Physics & Radbio

[RickyScott]

FYI, courts hate to get involved in this kind of thing and will defer to the ABR. They will not take jurisdiction away from a professional society. A federal court is simply not going to substitute its judgement for that of the ABR, barring something completely outrageous like only failing candidates of color. (this is coming from a 1000$/hour lawyer from big law). Any lawyer that tells you otherwise is stealing your money.

Regarding leadership of ASTRO: they care less than zero and if anything see this fiasco as a bonus, potential increase in fellowship candidates. They have more than doubled resident slots over the past 10-15 years, which in the long run is of much greater damage to salaries and mobility than this exam, which will undoubtedly be an annoying blip in your careers.

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[deleted947887]

FYI, courts hate to get involved in this kind of thing and will defer to the ABR. They will not take jurisdiction away from a professional society. A federal court is simply not going to substitute its judgement for that of the ABR, barring something completely outrageous like only failing candidates of color. (this is coming from a 1000$/hour lawyer from big law). Any lawyer that tells you otherwise is stealing your money.

Regarding leadership of ASTRO: they care less than zero and if anything see this fiasco as a bonus, potential increase in fellowship candidates. They have more than doubled resident slots over the past 10-15 years, which in the long run is of much greater damage to salaries and mobility than this exam, which will undoubtedly be an annoying blip in your careers.

A professional society (or any company for that matter), can not take your money, give you an exam and tell you come back next year because you failed, without clarification (The percentile email clarification was not sent to trainees. It was for chairs and PDs. Trainees are children and are not yet able to read emails; any clarification is directed to their parents, the chairs and program directors). That is what is referred to as a con artist (a person who cheats or tricks others by persuading them to believe something that is not true). This is coming from anyone on the street. That being said, there is always a risk of losing in court. If you are trying to put people in jail because you failed an exam, then you're a fool. If you want your money back because the exam they gave you was flawed because the people charged with creating it, did a poor job (which seems to be the case), then you have a strong case. Even if you lose, at least you don't look like an idiot. That's over $50,000 they made from that exam. Professional society or not, you can't do that. My 2 cents.

 

[KHE88]

Just to be clear, the purpose of legal action and seeking monetary damages would be to hold the ABR accountable, not to personally enrich myself. And yes, if you interviewed for a competitive job and were denied because you failed your boards first try, and you instead took a fellowship position or something, and could prove the exam was flawed, then a case could be made for compensatory damages in that regard. It's disheartening to see a number of people jump on the bandwagon of trying to ridicule someone just trying to get justice for those who unfairly were harmed by this exam. I'm not a lawyer. I never claimed to be. Apparently some here are? But I feel strongly there was an injustice here, and if there is a legal remedy to correct it, I feel it should be pursued. I don't care if the term 'RICO' is some random lawyer's pet peeve. This is a serious problem. If you disagree fine, but no need to try and spin what I say into absurdity.

The ABR is not going to reverse their decision. We will be taking the exam again next July unless there is some backroom deal made. Nothing we do will fix that. Letters and protests may publicize the issue briefly, but lasting change will only come through more formal and serious venues. The question is: Do you want change, or do you just want to pass and get yours and forget about it?

 

[multitudes]

https://www.astro.org/ASTRO/media/ASTRO/AffiliatePages/arro/PDFs/ARROLettertoABR.pdf

Thanks, ARRO. This is really well done. The statistical analysis is damning.

 

[ARRO official 2018]

https://www.astro.org/ASTRO/media/ASTRO/AffiliatePages/arro/PDFs/ARROLettertoABR.pdf

Thank you again for all of your emails and feedback regarding the ABR Radiation Biology and Physics exams. The ARRO and ACRO resident committees have submitted a letter to the ABRaddressing the issues with the most recent ABR exams. This letter has been posted on the ARRO website, so please pass along the message to your peers and colleagues who might not have received this email.

As resident representatives, we hope to begin a discussion with the ABR and ADROP in person at the upcoming ASTRO Annual Meeting in San Antonio and continue that conversation into the coming months. We hope to collaborate as a whole to improve the exam experience for residents in the future. ARRO welcomes any feedback or further suggestions in regards to this matter. We thank you for your patience and we will continue to advocate on behalf of radiation oncology residents

 

[radbioistheworst]

https://www.astro.org/ASTRO/media/ASTRO/AffiliatePages/arro/PDFs/ARROLettertoABR.pdf

Thank you again for all of your emails and feedback regarding the ABR Radiation Biology and Physics exams. The ARRO and ACRO resident committees have submitted a letter to the ABRaddressing the issues with the most recent ABR exams. This letter has been posted on the ARRO website, so please pass along the message to your peers and colleagues who might not have received this email.

As resident representatives, we hope to begin a discussion with the ABR and ADROP in person at the upcoming ASTRO Annual Meeting in San Antonio and continue that conversation into the coming months. We hope to collaborate as a whole to improve the exam experience for residents in the future. ARRO welcomes any feedback or further suggestions in regards to this matter. We thank you for your patience and we will continue to advocate on behalf of radiation oncology residents

Could not have been better written. Proud to call you guys my colleagues!


Sent from my iPhone using SDN mobile

 

[scarbrtj]

I ask this based on the ARRO letter (moderator feel free to delete or move this post if nec), but it would appear based on historical outcomes that, clinically, radiation oncology is pretty easy but physics-wise and rad bio-wise it is SIGNIFICANTLY harder. I never realized this, statistically. If you apply roughly the same statistical methodology (well actually Student's t vs Z-scoring) to clinical vs physics pass rates historically, clinical pass rates are better than physics at p<<0.001. And in 2018 that trend stayed exactly the same. Thus in some ways: no shocker. Also, clinical pass rates better than rad bio at p<0.001. Again, in some ways: no surprise. Physics and rad bio pass rates have always been worse, and have been throughout our history.

I wonder: why take a separate physics exam? In every department I have ever worked in, there is a physicist there. "Well to be a rad onc, you have to know physics." Granted. But that is testable in clinical. "Everything in a department is the rad onc's responsibility, even physics issues." Really? I have no idea how to QA a machine. I wager no rad onc knows how to beam on. I wager no rad onc knows how to take beam data into the TPS, etc. We have to rely on physicists for this. My point is: we need the barest minimum of physics knowledge as an MD versus the physicist who essentially must be there in modern radiation oncology. Each day, the field of cancer is getting bigger and bigger... as is the knowledge base. In rad onc, I fear our knowledge base is not getting any bigger (ie too much time spent sweating physics which is silly for a rad onc MD to do) which just means we as rad onc are more and more marginalized within the arena of cancer overall. Great! You passed physics boards. Now literally go forth and never do physics again. A hyper-focus on physics might've been good 40 years ago. It ain't now IMHO. (Discussion about usefulness of rad bio to the practicing MD at another time wink wink.) Perhaps make rad onc more like radiology: a core exam and then a certifying exam. Put the core aspects of rad bio and physics that we need as MDs inside the core exam. Of course, this is pie in the sky and helps no one now. But I do believe the day will come when we see separate physics written boards for the rad onc MD as antediluvian folly.

 

[Chartreuse Wombat]

I ask this based on the ARRO letter (moderator feel free to delete or move this post if nec), but it would appear based on historical outcomes that, clinically, radiation oncology is pretty easy but physics-wise and rad bio-wise it is SIGNIFICANTLY harder. I never realized this, statistically. If you apply roughly the same statistical methodology (well actually Student's t vs Z-scoring) to clinical vs physics pass rates historically, clinical pass rates are better than physics at p<<0.001. And in 2018 that trend stayed exactly the same. Thus in some ways: no shocker. Also, clinical pass rates better than rad bio at p<0.001. Again, in some ways: no surprise. Physics and rad bio pass rates have always been worse, and have been throughout our history.

I wonder: why take a separate physics exam? In every department I have ever worked in, there is a physicist there. "Well to be a rad onc, you have to know physics." Granted. But that is testable in clinical. "Everything in a department is the rad onc's responsibility, even physics issues." Really? I have no idea how to QA a machine. I wager no rad onc knows how to beam on. I wager no rad onc knows how to take beam data into the TPS, etc. We have to rely on physicists for this. My point is: we need the barest minimum of physics knowledge as an MD versus the physicist who essentially must be there in modern radiation oncology. Each day, the field of cancer is getting bigger and bigger... as is the knowledge base. In rad onc, I fear our knowledge base is not getting any bigger (ie too much time spent sweating physics which is silly for a rad onc MD to do) which just means we as rad onc are more and more marginalized within the arena of cancer overall. Great! You passed physics boards. Now literally go forth and never do physics again. A hyper-focus on physics might've been good 40 years ago. It ain't now IMHO. (Discussion about usefulness of rad bio to the practicing MD at another time wink wink.) Perhaps make rad onc more like radiology: a core exam and then a certifying exam. Put the core aspects of rad bio and physics that we need as MDs inside the core exam. Of course, this is pie in the sky and helps no one now. But I do believe the day will come when we see separate physics written boards for the rad onc MD as antediluvian folly.

Completely agree. RadOnc is like no other discipline in requiring three separate exams PRIOR to ORALS. Make one exam to be taken immediately after training which included clinical oncology, radiation biology and radiation physics. If passing grade then take orals. The problem is that there is not a large enough constituency with skin in the game that would take the time required to make this case and change the process.
Verbatim from the ABR website.
The mission of the American Board of Radiology (ABR) is to serve patients, the public, and the medical profession by certifying that its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill, and understanding essential to the safe and competent practice of ....radiation oncology.
Understanding the details of DNA damage repair pathway is not important for practicing clinicians.
The ABR is engaging in mission creep if they view one of their goals is to push the science forward. That mission is for institutions like medical schools and research organization.

 

[evilbooyaa]

In rad onc, I fear our knowledge base is not getting any bigger

Here's the issue - that's not true. There is SO much more data now than there was even 5 or 10 years ago that RO residents are responsible for. We need to know what the PFS numbers in the Gomez trial for oligometastatic NSCLC were, but we better also remember the pCR rates on CROSS, and the rates of local recurrence from the german rectal trials! We better remember the 4 arms of RTOG 9003 and which one did marginally better, even though we'd never treat like that in the current day and age. We better know what split course means across the multiple studies that evaluated it across disease sites even if we do that for essentially zero percent of cases anymore. We better know how RT was done 'in the old days' even though doing 3D-CRT for definitive H&N would be considered borderline malpractice in the US in this day and age. We better know the classical definition of what a PAB looked like back when we only used x-rays, forget the fact that we're doing CT sim, contouring nodes, and evaluating DVHs when we use a posterior field now in 3/4-field breast plans.

 

[Mandelin Rain]

"The statistical probability that this difference occurred by chance is <0.1%"

 

[scarbrtj]

that's not true.

Yes I see your point. BUT--we are angels dancing on the head of a pin with our single-trick-pony (external beam, which comprises >99% of a rad onc's tx routine tx armamentarium) minutiae (dose, fractionation, tx area, and tx or no tx--and Mayneord F factor!!!!) whilst med oncs have CART, immuno, orals, systemics, anti-hormonals, years of therapy with a patient compared to our single fx tx's, etc. I love my single-trick pony, he is great, don't get me wrong. But MR-guided therapy, or protons (oy vey), cool as they are, just sort of further marginalize us while in the meantime now we are publishing here in an open forum our residents evidently can't even pass their boards anymore. The impact of herceptin e.g. is just, well, way more impactful than yes-or-no PAB. We should keep this in mind while we're eating our young.

 

[medgator]

just sort of further marginalize us

No more than the scalpel or the robot marginalizes our surgical oncology colleagues. Radiation and surgery will be here for a long, long time

 

[scarbrtj]

"The statistical probability that this difference occurred by chance is <0.1%"

The statistical probability that the written physics and rad bio sections are just, by chance, harder to pass than the clinical sections is also <0.1%. That's kind of surprising too. That this is acceptable to the ABR--clinical consistently & historically having statistically higher pass rates than physics & rad bio--must be a feature vs a bug for the ABR.

 

[scarbrtj]

No more than the scalpel or the robot marginalizes our surgical oncology colleagues. Radiation and surgery will be here for a long, long time

Of course I don't disagree that radiation will be around a long time, as will surgery. But we are doing WAY less cancer surgery than we used to 20+ years ago. Less radiation too. The pure surgical oncologist, versus the surgeon who happens to treat cancer patients, is a rarer and rarer breed. And I don't wanna be "that guy." On the other hand, as I have said before (and this was ~2013): "The overall state of NIH funding in radiation oncology raises great concern. Many academic radiation oncology departments have already become 'service' departments, where novel research is limited and little or no translational efforts occur." (In 2017, only 4% of NIH funded cancer research concerned radiation.) And yet it's in translational efforts, IMHO, where cancer breakthroughs are occurring at an increasing pace.

 

[Mandelin Rain]

The statistical probability that the written physics and rad bio sections are just, by chance, harder to pass than the clinical sections is also <0.1%. That's kind of surprising too. That this is acceptable to the ABR--clinical consistently & historically having statistically higher pass rates than physics & rad bio--must be a feature vs a bug for the ABR.

I'm not sure it's surprising.

In a given week I'd wager that an average resident is exposed to perhaps 60-65 hours of information that is at least tangentially relevant to the clinical boards, and perhaps an hour pertinent to the physics/rad bio boards (during which they are probably paged out 2-3 times).

Additionally, aspects of clinical medicine is in much more in the wheelhouse of a typical physician as opposed to nuclear physics and cancer biochemistry.

Put these things together, and I'd almost assume that more residents struggle with those tests than the clinical boards. I wouldn't, however, expect to see wide year-over-year variation within the same data set.

 

[thecarbonionangle]

The letter is well written for what it is. I did not expect a resident organization to go for the jugular. We are powerless. I do wish those with actual power, if you are reading, to take this opportunity to push for significant real change. Most reasonable people would agree we have way too many exams. I would argue we could have one written exam and maybe even get rid or orals ( but this is a different topic). I will point out that most fields have a test and are able to put out competent physicians. little fields have oral boards. NO field that i know of has THREE separate written tests followed by oral boards. Lets push for real change not just a fix for the year.

One thing that is apparent to me is how little the ABR cares about rad onc. The letter brilliantly points out they offer a retest midyear for radiology and far more study resources. Why are we seriously still under them? Clearly the two rad onc “leaders” in charge at ABR are not advocating for us. They are racking it in then will slip out back door when their last practicing days come. This is happening all over our field with our generation bearing the burden of their greed, closemindedness and lack of leadership and foresight. We need true leadership in charge of our organization who have our interests in mind. I pay so much money yearly to the ABR that i do not have, its theft for THREE exams littered with clinically irrelevant subjects. i just want to be a doctor and help people. Why cant you test me on what truly matters?!

 

[scarbrtj]

One thing that is apparent to me is how little the ABR cares about rad onc. The letter brilliantly points out they offer a retest midyear for radiology and far more study resources. Why are we seriously still under them?

I blame laziness. Lack of foresight. But more importantly, our history. We are the sons & daughters, sadly.

 

[Corgi4Prez]

The letter is well written for what it is. I did not expect a resident organization to go for the jugular.

I also had low expectations, but they did a great job with this letter. Nice work ARRO/ACRO!

 

[Gfunk6]

ARRO/ACRO, very well written letter. Polite but to the point and comprehensive.

 

[radiaterMike]

Radiation biology and physics are important to learn, understand and be tested on. Just go back and scour through scarbrtj's posts to know that practicing radiation oncologists use this stuff. You need to understand the linear quadratic model (and know that it is a model), time/dose/fractionation effects, late vs. early responding tissues, serial vs. parallel organs, understand how photons, electrons and protons interact with matter, how to do a MU calculation, the physics of brachytherapy, etc. But it is NOT necessary to know or test the minutia that has been described in this thread. I agree with CW in that one written exam should be sufficient, with the emphasis on clinically relevant questions that test whether or not the examinee understands important concepts.

 

[deleted947887]

Clearly the two rad onc “leaders” in charge at ABR are not advocating for us. They are racking it in then will slip out back door when their last practicing days come.

I agree with this. It seems like their role at the ABR, is to keep the radoncs "in check," by utilizing the least amount of resources. This is especially apparent through their communication with the PDs. I think they failed to recognize that the residents that took the exam are consumers that paid for a product. That product was defective. They are accustomed to treating residents like second class citizens and figured this would slide too.

 

[RO2019]

Fantastic, well-written letter by ARRO.


ABR trying to make RadOnc the red-headed step child, needs to end.

 

[RO53]

The ABR used to allow residents to retake a failed physics/radbio test in January of the following year. This has not been the case for the past few years. Has anybody spoken to the ABR about the low pass rate and adding a re-examination date prior to July 2019?

I failed physics 2 years in a row now. My break down this year was 1 1 2 2 2 (not in that order). I was doing very well on the Raphex exams and I came out feeling comfortable about the physics exam this year. I would really like to sit for my oral boards in May. Is there any hope?

 

[RO28]

The ABR used to allow residents to retake a failed physics/radbio test in January of the following year. This has not been the case for the past few years. Has anybody spoken to the ABR about the low pass rate and adding a re-examination date prior to July 2019?

I failed physics 2 years in a row now. My break down this year was 1 1 2 2 2 (not in that order). I was doing very well on the Raphex exams and I came out feeling comfortable about the physics exam this year. I would really like to sit for my oral boards in May. Is there any hope?

Hey, I’m in the same position as you and after asking until I was blue in the face all I got for a mid year re-take was a big fat NO. I also failed physics two years in a row...last year I think I deserved it, but this year I also felt really good coming out of the exam and had been doing well on raphex so my fail was came as a total surprise to me (1 2 1 3 3). I would also really like to sit for my oral exam, I’m hoping that something will come out of the ADROP/ASTRO meeting.....

 

[Tony&lisa]

Agree, very well written letter. Thank you ARRO. I think you gathered and expressed our concerns very well. I personally forwarded the letter to my chair, PD, and head of physics curriculum so they know where we are and we are all on the same page. I recommend everyone taking the 2 minutes to do the same thing, since with how busy they are we can't expect them to have the time to go looking for it. The people with more power should see this wonderfully worded letter.
I also got a big "no" re the idea of a mid-year exam, or more accurately a pretty rude "no" with various lines that borderline extended into criticizing me personally and my professionalism, but that is why we aren't giving up and continuing to push forward. The ABR is not our overlord. To effect change we need to push forward despite hearing "no".

 

[RO28]

K

Agree, very well written letter. Thank you ARRO. I think you gathered and expressed our concerns very well. I personally forwarded the letter to my chair, PD, and head of physics curriculum so they know where we are and we are all on the same page. I recommend everyone taking the 2 minutes to do the same thing, since with how busy they are we can't expect them to have the time to go looking for it. The people with more power should see this wonderfully worded letter.
I also got a big "no" re the idea of a mid-year exam, or more accurately a pretty rude "no" with various lines that borderline extended into criticizing me personally and my professionalism, but that is why we aren't giving up and continuing to push forward. The ABR is not our overlord. To effect change we need to push forward despite hearing "no".

Yes, I also had the same experience accompanying the “no”, it was a rather paternalistic, condescending reply.

 

[seper]

read the letter. 70% pass rate? Do you figure that was done intentionally to try to alter supply/demand?

 

[Tony&lisa]

Again, thank you to the ABR for such a well written letter. My PD and Chairman were both impressed.
I do have another question for ARRO: what about, in addition to the open letter, sending an official letter, probably a very similar one, to the President/Chair of the ABR, to ask if they can investigate at a level above Wallner/Kachnic?

 

[ABRforTRUMP]

Thank you ARRO and ACRO for a strong and poignant message.

I wanted to share the ABR's reply to a colleague, from Dr. Wallner, that I feel reflected poorly and did not help the examinee in any sense when he/she tried to inquire about options and direction for reexamination and the state of the exam prior to their "exam results" being publicized.

Wallner, Paul wrote:

...."I find many of your remarks offensive, your impressions ill-informed, and your threats unprofessional. Several observations:

With regard to exam preparation, I would suggest that you take that issue up with your program director and the physicists and/or radiation biologists who are expected to be integral members of your department. You would also be well served to speak with the majority of your peer group who passed the exam(s) and do not feel as you do about the material covered. The ABR will shortly launch a series of FAQs on the website which may assist in answering some of your questions.

The exams are developed by physicians, physicists and biologists who are actively involved with clinical radiation oncology and teaching residents. Many of the biologists are also clinicians with active practices. It is not up to residents to determine what is relevant, and the biology exam is clearly designated as radiation AND cancer biology. The ABR does not develop curricula, but has encouraged the ACGME and ASTRO, in cooperation with other stakeholders, to develop more granular curricula to guide educators and assessors of knowledge.

The ABR study guide is meant to serve as a roadmap for topics that may be covered, and not as a preparation text. Short of providing added references, there is little else that the ABR can do, since we do not provide courses or educational content.

The notion that all the ABR should evaluate is clinical competence is contrary to the requirements for training in radiation oncology as outlined by the ACGME.

No further communication from you would add to this response.

Paul E. Wallner, DO, FACR, FASTRO, FACRO, FAOCR
Associate Executive Director for Radiation Oncology

[Contact info redacted by SDN moderators]

 

[Tony&lisa]

That response is plain and simple mean, patronizing and defensive. Not too dissimilar to the response I got, especially the first part. Dr. Wallner, this isn't personal, one does not need to feel "offended" and one certainly should not be passing judgement with one's opinion on professionalism. This is extremely dissapointing coming from one of the most powerful people in our field who is supposed to be working for us and in our best interest. It is also remarkable how much he harps on the "majority" of people who passed. The entire point is that it was barely a majority this year! It should have been 90+%, not 50-60%.
Thank you for sharing that. I really hope there are PDs and chairs whonare seeing this and willing to participate in our attempt at obtaining justice and fairness.

 

[Ray D. Ayshun]

Thank you ARRO and ACRO for a strong and poignant message.

I wanted to share the ABR's reply to a colleague, from Dr. Wallner, that I feel reflected poorly and did not help the examinee in any sense when he/she tried to inquire about options and direction for reexamination and the state of the exam prior to their "exam results" being publicized.

Wallner, Paul <Paul.Wallner@21co> wrote:

...."I find many of your remarks offensive, your impressions ill-informed, and your threats unprofessional. Several observations:

With regard to exam preparation, I would suggest that you take that issue up with your program director and the physicists and/or radiation biologists who are expected to be integral members of your department. You would also be well served to speak with the majority of your peer group who passed the exam(s) and do not feel as you do about the material covered. The ABR will shortly launch a series of FAQs on the website which may assist in answering some of your questions.

The exams are developed by physicians, physicists and biologists who are actively involved with clinical radiation oncology and teaching residents. Many of the biologists are also clinicians with active practices. It is not up to residents to determine what is relevant, and the biology exam is clearly designated as radiation AND cancer biology. The ABR does not develop curricula, but has encouraged the ACGME and ASTRO, in cooperation with other stakeholders, to develop more granular curricula to guide educators and assessors of knowledge.

The ABR study guide is meant to serve as a roadmap for topics that may be covered, and not as a preparation text. Short of providing added references, there is little else that the ABR can do, since we do not provide courses or educational content.

The notion that all the ABR should evaluate is clinical competence is contrary to the requirements for training in radiation oncology as outlined by the ACGME.

No further communication from you would add to this response.

Paul E. Wallner, DO, FACR, FASTRO, FACRO, FAOCR
Associate Executive Director for Radiation Oncology
The American Board of Radiology
856-780-5111 (land line)
856-789-5342 (fax)
239-910-0056 (cell)
pwallner@theabr"

What did the message this was responding to look like?

 

[OTN]

"No further communication from you would add to this response."

That is stunningly unprofessional. Dr. Wallner proves once again that an increasing # of capital letters after your name is a poor prognostic indicator.

 

[evilbooyaa]

Ah yes the great "unprofessional" remark (from Wallner to this person) to somebody saying something you don't like.

I'm sure he's sick of dealing with it by this point, hence the curt, useless replies. I expect he'll get his just desserts at ASTRO.

 

[OTN]

Ah yes the great "unprofessional" remark (from Wallner to this person) to somebody saying something you don't like.

I'm sure he's sick of dealing with it by this point, hence the curt, useless replies. I expect he'll get his just desserts at ASTRO.

It's not that I don't like it, it's that his response is dismissive, presumptive, arrogant, and uncaring. If he didn't want the responsibility of dealing with this clusterf___ of his own creation he shouldn't have become ABR president.

 

[Tony&lisa]

Seriously

 

[maruchan]

Thank you ARRO and ACRO for a strong and poignant message.
The notion that all the ABR should evaluate is clinical competence is contrary to the requirements for training in radiation oncology as outlined by the ACGME.

Where are these ACGME requirements that supposedly contradict the notion that competence is what should be evaluated?

You can find the ACGME program requirements here. I searched the whole document for anything related to physics or biology. Contrary to what Dr Wallner says, the ACGME actually explicitly states that residents should demonstrate competence.

 

[Mandelin Rain]

The guy gets paid at least 270k of our dues annually to deal with this hornet's nest he went out of his way to create. For that kind of bread, he can maintain some level of professionalism.

 

[evilbooyaa]

It's not that I don't like it, it's that his response is dismissive, presumptive, arrogant, and uncaring. If he didn't want the responsibility of dealing with this clusterf___ of his own creation he shouldn't have become ABR president.

I was referencing when Wallner referenced "unprofessional threats" in his e-mail. Not related to your post.

 

[Mandelin Rain]

I expect he'll get his just desserts at ASTRO.

The whistle doth blow for you Paul.

Oh wait, that already happened.

A few times.

 

[thecarbonionangle]

WOW!!! This Wallner character really is a caricature. Quite a nasty response! this is such a great example of the entrentched out of touch putridness of “leaders” in our field. This is not a reasonable person you can have any sort of reasonable outcome with for us. There are only two options: he gets his way and nothing else or he gets fired. These people do not know reason. He cannot be bothered to even do his job!!

 

[winstonfoot5]

I’m not sure it matters what email he is responding to. No response would have been more appropriate than that response.

There needs to be a leadership change at the highest level of the specialty. This has been clear for some time

 

[RO28]

I’m not sure it matters what email he is responding to. No response would have been more appropriate than that response.

There needs to be a leadership change at the highest level of the specialty. This has been clear for some time

That is a horrible reply, no one should treat someone like that. In my experience, people only get THAT defensive if they have something to hide.

 

[deleted947887]

I said this before and I'll say it again. The only way to resolve this will be through court. The exam results are ludicrous and the examinees should get a refund. The recently published articles strengthen your case. Also, if you follow Valerie Jackson's tweets, you get a sense of what is acceptable (in their realm). And the results of the RO exam are way off. I wouldn't feel comfortable being assessed by the ABR. Kachnik and Wallner are using the ABR for their own agenda. This exam was retaliation for Amdur and Lee.


Her clarification to radiology's exam results:

We want to correct the misinformation that has been posted recently about the Diagnostic Radiology Core Exam. The fail rate for first-time takers for the June 2018 exam was 13.0%. The average fail rate for the past 6 years is 10.1%.

 

[VulgarDisplayOfPower]

This is disgusting. The phrase "makes me feel sick" gets thrown around a lot, but I truly had a visceral response to reading that email from Wallner.

This is a complete disgrace, and Paul Wallner is an embarrassment to our field. The ABR has repeatedly demonstrated itself as a corrupt organization from the top down. Paul Wallner needs to be stripped of all of those ridiculous initials he feels necessary to include after his name. Even the DO.

 

[multitudes]

Even the DO.

Dang.

 

[MadamCurie]

I personally forwarded the letter to my chair, PD, and head of physics curriculum so they know where we are and we are all on the same page.

And don't forget your head radiation/cancer biology instructor. At least half of us always seem to be out of the loop when it comes to things that matter, and we shouldn't be.

 

[scarbrtj]

Thank you ARRO and ACRO for a strong and poignant message.

I wanted to share the ABR's reply to a colleague, from Dr. Wallner, that I feel reflected poorly and did not help the examinee in any sense when he/she tried to inquire about options and direction for reexamination and the state of the exam prior to their "exam results" being publicized.

Wallner, Paul <Paul.Wallner@21co> wrote:

...."I find many of your remarks offensive, your impressions ill-informed, and your threats unprofessional. Several observations:

With regard to exam preparation, I would suggest that you take that issue up with your program director and the physicists and/or radiation biologists who are expected to be integral members of your department. You would also be well served to speak with the majority of your peer group who passed the exam(s) and do not feel as you do about the material covered. The ABR will shortly launch a series of FAQs on the website which may assist in answering some of your questions.

The exams are developed by physicians, physicists and biologists who are actively involved with clinical radiation oncology and teaching residents. Many of the biologists are also clinicians with active practices. It is not up to residents to determine what is relevant, and the biology exam is clearly designated as radiation AND cancer biology. The ABR does not develop curricula, but has encouraged the ACGME and ASTRO, in cooperation with other stakeholders, to develop more granular curricula to guide educators and assessors of knowledge.

The ABR study guide is meant to serve as a roadmap for topics that may be covered, and not as a preparation text. Short of providing added references, there is little else that the ABR can do, since we do not provide courses or educational content.

The notion that all the ABR should evaluate is clinical competence is contrary to the requirements for training in radiation oncology as outlined by the ACGME.

No further communication from you would add to this response.

Paul E. Wallner, DO, FACR, FASTRO, FACRO, FAOCR
Associate Executive Director for Radiation Oncology
The American Board of Radiology
856-780-5111 (land line)
856-789-5342 (fax)
239-910-0056 (cell)
pwallner@theabr"

About that "radiation oncology is the greatest" thing...

You guys have been studying for boards. Now you can start studying what to say to Wallner when you see him at ASTRO.

 

[RO28]

So someone mentioned the acgme, does anyone know how to get them involved? Thoughts on if this would be fruitful or a good idea?

 

[radiaterMike]

The email by Wallner could have said the same thing in a less confrontational manner. And while we don’t know what lead to that response, he is the one in the leadership position who should ensure his emails are professional. I do think that some here are misinterpreting what he said though.

“The notion that ALL the ABR should evaluate is clinical competence is contrary to the requirements for training in radiation oncology as outlined by the ACGME. “ (the emphasis on “all” is mine) probably means that the ACGME requires competency in radiation/cancer biology and radiation physics. Therefore his statement is correct.

I would not waste time with the ACGME. Their sole mission is resident education and not certification (other than to ensure that programs are graduating residents that go on to be certified). The residency review committee - as part of the ACGME - are the radiation oncologists who ensure that individual programs are fulfilling ACGME requirements (and the group that approves new programs and expansion FWIW). They too have no direct sway over the ABR (as evidenced by the fact that Amdur and Lee - past RRC members - cannot elicit the changes they suggest). It looks like Wallner has his hands in the ACGME too — https://acgme.org/Details-Page/ArticleID/5945/Radiation-Oncology

ARRO, ADROP, ASTRO. ACRO etc are the groups that should be involved. Ultimately the ABR is its own entity that is independent from these groups - though Wallner and Kachinic are active in ASTRO - and therefore probably does not have to acquiesce to any demands. In reality this is a small field - such that if the leadership of the major organizations demand change it should happen.

The only other possibility is that the ABR falls under the ABMS though I honestly don’t know what authority it has over the ABR. One might want to look into that if they want to go over the heads of ABR leadership (since I doubt that Valerie Jackson will do anything or care).

 

[deleted947887]

The email by Wallner could have said the same thing in a less confrontational manner. And while we don’t know what lead to that response, he is the one in the leadership position who should ensure his emails are professional. I do think that some here are misinterpreting what he said though.

“The notion that ALL the ABR should evaluate is clinical competence is contrary to the requirements for training in radiation oncology as outlined by the ACGME. “ (the emphasis on “all” is mine) probably means that the ACGME requires competency in radiation/cancer biology and radiation physics. Therefore his statement is correct.

I would not waste time with the ACGME. Their sole mission is resident education and not certification (other than to ensure that programs are graduating residents that go on to be certified). The residency review committee - as part of the ACGME - are the radiation oncologists who ensure that individual programs are fulfilling ACGME requirements (and the group that approves new programs and expansion FWIW). They too have no direct sway over the ABR (as evidenced by the fact that Amdur and Lee - past RRC members - cannot elicit the changes they suggest). It looks like Wallner has his hands in the ACGME too — https://acgme.org/Details-Page/ArticleID/5945/Radiation-Oncology

ARRO, ADROP, ASTRO. ACRO etc are the groups that should be involved. Ultimately the ABR is its own entity that is independent from these groups - though Wallner and Kachinic are active in ASTRO - and therefore probably does not have to acquiesce to any demands. In reality this is a small field - such that if the leadership of the major organizations demand change it should happen.

The only other possibility is that the ABR falls under the ABMS though I honestly don’t know what authority it has over the ABR. One might want to look into that if they want to go over the heads of ABR leadership (since I doubt that Valerie Jackson will do anything or care).

Agree. Seemed normal to me. That said, it's irrelevant. Y'all shouldn't be discussing trivial emails or posting his cellphone on a public forum. That's more inappropriate to me. You are professionals. Either do this the right way, or don't do it at all. If you've been wronged, there are professional ways to make things right. This isn't one.