So I am going to give a slightly different perspective.
1. Let's find out what the pass rate is first. If the pass rate is in the 80% range then guess what - that is in keeping with what this exam has been. We will argue whether that is proper or not in a subsequent point. BUT until you know the pass rate, this threat of litigation and destroying the ABR is premature. Thank you for those who introduced me into the way back machine. Just like I argue about with regards to the job market, the data is important.
2. The concept that 'normative' function of these exams should be abolished is not shared by all in the field nor the data which shows fluctuating rates consistent with what an Angoff method should produce
These exams SHOULD NOT be used as a another weed out or a work around for programs abusing the ACGME system to expand. BUT, if we are going to pump out so many more residents with AD after AD and chair after chair just shoving them in, then we are obligated to make sure standards are upheld. I don't want board exams to be hard or ruin people's career. BUT if so many in our field stated we could almost double the amount of residents and keep education the same - put up or shut up. The angoff method is flawed because people are flawed, but it is the best we have. These exams are not normative, but the only way to make sure these new programs [and old programs who just kept adding people on like candy without increase in educational resources] are training people. There are many people in the field, like myself, who take no joy in seeing people fail board exams but cannot possibly fathom how all these new resident slots were started almost overnight. I don't want them to be weeded out after the fact - but I sure do want a body of experts removed from this decision making a board exam by the Angoff method. There is no way we went from 130 -> 200 test takers and kept educational standards the same.
In that vein, unless the pass rate was 60% (which has to be proven) it would be the height of irony for ADROP to then complain to the ABR after assuring them and the ACGME about how capable they were of training all these new residents.
3. Radiation biology is important. I do not have a lab, I am not a radiation biologist. The classic data provides a framework for understanding radiation and if we are in charge of this very unique modality we need to know it. Just because SBRT was not described by the LQ model does not mean all that data is wrong. In fact, some of the classic data including some of the human experiments or exposures make up the basis of Quantec. It would be great to better link those to a review of quantec, and I agree, knowing a specific protein phosphorylation site would not change patient management, but to state that the biologic foundation of radiation therapy and the pathways of cell division, repair, and death should not be required [as some here are advocating] is hilariously tragic. We need to know what we do on a cellular level to understand, as best we can, what we do on a personal level.
I completely agree with the calls for updated syllabus and text books. My idea would be to have the syllabus be Hall, the ASTRO study guides for questions, and then a rotating group of 30-40 primary scientific articles identified by ABR the year before the exam. Keep it updated. I am getting referrals for 'abscopal effect'. I am getting referrals for RT with the new cdk4/6 inhibitor. Make it a mix of preclinical and clinical papers. On that point I completely agree. But then hold the examinees to that and continue the Angoff method.
4. If the complaint is about the relative importance of radbio compared to clinicals, then fine - make the clinical writtens more comprehensive. Make it 400-500 questions, including required sections on brachy, SBRT, SRS, dose constraints, techniques, etc. Again, I don't want to make residents fail, but people are here complaining about radbio when clinical writtens are a joke both anecdotally and by the abr data. No, not everyone should pass their boards, unless they are competent. If 100% pass because they all know the answers, that's awesome. If 50% pass because on a theoretical actually well tuned clinical written half the new residents weren't able on a multiple choice test to identify important points on techniques which should be common place, then that's ok too.
It sucks if people failed, but this thread is going in a crazy over-reaction way. Get the course materials for rad bio better, and in mine [and at least in the view of the people I talk to] update the curriculum to include primary contemporary literature that will require more work on the part of trainees but also be more relevant in time and clinical orientation.
And this idea that everyone should pass their boards because they got here is horrendous. Congratulations on getting here. The job of the training program and body is to make sure the certification of you going from here to the clinic designates a certain level of knowledge and competency of all aspects of radiation. That is how standards of endorsing an autonomous physician should be, both for the field and for the public.
