Inservice

[RO2019]

thoughts on this year’s exam? Thought overall, though there were some wtf questions as always and some weird typos and hard to see pictures - overall was a better and More fair test than recent years. Not that it means anything but at least I felt this test was probably more in line with things a resident should aspire to know. What did others think?

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[MadamCurie]

1. There were around a half dozen biology questions that were hardcore molecular biology minutiae - never seen things go that "deep" on the In-Training before! Deeper than what I typically would teach, too; there were at least two that I didn't even know the correct answers.

2. Another first for the In-Training – at least since they rebranded the test as a study aid and allowed residents to keep the booklets (2006 I think?) – was the presence of a few recycled questions from previous years.

And yes, the usual number of typos and poorly written questions...nothing new there. Other than that, the remainder of the biology questions seemed a fairly reasonable mix of old-school and newer rad bio concepts.


Interesting. Makes me wonder a couple of things, such as, whether one or more "residents should all be PhD-level molecular biologists" enthusiasts are now writing biology questions for the In-Training exam, in addition to the actual ABR exam. On the other hand, the use of recycled questions for an exam that goes public immediately after use might suggest that there aren't enough biology question writers to come up with the required number of new questions per year. (This was a chronic problem back when I used to be involved with the In-Training.) Or maybe the ACR realized that they needed to include a few "old" questions for test validation purposes?

 

[KHE88]

Meh.

The biggest change I noticed was the inclusion of a handful of radbio questions asking you identify names of obscure three-letter-acronym players in molecular biology pathways. The remaining radbio questions were appropriate and tested core fundamental concepts, and these were actually much better and relevant questions that what was on that piece of garbage that we seniors endured last July.

Presumably this has something to do with the content on last years ABR radbio exam, although the test explicitly said it was unrelated to the ABR.

These questions are completely pointless trivia unrelated to clinical competency or high-level fundamental understanding of cancer biology as previously discussed ad nauseum. It's basically a vocabulary test in a foreign language. Doesn't matter if you understand the grammar structure and syntax of the language and can functionally and appropriately use the language -- it's just asking you to pick out specific words and match them, which in the scheme of things doesn't really mean anything. You could memorize word meanings and have no idea how the language works and ace a Spanish exam only testing vocabulary. It is a shame that a few higher ups in the field have pushed this educational shift. I heard comments from younger residents about how hard the rad bio questions were. I refrained from commenting that the ABR exam was even worse.

I honestly didn't see much else in the clinical section of a change from previous years so wouldn't say it was more or less fair.
The questions about identifying approximate response rates in certain scenarios where answers differ by 5-10% continue to exist and continue to remain ridiculous.
A splattering of questions that are just outright memorization of low level trial data (not major conclusions from trials)
Questions about recent trials over the past year.

Notably trials, like CARMENA, that had nothing to do with radiation. Yes, it was a major hit from ASCO last year and that's why I knew about it, but why is the radiation oncology inservice exam asking about trials that don't involve radiation even tangentially? We do not prescribe sunitinib, and we do not perform cytoreductive nephrectomies.

 

[RO2019]

I'm with you for sure on the rad bio alphabet soup as well as them asking about minor points about trials rather than major points.

however - one of the things i liked about rad onc when i was entering the field and still do about well-trained rad oncs is that we know about the surgeries and the systemic therapies (generalities) and often are the most comprehensively oncologically sound in a tumor board room in comparison to our med onc and surgeon colleagues. That's what makes us good.

so major systemic therapy trials or a potentially practice changing trial like CARMENA? I think worth knowing. knowing that patients with pancreatic cancer should adjuvantly be getting FOLFIRINOX now or being able to see a lung patient and see their PD-L1 expression and know that they will/should get Pembro monotherapy versus combination chemo/immune etc. big things. so the questions on those things I felt were fair.

 

[emt409]

Meh.

The biggest change I noticed was the inclusion of a handful of radbio questions asking you identify names of obscure three-letter-acronym players in molecular biology pathways. The remaining radbio questions were appropriate and tested core fundamental concepts, and these were actually much better and relevant questions that what was on that piece of garbage that we seniors endured last July.

Presumably this has something to do with the content on last years ABR radbio exam, although the test explicitly said it was unrelated to the ABR.

These questions are completely pointless trivia unrelated to clinical competency or high-level fundamental understanding of cancer biology as previously discussed ad nauseum. It's basically a vocabulary test in a foreign language. Doesn't matter if you understand the grammar structure and syntax of the language and can functionally and appropriately use the language -- it's just asking you to pick out specific words and match them, which in the scheme of things doesn't really mean anything. You could memorize word meanings and have no idea how the language works and ace a Spanish exam only testing vocabulary. It is a shame that a few higher ups in the field have pushed this educational shift. I heard comments from younger residents about how hard the rad bio questions were. I refrained from commenting that the ABR exam was even worse.

I honestly didn't see much else in the clinical section of a change from previous years so wouldn't say it was more or less fair.
The questions about identifying approximate response rates in certain scenarios where answers differ by 5-10% continue to exist and continue to remain ridiculous.
A splattering of questions that are just outright memorization of low level trial data (not major conclusions from trials)
Questions about recent trials over the past year.

Notably trials, like CARMENA, that had nothing to do with radiation. Yes, it was a major hit from ASCO last year and that's why I knew about it, but why is the radiation oncology inservice exam asking about trials that don't involve radiation even tangentially? We do not prescribe sunitinib, and we do not perform cytoreductive nephrectomies.

Yes, but you participate in multi-disciplinary cancer care and it was an important practice changing study.

 

[scarbrtj]

I'm with you for sure on the rad bio alphabet soup as well as them asking about minor points about trials rather than major points.

however - one of the things i liked about rad onc when i was entering the field and still do about well-trained rad oncs is that we know about the surgeries and the systemic therapies (generalities) and often are the most comprehensively oncologically sound in a tumor board room in comparison to our med onc and surgeon colleagues. That's what makes us good.

Yes, but you participate in multi-disciplinary cancer care and it was an important practice changing study.

What a piece of work is the radiation oncologist. How noble in reason, how infinite in oncologic faculty. And yet what is the quintessence of his practice, so limited in oncologic scope?

 

[RO2019]

lol nothing worse than a sef-hating rad onc. There are enough of those in other fields without having ignorant rad oncs in our own specialty.

Radiation is an integral part of cure for multiple solid malignancies (name one that med oncs cure on their own?) and half of cancer patients require radiation.

Seriously - that's like something we talk about to medical students, not to people that are long experienced in our own field? embarrassing.

 

[evilbooyaa]

It was fine overall. Yes, nit picky things that no rad onc should have to know (how are teeth numbered? What are we now, dentists??), and some onc but not rad onc things (CARMENA trial for example). Disappointing when they literally repeat one question (on an obscure trial no less). But overall it was as usual.

 

[scarbrtj]

lol nothing worse than a sef-hating rad onc. There are enough of those in other fields without having ignorant rad oncs in our own specialty.

Radiation is an integral part of cure for multiple solid malignancies (name one that med oncs cure on their own?) and half of cancer patients require radiation.

Seriously - that's like something we talk about to medical students, not to people that are long experienced in our own field? embarrassing.

Huh.

 

[KHE88]

lol nothing worse than a sef-hating rad onc. There are enough of those in other fields without having ignorant rad oncs in our own specialty.

Radiation is an integral part of cure for multiple solid malignancies (name one that med oncs cure on their own?) and half of cancer patients require radiation.

Seriously - that's like something we talk about to medical students, not to people that are long experienced in our own field? embarrassing.

It's not that cut and dried.

There is an appropriate middle ground between "we are just x ray technicians in the basement and follow our orders" and "we are experts in all things oncology including radiotherapy, chemotherapy, immunotherapy, surgical oncology, medical physics, radiobiology, and cancer biology."

We already have 4 board exams, should we add a 5th to cover med onc?
At the end of the day we are sub-specialists after all, cancer is a heavily sub-specialized discipline, and I think it's important to keep a reasonable focus on our specialized scope and role.

Reality: Many of those who have trained us are so heavily site specialized that they are no longer capable of managing a simple breast or prostate case. Yet, they love to beat on the residents that we need to know about more about everything than everybody in the tumor board.

All that said, I don't have a problem with 1 or 2 questions on a 300 question inservice exam about very major recent chemo trials.
I do have a problem with >25% PhD level cancer biology on a board exam for clinical competency.

And snarky patronizing comments from junior residents (not you) reminding me of my role in multi-disciplinary cancer care are just a teeny tiny bit grating. I do think it's important to know your place and scope as a sub-specialist while at the same time not being a total idiot about anything not involving hurling xrays or charged particles at chunks of meat. I am certainly not advocating for willful ignorance to the point where I become the deer in the headlights when somebody mentions renal cell carcinoma: "huh, what...renal cell...where's the bone met!?!!"

Call me crazy.

 

[emt409]

It was fine overall. Yes, nit picky things that no rad onc should have to know (how are teeth numbered? What are we now, dentists??), and some onc but not rad onc things (CARMENA trial for example). Disappointing when they literally repeat one question (on an obscure trial no less). But overall it was as usual.

If you suckers had brushed your left upper molars slightly worse, you might have gotten a cavity in #15 like me, and then you would have known!