Program pass rates

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i61164

Polar Bear, MD
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Does anyone know if there is a list of board exam pass rates for psychiatry programs? I have seen such lists for peds, internal medicine, and surgery posted on the board websites as public information. I couldn't find this type of info on the ABPN website.

A google search turned up an article from 8 years ago saying that psych had the lowest board pass rate of any specialty (~60%) and that the exam questions did not reflect what you actually needed to know to practice psychiatry. Any truth to this? Has it gotten better?

An advisor told me that it is useful to look at these pass rates because if they are too low you can infer that the teaching is not very good at that institution.

This advisor also said that students should check the financial stability of the teaching hospitals that they are considering because if they are not in good shape financially then the residents will do more scut work which negatively impacts learning. Does anyone know an easy way to find out which hospitals are in trouble financially?

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A google search turned up an article from 8 years ago saying that psych had the lowest board pass rate of any specialty (~60%) and that the exam questions did not reflect what you actually needed to know to practice psychiatry. Any truth to this? Has it gotten better?

Depends on what you mean by "need to know to practice." There's an awful lot of clinical neurology and neuroanatomy of the written boards that a lot of folks complain about as "irrelevant" - but I tend to disagree. I believe most folks fail the oral (not written) boards - which to my experience seemed to be a reasonable test of clinical acumen.
 
At least at my program, what Samson wrote is true. People at my program--most of them pass their written boards, but the oral board pass rate was far worse.

However last years graduating class I believe all passed their oral boards.

A google search turned up an article from 8 years ago saying that psych had the lowest board pass rate of any specialty (~60%) and that the exam questions did not reflect what you actually needed to know to practice psychiatry. Any truth to this? Has it gotten better?

IMHO there is some truth to this only based on what I see on the PRITE. Several questions on the PRITE are things not seen in clinical practice. Several things in it are based on the history of psychiatry. I've never for example heard IM residents having to memorize use of leeches in the past on their board exams. Several questions are based on meds hardly ever used these days. There also questions based on theories that have now fallen out of favor.

This is more philosophical than evidence based, but some have defended such practices because they claim Psychiatry is more subjective a field, and that the history needs to be tested upon because knowing the history will help us to understand the reasoning behind why we do what we do.

I think that's a valid argument except for the fact that by studying for the PRITE, I got to spend dozens of hrs memorizing stuff that has now fallen out of favor--as if its something you need to know for clinical practice. Every single IM question I've seen on their practice boards never test you on stuff like that. If they did something like put the "fallen out of favor" theories as wrong choices on an exam instead of directly testing knowledge of those theories--it'd be much more practical, but the questions are worded in a way in which you have to know the out of date stuff in as much detail as the current stuff.

This advisor also said that students should check the financial stability of the teaching hospitals that they are considering because if they are not in good shape financially then the residents will do more scut work which negatively impacts learning. Does anyone know an easy way to find out which hospitals are in trouble financially?

I've noticed that this perhaps is true, but also that some programs are stuck with crappy faculty because of the shortage of psychiatrists. Without going into too much detail--partly out of self preservation, in some community hospitals I've seen, several of the attending psyche docs leave much to be desired. E.g. interviewing a non English speaking pt without a translator, giving regular diets to pts with multiple MIs, not getting pts with multiple medical problems their meds when they're on the psyche unit. Those hospitals would fire the bad attendings except that they can't replace them.

I don't know an easy way to find out which are the hospitals that'll work you unfairly except to say that when you interview, ask the residents how the hours are. I've also noticed (based on anecdotal experience) that its poor inner city areas that end to work residents the crazy hrs. Rural programs tend to work residents less. I've stated this in several past posts but IMHO you're going to get better training if you work in a program that has good rural & urban exposure because you'll see lots of cases from one environment that don't happen much in the other.
 
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I believe most folks fail the oral (not written) boards - which to my experience seemed to be a reasonable test of clinical acumen.

Do you think that the percentage that fail is likely to be highly variable by program? And do you think that the pass rate is more influenced by quality of teaching or caliber of the residents? I guess these types of questions would be easier to answer if we could find out what the pass rates are by program (which is easy to find out in other specialties, but seems to be kept secret in psychiatry).
 
Do you think that the percentage that fail is likely to be highly variable by program? And do you think that the pass rate is more influenced by quality of teaching or caliber of the residents? I guess these types of questions would be easier to answer if we could find out what the pass rates are by program (which is easy to find out in other specialties, but seems to be kept secret in psychiatry).

I think the major factors in passing the oral boards are:

1) Being able to conduct a complete psychiatric interview in 30 minutes
2) Being able to make a diagnosis and biopsychosocial formulation and treatment plan off the cuff
3) Being able to establish a realtionship with the patient that keeps them in the room for 30 minutes without threatening to leave
4) Having a personality and not just reading off a checklist of questions.
5) Being comfortable doing an interview with 2 complete strangers staring at you

Thus, I think programs that emphasize clinical excellence (with a multitheoretical approach) are most likely to produce passing boards scores.
Having said all of that, young jedi, there's every chance that the oral boards will no longer exist by the time you're graduating residency.
 
Having said all of that, young jedi, there's every chance that the oral boards will no longer exist by the time you're graduating residency.

Excellent point. Still though, I wonder about pass rates for the written boards. If a program's residents are having a hard time passing the written test, then it would be a red flag IMO.

On my quest to find unbiased dirt on programs these are the things that I have found so far:

One psych program is on probationary accreditation with the ACGME: Meharry in Georgia since 4/17/2005
Reference: ACGME

On the ACGME website you can also find out the "cycle length" of a program which is how often they get inspected by the ACGME. A good cycle length is five years. Two years is not so good. It doesn't say specifically why they are checking up on a program more often, but they must have some concern about that program.

One more piece of information that I have dug up is how many approved positions there are, and how many are actually filled. I'm not completely sure how to interpret this info. For example, Wake Forest has 6x4=24 approved spots and only 22 residents. Duke has 64 approved positions and only 39 residents. In fact, most programs I've looked at have a substantial gap between approved positions and actual residents. What does this mean?

I think it is good to get this kind of objective data on programs because even though some residents will give you warnings about a program during your interview, they have a conflict of interest and may try to recruit you to make their own lives easier.
 
Having said all of that, young jedi, there's every chance that the oral boards will no longer exist by the time you're graduating residency.

Latest I heard from my faculty was that oral boards may be replaced by attendings doing 3 oral exams--and would be judged by the program the resident was in, not by an official board exam.

I don't know when this will go into place.
 
Latest I heard from my faculty was that oral boards may be replaced by attendings doing 3 oral exams--and would be judged by the program the resident was in, not by an official board exam.

I don't know when this will go into place.

Not a chance!
If we had to pass them, we're going to make danged sure you have to too!!! :smuggrin:

You can't join our frat unless you can handle the hazing--right, Doc S.?
 
Not a chance!
If we had to pass them, we're going to make danged sure you have to too!!! :smuggrin:

You can't join our frat unless you can handle the hazing--right, Doc S.?

I totally agree :cool:... unfortunately it looks like the ABPN disagrees and the oral boards will be performed by the residency programs themeselves - the details of how and when are still up in the air.
 
I hadn't heard that rumor, but the ACGME and the ABPN are different organizations, and I'd be surprised if the ABPN would give up one of its central purposes to the residencies. At the same time, I guess I could imagine them continuing the evolution of the oral exam into something less time consuming for everyone. As for letting the residencies eval their own residents... that seems against the whole mission of anonymous evaluations (examiners never find out where you are from in an effort to remain impartial).
 
I hadn't heard that rumor, but the ACGME and the ABPN are different organizations, and I'd be surprised if the ABPN would give up one of its central purposes to the residencies. At the same time, I guess I could imagine them continuing the evolution of the oral exam into something less time consuming for everyone. As for letting the residencies eval their own residents... that seems against the whole mission of anonymous evaluations (examiners never find out where you are from in an effort to remain impartial).

Not a rumor. This has already been presented to AADPRT and AAP by ABPN. It's really now down to figuring out the logistics and schedule. The ABPN claims to be making a financial loss for every administration of the oral boards (makes some sense... each candidate pays ~$2000, but meets with 7-8 examiners all of whom need room/board, etc.).
 
I'm not liking the idea of taking my oral boards. Reason why is because everytime we have a mock board at my program, the guy judging me tells me I should've done something that another judge said was wrong. These judges are also people who have been certified to judge on exams.

I hate it when tests that are riding on so much have a contradictory subjective method of grading. Its not fair to the test taker. "X is wrong, if you do it you'll fail." "why aren't you doing x? if you don't do it you'll fail".

I think having programs handle it makes it fairer in this sense because at least the people judging you know you.

However the problem here is that this increases the subjectiveness even more. I'm sure there'll be several programs that just let everybody pass, and other programs will make it very hard in comparison.
 
I'd be very concerned if they did away with national oral boards. Although I don't look forward to the process, I know it is one of the few things that will give me credibility as a psychiatrist.

A popular perception inside and outside of psychiatry is that we practice a subjective field. Having residency programs administer their own oral boards will only fuel this perception.

Even though I'm pretty sure my program is a strong one, there's also a part of me that would wonders whether or not I'd be able to meet the same anonymous national standard as everyone else. Having anoymous oral boards looming over us will inevitably prompt us to study just a little bit harder.

Despite being a painful process, Psychiatry needs standardized anoymous national boards for its own sake and for the sake of its graduates.
 
So now the abpn has changed the oral exam to the 3 examiners, where can I get one of these certificates? I graduated prior to this requirement and am having a hard time finding a program to help with this.

I think it would be a good money maker for a program to take this up.

Pass rate for oral boards is on this site.

http://www.abpn.com/downloads/misc_publications/pc_2011_AADPRT_Presentation_final.pdf

I don't think the general public or even other docs in other fields understand our board certification since the other fields with oral boards do not use a real patient on their exam. Does anyone know of any other field that uses real patients like we do (surgery, pmnr, obgyn, etc)? I don't think an anonymous certification system for us makes any difference in the eyes of people to vaidate psychiatry.

If you feel it should be anonymous, get your CSA certificate from another residency program.
 
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