond radiologists would add to the discussion.

 

[mlw03]

They're changing the boards starting with the current pgy-3 class, so should be a non-issue.

It may be a non-issue going forward, but what about what's already occurred? What if you knew someone who failed because they didn't have access to the question bank, or felt that using it was wrong?

 

[smq123]

I put this in the general forum because I do not think this is something unique to radiology. Pathology residents speak of "rememberances" which are not exact questions like talked about in this case, but do refer to particular pathologic entities tested on slides. But this is more overt, in my opinion, and I'm surprised that it seems to have been going on for so long, leading me to believe the ABR had to know about it. Please consider returning this to the general forum, because I bet similar stuff is occurring in other specialties, and I think the perspective of other residents beyond radiologists would add to the discussion.

Well, it's not really an issue in Family Med - if there's anything similar floating around, I've never heard of it. But you've convinced me; I'll move it back to gen res for now.

 

[mlw03]

Well, it's not really an issue in Family Med - if there's anything similar floating around, I've never heard of it. But you've convinced me; I'll move it back to gen res for now.

Thank you. Perhaps I'm wrong and it's mainly the radiologists and pathologists who do this sort of thing. Hopefully residents and/or recent residents from across lots of specialties will chime in. That said, I don't know what board pass rates are in various specialties. In path, I believe they're between 70-80%, so it's not like USMLE step 2 CS, where >95% of first-time takers pass. The stakes are very high, again at least in pathology, as it is incredibly difficulty to get and keep a job without board certification.

Maybe it's not an issue in some other specialties because residents feel the exams are more fair and reflective of what they do day to day (pathology exam partly is, but plenty of zebra diagnoses no one would ever make without extensive workup and showing the case to multiple other pathologists, and just lots of stuff not seen routinely).

 

[cowme]

huh? this sounds just like USMLE world. WTF is the issue here?

 

[radspouse]

The comments below that CNN story have a great deal of information that CNN was missing:

"As a radiology resident, we had a test bank of old questions. Our smartest resident, the one we could go to for questions, did not use the test bank to study from. He knew textbooks forwards and backwards, and could find the errors in them. He failed the written board exam. The next year, he used just the test bank and scored 90+percentile. The majority of the board tests are not "real world". You study one set of information to pass the tests, and a different set of information to actually treat your patient." - isildain

"First of all, as a doc who was in other fields before entering radiology, this happens in ALL medical fields, so I don't know why CNN is singling out radiologists. The written ABR exam means little. When you've passed an oral exam getting grilled a panel of angry attendings who can throw out questions as they please, why are we even talking about this?" - InfinityRun

"Just to shed some light on the exams:

1. The 'alleged cheating materials' are literally hundreds of pages long. They are usually accompanied by an explanation of why the 'right' answer is right. Some of these explanations are a page or two long. To 'memorize' the answer means learning the reasoning behind the exam question. On the actual exam, some questions are directly the same question, but others are tricks--where the only way of obtaining the right answer is understanding the concept of the question. So, it's not a simple matter of saying 'well, the answer is C, so that's what i'll put on the exam.' Actually, most modern computer based exams scramble choices from test-taker to test-taker.

The field of radiology is so difficult and broad, that the only way to reasonably focus studying is to use recalls. The exam Dr. Webb failed also requires memorizing an additonal book from cover to cover (Huda, the radiological physics masterbook), and using a much larger books to provide supplementary material. In fact, the dangerous route would be to try and just do recalls without reading up on the exam. You need to be able to apply concept rather than just puke up material.

This is, by the way, one of 3 exams that radiologists take in training to get certified. The final exam is an oral exam where a random case is show in 13 disciplines--this one is fairly randomized, so there is not 'cheating' (though common cases can show up--you want everyone certified to be able to recognize a pneumonia or a case of abuse, wouldn't you?)

The only difference between Radiology and other high level exams is that these questions are traditionally distributed amongst residents rather than a company that sponsers a question bank. The equilvalent would be having to pay Kaplan or Princeton Review (are they even around) for access to a question bank...." - RadDoc333

"Well put. I'm also not sure how this could be considered cheating unless the questions are the same every single time, and they're not. At least as it applies to the Surgery boards, you could study old exam questions and maybe see a handful of questions that have been recycled, but all in all you still wouldn't pass unless you had a broad knowledge of all the available material.

Honestly this sounds like a case of a bitter resident who failed and wanted to take it out on his program." - DrPete

"Well put, and exactly correct. The crux of this "story" is that the head of the ABR calls this cheating. It is not cheating, for all the reasons listed above. Furthermore, the ABR tacitly condoned this practice for years, at least in part because they never published a test syllabus or study guide. They only call it cheating once put to the screws by CNN, instead of rightfully assigning blame to themselves." - COHawk

"I am radiologist who has been in practice for 15 years. I took the Kaplan SAT prep course, I took (and later taught) the Kaplan MCAT course. And yes, I and every radiology resident I know, used a bank of old question "recalls" to prepare for the written portion of the board certification exam. My education was 4 years of undergrad, 4 years of medical school, 5 years of a radiology residency, and an additional year of subspecialty fellowship. In addition to the routine work, study, and hands on "at the alternator" work of radiology training, I estimate that I have spent literally hundreds to thousands of hours in exam preparation study. This is the norm for people who want to become radiologists. We board certified radiolgists are well trained professionals, deeply conscientious and QUALIFIED. I regret the words of the ABR and the sensationalistic tone to CNN reporting as they do a disservice to the community." - dergon

"As someone who is in the field of radiology and who has been a first hand witness to the certification process, it is clear to me that the ABR has brought this upon themselves. The tested material that the ABR expects radiology residents to memorize is so far detached from reality and dives so deeply into useless minutia that it is not beneficial nor practical for any resident to waste their time attempting to learn a large chunk of what is tested on these exams. The written exam itself is thought of as a joke amongst many residents, and rightfully so. If the ABR decides to rejoin the real world and test on was is truly needed for good patient care in a daily radiology practice then they can expect the proper respect from those who will be taking their exam." - boomslice

"I am an associate professor of radiology who has been practicing for 15 years and must disagree strongly with the conclusions of this report. I see the use of board recall questions as a legitimate study tool for radiology residents. Why? because they inform the residents what the "experts" making the test consider to be the knowledge that radiologists need to know. There are literally thousands of questions that could be asked in literally millions of different ways. The recall questions are neither complete nor fully accurate, and they do not come with answers. When I was a resident, we got the recalls from the previous class, then spent hours in the library looking up answers in textbooks. In doing so we added to our knowledge base. If, for example, someone recalled a question on lymphngioleiomyomatosis, and I realized that I didn't know what lymphangiomyomatosis was, then I looked it up and learned the radiographic appearance of LAM. If you take 10 or more years of recall questions and put them together, you have 20 hours or more of material to review. This a far cry from someone giving you the questions and answers to the test that you, yourself are going to take. The recalls, without a base of knowledge to put it in context, are useless.

Now that I am instructing residents rather than studying myself, I still ask the residents for their recalls. Why? because I know that my lecture curriculum is not perfect and is not comprehensive. Most of what they tell me are things I already know, but every year they come up with one or more topics that I realize I have not covered adequately, and I revise my lectures to fill in the gaps. It is a process of constant improvement.

That the questions are posted on web sites demonstrates how benign a process this is considered by residents. The purpose of cheating is to gain an unfair advantage over your fellow residents. Here, the knowledge is shared so that everyone can compete on a level playing field.

The ABR can easily eliminate this problem if they so desire. First, they can stop repeating such a high percentage of questions. I would have guessed that 10-20% were repeated: to hear that the number is 50% is shocking. Second, they can replace the current format, where the majority of questions rely on the recall of obscure facts, with one in which the resident is presented with an image: an x-ray--a CT scan, an ultrasound, etc--and are asked to make a finding. It is a far more realistic way to test how well a student will actually be able to perform his or her job. Image-based questions cannot be easily recalled: without the image, they are worthless. Besides, it is far more important to know that your radiologist can read an x-ray than to know that he remember which arm of which chromosome the Von Hippel-Lindau gene is located." - Guest

"I am a radiologist and completely agree with many of the other radiologist postings in response to this story. This was a poorly researched and Dr. Webb was apparently poorly vetted by CNN journalists in regards to his status as a "whistleblower." AC and his crew seem to imply that he was released from the his residency program as a sexual harrasser in response to his blowing the whistle on his Army residency. I suspect that he was first punished for unrelated unprofessional behavior and retaliated by alerting CNN to what he hoped would come across as a scandalous story for the military. CNN apparently took the bait hook, line and sinker. The use of recalls to study for board exams is no scandal. For the ABR president to appear shocked that a residency program was using recalls is at best completely uninformed, at worst, hypocritical and disengenuous. The American Journal of Roentgenology, the flagship journal of U.S. radiologists published an article in 2008 (AJR 2008:191:954-961) which surveyed the vast majority of radiololgy residencies in the U.S. The survey showed that the vast majority of most residents in most U.S. radiology residencies used recall questions as a substantial component of their written board preparation... so this is not breaking news or a scandal... Apparently Dr. Becker and Dr. Webb don't read the AJR and CNN doesn't know how to look up facts on Google Scholar before they run a story. Shame on you Anderson Cooper and your sloppy, sensationalistic journalism. I'll turn the channel back to MSNBC." - BWC13

"So for people who fail and retake the radiology board exam, they are cheating every time without even knowing it? This is a joke. A complete joke." - rawpimple

"First of all, as a practicing radiologist who recently graduated from residency and fellowship, I can say with near certainty that the ABR absolutely DID know that residents were using recalls for years. Second, as many have already pointed out, the practice of using recalled questions from prior exams is all-encompassing across all avenues of higher education. It's called studying. And from my own experiences, I can tell you the great majority of supposed "recalls" are very ambiguous at best. Imagine getting a stack of paper with recalls like "something about cerebellar ataxia"...or "know staging for RCC"...that's your recall. Great; go with it. The simple fact is recalls are not the answer, and they only provide a way of focusing the residents' studying toward topics that they should make sure they are familiar with. I personally have seen literally thousands of recalled questions from numerous years of various residency collections (yes, every single program has them). I can tell you with no uncertainty that the majority of the recalls were either incorrect, vague, or incomplete. They are a study aide. PERIOD. It is not cheating, no matter how the ABR wants to spin the recent "complaint" and it's subsequent investigation. Radiology residents spend hundreds of hours studying for each of their board exams. No exception. These are not exams that you can read through the "recalls" the night before and pass.
Third, pointing a finger at radiology residents and proclaiming them "cheaters" to the world is in very poor form by CNN. They should be ashamed of themselves. In a society such as ours, pointing a blaming finger at any one group can do insurmountable damage to every individual in that group, regardless of their previous work or merits. We have all just been lumped into one big pile of "cheaters" by CNN. Perhaps CNN would also like to say that all radiology reports must then be in error and every one the past 20 years who has had an MRI, CT, ultrasound, xray, stress test, nuclear medicine therapy, PET scan, angiogram, angioplasty, percutaneous drainage or biopsy, mammogram, or radiation treatment must have had their test or treatment inappropriately too? Maybe we should just get rid of radiology altogether? We can go back to the good old days when physicians examined the patient and then GUESSED what the possible problem was. (Do you have any idea how many normal appendixes were removed in the years before medical imaging?). Radiology has advanced more rapidly than any other field of medicine and the practice of medicine would be largely ineffectual without imaging.
Fourth, radiology residency is one of the longest residencies in medicine, and consistently one of the most difficult residencies to gain entrance into. Top that off with the great majority of graduating residents going on to complete subspecialty training in a 1-2 year fellowship. The typical radiology resident is in the top 10% of their medical school class. Radiology residents are the ONLY medical residents who are required to take THREE separate board examinations DURING their residency. (Most others take 1 during, or even after, their residency.) Did CNN mention any of this? NO, they just pointed a fionger and said "radiology residents are cheaters". Well done. Makes you wonder what the motives of such an article really are.... " - neurorad

"After thinking about this more, I wonder if CNNs intent in targeting radiology has to to with political motivation and the inherent expense of imaging in health care. If they can demonize radiologists among the general public, perhaps the government can gain public support towards further reducing the medicare payments for imaging. They have done it already somewhat, so maybe they are trying to influence the public not to fight back in support of radiologists, or even medical reimbursement in general. Just a thought. I'm not sure why CNN would try to construct such a damning story otherwise." - ADJJUNE

 

[radspouse]

Now that I have quoted myriad radiologists here are my comments:

This is not "cheating" at all.

It's the same thing that the SAT, ACT, and pretty much every single other standardized tests have: test banks. These are thousands of questions from prior exams with detailed explanations of the correct answer.

There are several issues with this story:

1) This former army radiology was actually fired from the residency program waaay before his disingenuous "whistleblowing". Why? Really, really bad sexual harassment. I remember dh mentioning this to me last year (in very general terms - I am not privy to any private information). The entire case was sickening from what he could relate. And, the guy is trying to discredit ALL radiologists, because he's never really going to be able to work again once his military service is finished. I'm actually surprised they didn't give him a dishonorable discharge for his really awful behavior towards female staff. There has been absolute no retribution from the military regarding this CNN story. The only retribution this guy will face is being shunned by the entire world of radiology for being a big rear-end.

2) Radiology's written boards are notorious for being completely unrealistic. They don't cover real-world scenarios. The oral boards do. And, the oral boards are HARD - hard in a way that you won't find in many other specialties. The written boards can certainly be passed without studying prior exams. However, just as you do better on the SAT by studying previous SAT content, you do so for the Radiology written boards as well. It's not "cheating" - it's called studying.

3) This is something that happens in pretty much every single radiology program across the country. AND the American Board of Radiology ENCOURAGES radiology residents studying prior year's exam questions. And, the questions are not "verbatim". Essentially these are questions that are developed from residents remembering the general topic or subject matter of various questions. Again, this is called studying what content to expect on an exam.

4) If this were "cheating" then every single radiology resident who has failed their boards at some point (and, it does happen often - although dh didn't fail any of his) would be "cheating" the next year when repeating the exam. Why? Well, that resident would have been personally privy to the last year's questions. You see how silly it is to call this type of studying "cheating"? It makes every single re-taker of their boards an automatic "cheat". Just silly.

5) The sexual-harrassing ex-resident is someone who actively ENCOURAGED this type of studying. How do I know? One of dh's colleagues saved this particular ex-resident's EMAILS ON THE SUBJECT. Yup, chances are good that particular radiologist will be ignored by CNN as he submits his information (which, as of last night, he was forwarding those emails to CNN to my knowledge). This is a case of a guy who got kicked out of a program for being a truly awful human being and then decided to "get back" at not just the program, but the entire world of radiology. This man is NOT a good guy in any way, shape, or form. And, his "whistleblowing" is basically trying to get residents in trouble for doing basic studying. He has issues with a capital "I".

6) Oh, yeah. I know a whole lot about this. More than CNN does. And, I know it on a personal level. It's CNN trying to create a story where there is none. Watch them go after other major exams' test banks next. SAT, MCAT, ACT, all the other board exams for medicine - they're all on the table for studying being called "cheating". Slippery slope, anyone?

 

[radspouse]

huh? this sounds just like USMLE world. WTF is the issue here?

Yup. This is exactly the kind of studying that you do for the MCAT, the LSAT, the USMLE, the SAT, the ACT, etc. It's called "question-banks" and companies such as Kaplan sell them. The difference here? None of the question-bank companies (such as Kaplan) has had the ability to sell their question-banks to radiology residents for exorbitant amounts of money, because the radiology programs (ALL of them) have been doing it - for free - for themselves. I guess the ABR might see a money-making opportunity here: Make residents take three board exams (two written and one oral) for thousands of dollars (this already happens) after making residents pay several hundred to a thousand dollars to purchase these same types of question-banks from the ABR or some designated company. Hmmmm.... Someone is going to make a ton of money here. AND suddenly it won't be "cheating" anymore to study previous exams in preparation for an upcoming exam.

 

[harmnot]

CNN...says it all. Remember when Obama falsely accusing physicians of making children sicker for the sake of reimbursement? Todays news and politicians alike are in the business of sensationalism...not truth telling.

 

[valkener]

It sounds like the guy (the accuser) is sleazy. However, I don't understand how it's ok for a school to keep/update/create a database with recalls - imo it's different from TPR or Kaplan doing this as an independent organization.

One important fact here would be how much these questions were "verbatim". If they were indeed verbatim then you can spin it how you want it, it's cheating.

Cheating is not an answer to an unrealistic test.

 

[smq123]

It sounds like the guy (the accuser) is sleazy. However, I don't understand how it's ok for a school to keep/update/create a database with recalls - imo it's different from TPR or Kaplan doing this as an independent organization.

I don't think that the "school" (or the residency program) were collecting past exam questions. It sounds like radiology residents were sharing them, probably on Aunt Minnie forums.

(As an aside, please change your status. If you're in the class of 2015, you're clearly not yet an attending physician. Please change it to medical student or health student.)

 

[valkener]

I don't think that the "school" (or the residency program) were collecting past exam questions. It sounds like radiology residents were sharing them, probably on Aunt Minnie forums.

In the video it was stated that these collected from past exams by asking students to memorize them and then enter them into the database on a military computer server from the residency program. Did you even watch it?

 

[NotAProgDirector]

It's a really interesting question.

Using practice questions to study for an exam is fine.

Memorizing questions from an exam and then writing them down and giving or selling them to future test takers is illegal and wrong. It's amazing how people can rationalize it. Sure, maybe the exam is ridiculous and unfair -- but as mentioned above, it doesn't make this OK.

And, organizing a group where each person is instructed to memorize a certain question or range of questions is a conspiracy, and is worse.

Perhaps this happens in other fields. Perhaps USMLEWorld steals their questions from those taking the USMLE. It's still illegal.

Here's what should happen:

The ABR should release old questions for free that won't be used again. Then, people could use these questions to study. Although the question itself won't be used, presumably similar topics will be quizzed in the future.

Radiology PD's should pressure the ABR to change the exam to be more realistic, rather than condoning this behavior.

 

[ketamine]

The ABR should release old questions for free that won't be used again. Then, people could use these questions to study. Although the question itself won't be used, presumably similar topics will be quizzed in the future.

This problem was created by the laziness of the medical boards. Is the subject area so limited that the medical boards can't create a new exam every year?

Board exams should be published, soon after they are administered. All old exams for the last 7 to 10 years should be available for purchase by anyone. This will quickly stop the process of "cheating by remembering questions" but more importantly exams would be open. Bad questions could be debated and eliminated, thus improving the quality of the exam.

Exams published soon after they are administered are the only way to assure that the process is fair, honest, and transparent. Open exams will allow the public to be to be confidence of the system. Publishing exams will allow residents and attending to debate the contents of the exam, and thus the relevance of the exam.

 

[Law2Doc]

...

Perhaps this happens in other fields. Perhaps USMLEWorld steals their questions from those taking the USMLE. It's still illegal....

there's a huge difference between What you are calling "illegal" (ie a violation by the person breaching his agreement) and "cheating" (which presumes the person studying from the old questions is doing something wrong). There is no "perhaps" here. Test prep companies have been debriefing test takers and even hiring people to take the tests specifically for purposes of obtaining questions such that their qbanks are a reasonable facsimile of the real thing for decades. Everyone who ever went through a commercial qbank For any of the Steps, or anyone who took a prep class for the SAT or MCAT is using "recalls". This actually is more insidious than what's going on in radiology because money changed hands. Pretty much every med school grad has used some variation on this. It's not really cheating -- you don't know any questions that will be on the future exam unless the tester decides to reuse a question verbatim, which is simply lazy. Instead all you really know is what topics are high yield because they have been tested before. So that way you don't waste time studying stuff your board doesn't deem as important. The goal is to have people learn the material that the board deems highest yield, but the only way to really know what is deemed highest yield is based on what it historically tests on.

 

[mlw03]

Glad to see people discussing this. Will anyone comment about whether or not anything like this occurs in other specialties? I shared my comments about pathology above.

 

[Law2Doc]

.. Will anyone comment about whether or not anything like this occurs in other specialties? .

what do you mean by "like this"? Every question bank or question book for the steps and every specialty board or inservice is based on information from prior test takers, if not remembrances of the exact questions they saw. There is simply no other way to provide a high yield resource without knowing hat has historically been tested. You cannot study "everything" blindly in any field and expect to hit on many of the topics they will choose to cover in a 100-200 question exam. You will end up spending most of your time on things the profession doesn't care as much that you know. So old questions are an important learning tool. Every field of medicine, and actually every profession that uses standardized tests is "guilty" of this. I can tell you for sure that to prepare for the multistate bar exam in law people do thousands of problems that are based on prior test questions too. Thats not considered cheating.

 

[Montisumo]

This is ridiculous. In no way shape or form is this cheating... Everyone who has ever studied for a board, MCAT, GRE etc... has cheated according to CNNs definition. By this same logic, studying questions from a public Qbank developed by test takers = CHEATING; studying questions from a private company (Kaplan etc) in which YOU MUST PAY = not cheating.

Ridiculous...

 

[mlw03]

I agree with aPD in that there's a difference between remember topics tested versus organizing questions and answer choices to memorize. i've not heard something to that degree taking place elsewhere, which is why i think the radiology thing is taking it to another level.

 

[MiddleRoad]

I agree with aPD in that there's a difference between remember topics tested versus organizing questions and answer choices to memorize. i've not heard something to that degree taking place elsewhere, which is why i think the radiology thing is taking it to another level.

I second this. If a commercial test prep company hires people to take the test to then come back and recall what subjects were tested so that they can then write different questions that cover the same material, they are not simply recalling copyrighted material verbatim. Certain test prep companies have been prosecuted before for blurring this distinction. Something like First Aid covers all the subject areas covered on Step I-III, and they modify their book based on people submitting responses from tests they've taken. No one is claiming that First Aid is an illegal reselling of test material.

Nevertheless, it is a distinction and those who were recalling the exact questions and distributing them were on ethically shaky ground. The USMLE tests seem to be constantly updating and changing their questions (though, to be fair, they are evaluating a much larger number of total test-takers than the ABR).

That being said, it does sound like the test could stand being updated so that it is more pertinent to real life clinical situations.

 

[Law2Doc]

I agree with aPD in that there's a difference between remember topics tested versus organizing questions and answer choices to memorize. i've not heard something to that degree taking place elsewhere, which is why i think the radiology thing is taking it to another level.

I think you are trying very hard to create a distinction where none actually exists. It is just as against the agreement you sign of all these specialty boards if you reveal the topics you recall being covered as it is to offer your recollection of the questions. It's the same agreement you violate. And it's you the person making the recalls, or providing the topic information that violated it, not the guy who ends up with the questions several years later.

Additionally, I think all of us have seen questions in commercial qbanks that were the exact same questions as the steps, not a paraphrase. These are all "recalls", no matter how you slice it. The only real difference is that World, Kaplan etc do it for profit, whereas upperclassmen do it for free. So basically you guys are making a distinction that is the equivalent of saying it's okay to cheat on your spouse so long as it's with a prostitute.

Finally I would suggest that as you progress upwards within your training in any specialty, the availability of things to study from for boards that is similarly high yield to what you used in med school becomes more and more scant. There aren't commercially available qbanks for many of the professional boards. So you use whatever the program has collected over the years that prior folks have deemed useful, much of which is internally created. I think having to take a test where the specialty doesn't offer any study aids themselves, and where no commercial entity offers useful study aids, results in programs trying to create their own. Again the goal is to learn the material, not just to have residents flail blindly learning things the board doesn't deem that important. But how do you do that without some info as to what they deem test worthy? Again, the distinction you make between passing on info about topics tested versus passing on questions tested is a distinction not made by these specialty boards. Both are not allowed. It's ludicrous. The boards should all either start selling old tests themselves so folks have some semblance if a study guide, or make new test questions every year, so there is no concern that old test questions will come up again. Right now they seem to want a situation where you have to take a test, but can't know what kind of questions they plan to ask, so just go ahead and study the wrong stuff, so we can tell the world that our doctors don't cheat, they just don't know jack about the things we deem important because they didn't blindly stumble upon the appropriate topics...

 

[dragonfly99]

Yes, this sounds like cheating, if the exact questions and answers were being recalled. However, as pointed out by others on this thread, this was blown out of proportion in the news...one wouldn't get through radiology training just by taking this one test and doubtful that a question bank would help a crappy resident get a great score. You still have to understand something about what you are memorizing, I assume, to get through all the other radiology boards, not to mention monthly and yearly residency evaluations.
Does radiology have yearly "in service" exams? Just wondering.
Probably this whole scandal may cause the radiology folks to put out a study guide or some sort...they really should. Of course it will cost hundreds of dollars like all the study aids I've had to buy for cardiology...LOL.

 

[valkener]

I'm pretty sure Kaplan et al would get sued by the AAMC if they would publish 1:1 exact questions and materials by the testmakers. I think there is an important distinction to make here, but I don't want to repeat myself.

I also think it's almost an invitation to cheat to use the same tests again and again, but it's still not an excuse imo, especially if these are 1:1 - especially if the test is unrealistically hard.

 

[Law2Doc]

I'm pretty sure Kaplan et al would get sued by the AAMC if they would publish 1:1 exact questions and materials by the testmakers. I think there is an important distinction to make here, but I don't want to repeat myself....

I think most of us have seen exact duplicates on the steps of questions we have seen on qbanks, so I think you may be overstating the distinction, I also don't think it changes the CNN position if the folks recalling the questions mildly changed the answer stems.

 

[colbgw02]

For all of the people who believe this is cheating, I have a question.

First, two scenarios:

1) A resident takes a board exam, and then writes down a list of specific topics that were included on the exam for use by next year's residents.

Example: Make sure you know the most common type of vascular ring.

2) A resident takes a board exam, and then writes down the questions to include the answer choices to the best of his memory, but he does not provide the right answer, for use by next year's residents.

Example: The most common type of vascular ring is:
A) Double aortic arch
B) Right arch with anomalous left subclavian artery
C) Anomalous left pulmonary artery
D) Anomalous right subclavian artery

Is there any difference in what these two residents have done?

 

[Law2Doc]

For all of the people who believe this is cheating, I have a question.

First, two scenarios:

1) A resident takes a board exam, and then writes down a list of specific topics that were included on the exam for use by next year's residents.

Example: Make sure you know the most common type of vascular ring.

2) A resident takes a board exam, and then writes down the questions to include the answer choices to the best of his memory, but he does not provide the right answer, for use by next year's residents.

Example: The most common type of vascular ring is:
A) Double aortic arch
B) Right arch with anomalous left subclavian artery
C) Anomalous left pulmonary artery
D) Anomalous right subclavian artery

Is there any difference in what these two residents have done?

Bearing in mind that both are equally violative of any agreement not to share information about the test, they are equal transgressions. It's a breach of contract. I don't think that equates to "cheating" though. Perhaps that's a subtle distinction, but I think it matters in terms of underlying licensure, etc even if you don't end up board certified.

 

[NotAProgDirector]

Really the situation boils down a few issues:

1. How validly the test actually assesses the skills necessary in the profession.
2. How well the content is described by the test writers.
3. How clear and unambiguous the questions are.

Imagine I write a test that actually tests how good of a radiologist you are. It is 80% routine stuff, and 20% zebras. I can then score you and tell you whether you're 1) incompetent; 2) competent at routine stuff, or 3) uber-competent at zebras. In that case, you shouldn't need to study at all. You should simply be able to walk in, take the test, and prove your competence. And then you can prove your "zebra skills" -- perhaps through a different exam if needed.

If the content of the exam is described adequately, then you should be able to review it without the need for old questions.

Old questions become very helpful if the questions on the exam are ambiguous or vague, or if there are "regional variations in care". When to get a stress test vs a cath is a very thorny question, for example.

Not reusing old questions is a solution. Writing a full exam of questions is not easy, but could probably be done. However, it depends upon the size of the specialty -- if the number of test takers is small enough, you might need one year of answers just to validate the question. needless to say, this would be lots of work, and might make the exams even more expensive than they are already. And, it might actually worsen the quality of questions (since when you reuse questions, you can keep the "good" ones and get rid of the "bad" ones).

Memorizing questions and writing them down with answers seems wrong to me, and clearly violates the agreement you sign when you take the exam.

Anyone generating their own questions from an exam blueprint is fine.

Using a qbank which is commercially available seems OK. People here seem to state that these questions are "obviously" stolen. I would assume that the USMLE (or other testing authority) regularly follows these companies and assesses their questions, to ensure that they are not stolen. Hence, it seems to me that these would be OK. One such company (Aurora testing, or something like that) was closed down recently, and anyone who took their course had their scores invalidated, for exactly this reason.

As mentioned above, if the exam was fair and tests the skills actually needed, then many of these complaints become invalid.

 

[Law2Doc]

Really the situation boils down a few issues:

1. How validly the test actually assesses the skills necessary in the profession.
2. How well the content is described by the test writers.
3. How clear and unambiguous the questions are.

Imagine I write a test that actually tests how good of a radiologist you are. It is 80% routine stuff, and 20% zebras. I can then score you and tell you whether you're 1) incompetent; 2) competent at routine stuff, or 3) uber-competent at zebras. In that case, you shouldn't need to study at all. You should simply be able to walk in, take the test, and prove your competence. And then you can prove your "zebra skills" -- perhaps through a different exam if needed.

If the content of the exam is described adequately, then you should be able to review it without the need for old questions.

Old questions become very helpful if the questions on the exam are ambiguous or vague, or if there are "regional variations in care". When to get a stress test vs a cath is a very thorny question, for example.

Not reusing old questions is a solution. Writing a full exam of questions is not easy, but could probably be done. However, it depends upon the size of the specialty -- if the number of test takers is small enough, you might need one year of answers just to validate the question. needless to say, this would be lots of work, and might make the exams even more expensive than they are already. And, it might actually worsen the quality of questions (since when you reuse questions, you can keep the "good" ones and get rid of the "bad" ones).

Memorizing questions and writing them down with answers seems wrong to me, and clearly violates the agreement you sign when you take the exam.

Anyone generating their own questions from an exam blueprint is fine.

Using a qbank which is commercially available seems OK. People here seem to state that these questions are "obviously" stolen. I would assume that the USMLE (or other testing authority) regularly follows these companies and assesses their questions, to ensure that they are not stolen. Hence, it seems to me that these would be OK. One such company (Aurora testing, or something like that) was closed down recently, and anyone who took their course had their scores invalidated, for exactly this reason.

As mentioned above, if the exam was fair and tests the skills actually needed, then many of these complaints become invalid.

A lot of your suggestions about what "seems okay" don't carry the legal or ethical distinctions you are ascribing. Under the agreements you sign when you take these tests that you aren't going to share information about the test, it is no worse a transgression to share an "exam blueprint" or verbatim questions. legally there is no difference. It's a breach of contract either way. That one doesn't bother you as much as the other doesn't change that fact unless you are the presiding judge in a court case. And you can continue to want to believe that the USMLE prep places just get lucky when a chunk of their questions end up being identical questions to those seen on the test, but statistically tats pretty unlikely. In fact either these are "recalls", or the boards are stealing questions from the qbanks, but however you slice it many of us have seen identical questions. And a lot of folks over the years have come across test prep organizations offering money for the opportunity to debrief test takers, and even have been known to hire folks to rake various multiple choice tests for this purpose. It's really the same thing. The notion that Kaplan and World must be doing things differently or they would have been sued by now is wishful thinking and circular logic, sort of like saying I must be president because nobody ever voted against me.

Two things need to happen, and the specialty boards can nip this in the bud. First they can release for sale books of old test questions. This will fund the creation of new questions and will give residents something "legal" and accurate to study. You don't even ave to release answers or explanations -- make them do their own research and learn in the process, but provide the blueprint. Second, they need to have a different test every time, or at least do variations on the old questions. Then there will be no realistic possibility of cheating. If the goal is to have test takers learn the material and pass, playing hide the ball with the content of these exams is the last thing a board should be doing.

 

[mlw03]

In my view, yes. I also agree with apd's earlier comment about the conspiracy issue.

For all of the people who believe this is cheating, I have a question.

First, two scenarios:

1) A resident takes a board exam, and then writes down a list of specific topics that were included on the exam for use by next year's residents.

Example: Make sure you know the most common type of vascular ring.

2) A resident takes a board exam, and then writes down the questions to include the answer choices to the best of his memory, but he does not provide the right answer, for use by next year's residents.

Example: The most common type of vascular ring is:
A) Double aortic arch
B) Right arch with anomalous left subclavian artery
C) Anomalous left pulmonary artery
D) Anomalous right subclavian artery

Is there any difference in what these two residents have done?

 

[colbgw02]

In my view, yes. I also agree with apd's earlier comment about the conspiracy issue.

So do you think that both scenarios are cheating? Are they both acceptable? What is the difference between the two?

 

[Werg]

Let me give some perspective from a non-radiology ABR test taker (they give boards for three main areas: rads, rad onc, and medical physics and sub-specialties of those).

I'm a medical physics trainee. If I want to study for Part 1 of the medical physics ABR exams, the ABR gives me a list of 18 topics and 14 total(!!) practice questions.

As an example, one of the 18 topics listed is biochemistry. Biochemistry is not part of the standard curriculum in medical physics grad school (and personally I have no idea what they could possibly ask about biochemistry). None of the 14 practice questions touch on any biochemistry. How do I go about studying biochemistry? How much of my 2+ months of preparation should I devote to studying biochemistry? Keep in mind there are no study books available for taking the medical physics board exams. Also biochemistry is not covered in any medical physics text books (that I'm aware of).

Some of the other topics listed are so broad that there is no way to direct your study effort in any efficient way based on the information you are provided by the board.

I think this is the main reason why "recalls" are also a constant issue for people taking the ABR exams in rad onc and medical physics, not just radiology.

Certainly, no one is sending in ringers or professional test takers to simply take the tests and memorize the questions. This is not the SAT, the bar to qualify just to take the exams is incredibly high. The problem is that the exams are poorly executed by the board. I would guess many people write down and consolidate questions they saw as a potential study tool for *themselves* in the event that they did not pass.

 

[NotAProgDirector]

Good points all. I basically agree with L2D's assessment.

When I said "blueprint", I was referring to an official, published blueprint by the examining group. Hence, this wouldn't be stealing/illegal. Usually the exam information booklet has some description of what's actually going to be on the exam. But, as pointed out above, in this case the description is so vague as to be useless.

I had thought that one of the USMLE prep companies had recently been shut down for stealing material like this -- but I was incorrect, it was an ABIM prep company. I am surprised that if USMLE prep companies steal questions, that the USMLE doesn't prosecute them. It would seem to be easy to sign up for one of these companies, review the questions, look for duplicates, etc. Or, hire people to sign up with the company for USMLE review, and then see if you get "propositioned" to report questions back. But, maybe the companies are just too smart for this -- they use a cadre of known people to get questions for them, change the questions enough so that they can't be prosecuted. In that case, I expect the USMLE does monitor their question banks, and then removes questions that have been stolen. Or, for the true conspiracy theorists out there, perhaps the test prep companies are actually run by the people at the USMLE to make more money.

As pointed out, the solution is more transparency, release of old test questions, and improved "relevance" of tested material. The ethics of the test writers selling old questions that you absolutely must have to pass the test is an interesting debate in itself.

 

[mlw03]

So do you think that both scenarios are cheating? Are they both acceptable? What is the difference between the two?

No, I draw a line between organized memorization of test questions and answer choices versus jotting down topics tested and sharing that info with future residents. In my view, the former crosses an ethical line against cheating, although I understand views that they're basically the same thing; I just disagree with such a view.

 

[Law2Doc]

No, I draw a line between organized memorization of test questions and answer choices versus jotting down topics tested and sharing that info with future residents. In my view, the former crosses an ethical line against cheating, although I understand views that they're basically the same thing; I just disagree with such a view.

Well, in a court of law, when you sign an agreement that you won't disseminate information about a test, both transgressions are equivalent. Doesn't really matter what your view is or where you draw the line, it matters where the agreement you signed draws the line. If we are labeling such a breach as "cheating" (which i dont think is accurate) then either neither is cheating or both are.

 

[b-real]

Good points all. I basically agree with L2D's assessment.

When I said "blueprint", I was referring to an official, published blueprint by the examining group. Hence, this wouldn't be stealing/illegal. Usually the exam information booklet has some description of what's actually going to be on the exam. But, as pointed out above, in this case the description is so vague as to be useless.

I had thought that one of the USMLE prep companies had recently been shut down for stealing material like this -- but I was incorrect, it was an ABIM prep company. I am surprised that if USMLE prep companies steal questions, that the USMLE doesn't prosecute them. It would seem to be easy to sign up for one of these companies, review the questions, look for duplicates, etc. Or, hire people to sign up with the company for USMLE review, and then see if you get "propositioned" to report questions back. But, maybe the companies are just too smart for this -- they use a cadre of known people to get questions for them, change the questions enough so that they can't be prosecuted. In that case, I expect the USMLE does monitor their question banks, and then removes questions that have been stolen. Or, for the true conspiracy theorists out there, perhaps the test prep companies are actually run by the people at the USMLE to make more money.

As pointed out, the solution is more transparency, release of old test questions, and improved "relevance" of tested material. The ethics of the test writers selling old questions that you absolutely must have to pass the test is an interesting debate in itself.

You are also correct about the USMLE prep company http://www.usmle.org/announcements/optima/optima-suit-update.aspx. They filed suit against Optima, and were awarded a $2.4 million judgment and the owners were indicted on fraud charges.

 

[mlw03]

Well, in a court of law, when you sign an agreement that you won't disseminate information about a test, both transgressions are equivalent. Doesn't really matter what your view is or where you draw the line, it matters where the agreement you signed draws the line. If we are labeling such a breach as "cheating" (which i dont think is accurate) then either neither is cheating or both are.

That's a fair point, and I'm certainly not a lawyer. I suppose that the precise language matters, from the legal standpoint at least. I was arguing more from the moral perspective. In my view, what the CNN story reports radiology residents doing (organized memorization of exact test questions and the answer choices) crosses a line beyond what I think a lot of others do, namely remember topics tested and sharing that info with future test takers.

 

[Law2Doc]

... In my view, what the CNN story reports radiology residents doing (organized memorization of exact test questions and the answer choices) crosses a line beyond what I think a lot of others do, namely remember topics tested and sharing that info with future test takers.

I think in the radiologists view, the other fields don't do recalls only because they get those questions through commercially or board related venues (some of which actually are recalls even if some choose to overlook this fact when money is involved). They aren't in the same position. But if the ABR is simply saying as their "study guide" that one of the covered topics is "biochemistry" as Werg pointed out above, there is simply no realistic way to study for such a test without studying from old tests. And studying from old tests isn't cheating -- most of us have studied for courses from old tests somewhere down the line.. I think it's easy to say it's immoral and yet you use World or Kaplan for your steps and happily laugh at the lucky "coincidences" that you just happen to see a few identical questions on your real test. Guess what -- you were using recalls. Only you paid money for them -- I guess that makes it moral. Again it's the argument I made above, apparently it's okay if money and strangers are involved -- it's not cheating on your wife if it's a prostitute. At any rate there's a pretty clear distinction between breaching an agreement and cheating. And that difference is significant in terms of licensure, not just passing boards.

 

[mlw03]

That was part of the reason I posted this thread, to see what happens in other specialties (not to really debate what the radiologists are doing). I posted what I experienced in pathology, but haven't seen many comments about what happens in other specialties. Do recalls exist in surgery, peds, IM, ob/gyn, psych, etc? If so, in what precise form.

 

[colbgw02]

I tend to agree with Law2Doc. It's not like radiology residents go into these exams knowing what's on the test and what the right answers are. They go into these tests knowing what has been on past tests and what the right answers are to past test questions, and I don't see how that is appreciably different than someone who has studied old tests or a question bank that is closely based from old tests. It's dressed up differently, but at its core, the information available to radiology residents is no different than what's available from numerous commercial test prep companies or - for that matter - an inpromptu conversation from a recent test taker.

The reliability of old questions showing up on new tests and the relative organization of recall process among radiology residents are really just confounders. Both are evidence of the ABR's intertia and unwillingness to release old exams, as residents first adopted and then formalized a proven methodology. Neither shows radiologists in training to be nefarious, but rather good test takers, which is part of the reason they are taking ABR exams in the first place.

I consider all of that a separate issue from the legality of the recalls. There is no doubt that if someone violates a contract, they are legally culpable, as appears to be the case in this situation. One might go even further in say that someone is morally wrong for doing so, but I think the immoral behavior stems from doing something one explicity agreed not to do, rather than inherent immorality from the act.

But if you think it was cheating, then ask yourself this question - if the ABR never stipulated that test takers not share information, would residents be wrong for doing so? I submit that the answer is no. And - as stated before - the fact that the shared information reliably proves to be useful and that the sharing is relatively formalized are incidental. If you answer "yes" to that question, then you're going to have to explain to me how the recall information is fundamentally different than any other information derived from old exams.

All of this, of course, assumes that the recalls are being obtained through "natural" avenues, meaning that residents are using their God-given talents to remember them, rather than hacking the ABR database or taking pictures of the computer screen with their iPhones.

Lastly, as an aside, I hope every realizes that radiology residents still actually have to learn this information - and not just because of oral boards. Most recalls either 1) don't have answers, 2) don't provide a right answer, or 3) provide the wrong answer. In any case, extensive research, understanding, and memorization is required even with the use of recalls. No one is walking into this test saying, "oh, I recognize this question; the answer is D."

 

[Droopy Snoopy]

Well, in a court of law, when you sign an agreement that you won't disseminate information about a test, both transgressions are equivalent. Doesn't really matter what your view is or where you draw the line, it matters where the agreement you signed draws the line. If we are labeling such a breach as "cheating" (which i dont think is accurate) then either neither is cheating or both are.

The ABRs statement contains this:

"Today we live in a world of instant information sharing and are aware that recalled test questions ("recalls") have been passed around and used not only to guide study, but at least by some to memorize exact questions and answer options, so as to increase chances of pa"ssing when these questions were encountered again on future examinations. The latter is a violation of ABR rules and constitutes cheating on the examination."

So what I gather there is, from the ABRs own perspective, that it's less about the legal side of things (intellectual property, breach of contract, etc) and more about the moral/ethical implications of cheating. Passing down generalized information or topics and using it informally to assist independent study is fine. Institutionalized stealing of specific questions and answers by residency programs is not.

 

[Law2Doc]

... Passing down generalized information or topics and using it informally to assist independent study is fine...

except that it isn't. The same agreement one signs agreeing not to disseminate test information prohibits this just as much as it prohibits exact questions. You can't say it's fine to violate an agreement as long as you only violate it a certain way. Sorry but the line you are drawing has no basis. It certainly doesn't exist in these agreements. It's an all or nothing proposition. An ABR comment after the fact and not as part of this agreement is legally irrelevant. Their contract doesn't carve out this exception, rendering all of it equally "cheating".

 

[dragonfly99]

someone asked about other specialties, like IM.
Actually the questions on the medicine board exam (from what I remember...it's been several years since I took the test) tend to be rather long and involved and I think it would be hard to memorize the questions and answers. Also the ABIM puts out something called the Medical Knowledge Self Assessment Program (MKSAP) which is basically sort of a study guide, with some questions, as I remember. The questions are not exactly like the actual exam - a lot of people say they are harder. There are study books, a CD, etc. Also there is a company called MedStudy which puts out review books also...a few questions but mostly a subject review. Most people say if you study from one or both of these you should pass the exam.
It seems like the radiologists need to put out some sort of study guide to alleviate this type of behavior. I do agree that over memorization of questions and answers is clearly cheating, but I also think that CNN made it seem like the radiologists are cheating on this exam and therefore they graduate from residency not knowing anything and just treating people while being completely ignorant. I think everyone on here knows how high the bar is to even get a radiology residency, and that there are 4 USMLE tests as well as many med school and residency exams and evaluations to pass, as well as this other exam...

 

[Law2Doc]

...
It seems like the radiologists need to put out some sort of study guide to alleviate this type of behavior. I do agree that over memorization of questions and answers is clearly cheating, ....

Some would argue that a profession-wide use of recalls was, in fact, putting together " some sort of study guide". Basically they were putting together for free what the qbank services do for profit. A bank of previously asked questions one could study from. A big qbank of many years of old questions - thousands of them. Basically a good study resource and learning tool which let's you know what is high yield, but not something you would ever try to memorize verbatim, any more than you might try to memorize an entire qbank for Step 1. Because in truth it's the same thing. A learning device, not a cheating device. Bear in mind that recalls aren't really memorizing the "answers", just the questions. You'd still have to look things up to find out the answers. I find it impressive that folks could go in, take their test, and remember a chunk of it usefully to transcribe for subsequent generations, but this has apparently been part of test taking in these tests at every radiology residency in the country for decades. So again yes it's violative of an agreement for the person who passes on old test questions, but for the subsequent test taker, who has yet to sign such agreement, studying from thousands of old test questions accumulated over the years just isn't different enough from how every med student has passed every multiple choice test throughout their academic career for it to be labeled "cheating" IMHO.

Anyway I think we've wrestled this topic to death. It really shows what a fiasco someone with an axe to grind can create when he starts flinging numerous accusations around to see what sticks. For the originator of this allegation, the recall issue was simply one of many tangential complaints he made after basically washing out of residency. I would be shocked if washouts in other specialties didn't start following suit, claiming that other programs with better old test based study resources, or faculty teaching things they consider historically high yield, thereby "cheated" and made them fail. I doubt it's unique to one specialty.

 

[mlw03]

That's interesting, and not too surprising, that such resources exist in a huge specialty like IM. I agree that having your own board provide study materials is the best scenario.

someone asked about other specialties, like IM.
Actually the questions on the medicine board exam (from what I remember...it's been several years since I took the test) tend to be rather long and involved and I think it would be hard to memorize the questions and answers. Also the ABIM puts out something called the Medical Knowledge Self Assessment Program (MKSAP) which is basically sort of a study guide, with some questions, as I remember. The questions are not exactly like the actual exam - a lot of people say they are harder. There are study books, a CD, etc. Also there is a company called MedStudy which puts out review books also...a few questions but mostly a subject review. Most people say if you study from one or both of these you should pass the exam.
It seems like the radiologists need to put out some sort of study guide to alleviate this type of behavior. I do agree that over memorization of questions and answers is clearly cheating, but I also think that CNN made it seem like the radiologists are cheating on this exam and therefore they graduate from residency not knowing anything and just treating people while being completely ignorant. I think everyone on here knows how high the bar is to even get a radiology residency, and that there are 4 USMLE tests as well as many med school and residency exams and evaluations to pass, as well as this other exam...

 

[MojoRisin]

I think you are trying very hard to create a distinction where none actually exists. It is just as against the agreement you sign of all these specialty boards if you reveal the topics you recall being covered as it is to offer your recollection of the questions. It's the same agreement you violate. And it's you the person making the recalls, or providing the topic information that violated it, not the guy who ends up with the questions several years later.

Additionally, I think all of us have seen questions in commercial qbanks that were the exact same questions as the steps, not a paraphrase. These are all "recalls", no matter how you slice it. The only real difference is that World, Kaplan etc do it for profit, whereas upperclassmen do it for free. So basically you guys are making a distinction that is the equivalent of saying it's okay to cheat on your spouse so long as it's with a prostitute.

Finally I would suggest that as you progress upwards within your training in any specialty, the availability of things to study from for boards that is similarly high yield to what you used in med school becomes more and more scant. There aren't commercially available qbanks for many of the professional boards. So you use whatever the program has collected over the years that prior folks have deemed useful, much of which is internally created. I think having to take a test where the specialty doesn't offer any study aids themselves, and where no commercial entity offers useful study aids, results in programs trying to create their own. Again the goal is to learn the material, not just to have residents flail blindly learning things the board doesn't deem that important. But how do you do that without some info as to what they deem test worthy? Again, the distinction you make between passing on info about topics tested versus passing on questions tested is a distinction not made by these specialty boards. Both are not allowed. It's ludicrous. The boards should all either start selling old tests themselves so folks have some semblance if(sic) a study guide, or make new test questions every year, so there is no concern that old test questions will come up again. Right now they seem to want a situation where you have to take a test, but can't know what kind of questions they plan to ask, so just go ahead and study the wrong stuff, so we can tell the world that our doctors don't cheat, they just don't know jack about the things we deem important because they didn't blindly stumble upon the appropriate topics...

great post. i hope that some of the 'powers that be' see this. archaic system, archaic results.

 

[MD forever]

Two things need to happen, and the specialty boards can nip this in the bud. First they can release for sale books of old test questions. This will fund the creation of new questions and will give residents something "legal" and accurate to study. You don't even ave to release answers or explanations -- make them do their own research and learn in the process, but provide the blueprint. Second, they need to have a different test every time, or at least do variations on the old questions. Then there will be no realistic possibility of cheating. If the goal is to have test takers learn the material and pass, playing hide the ball with the content of these exams is the last thing a board should be doing.

I will start by this statement. It is Health business, dictated by almighty the Dollar. Those who mention "ethics and copy writes protection" will sadly go through many reruns and Catch 22.

Many people in this discussion pointed fingers at the real elephant in the room "The Specialty Boards that create the testing industry" they get payed, so they better make sure their job is done. They need to be up to the beat, and constantly hiring new brains when the old ones dry out and can no longer generate the required questions.

I loved the suggestion above by Law2Doc about releasing the old exams immediately following the exam however, I think if someone want to put the answers it should be OK as well.

As everybody pointed out doctors should have higher ethical and moral values, the idea of signing agreement not to reproduce exams, IMHO is silly and people violate that anyway because it does not make sense, that had been debated above. Laws need to consider common sense, not work for the lazy folks " Boards". Cheers to the companies that help candidates to pass this hurdle.

 

[pgg]

Glad to see people discussing this. Will anyone comment about whether or not anything like this occurs in other specialties? I shared my comments about pathology above.

There's no such recall bank for anesthesia that I'm aware of.

The ABA has released some old exams from the 1990s which are still a reasonable representation of the real thing, and the ABA publishes a CME product twice per year with exam questions, explanations, and references. There are a couple of 3rd party review books with original questions and answers, though the best of these (Hall) is getting a bit old. There are 1000s of quality questions out there for this kind of studying.

I can sympathize with radiology residents taking a poorly written exam, but I just can't get over the widespread, years (decades!) long conspiracy to recall questions verbatim despite the obligatory signing of a pre-exam agreement not to. If there's anything shocking about the whole thing, it's how long it's taken for it all to blow up.

The ABR is sure deserving of plenty of blame, but I'm still left shaking my head and wondering what all these radiologists thought was going to happen.