Rad Onc Oral Boards: To quote or not quote studies?

[mistyforest]

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For responding to oral boards questions, general advice appears to be to avoid referencing studies directly as this will open up a can of worms.

However, this video posted by ABR reenacting an oral board exam with examples of clear fail/marginal fail/strong pass, the examiner feedback for strong pass specifically points out "...in addition was able to quote some studies on the use of tumor treating fields..." at 37:37 timestamp
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The examinee specifically mentions RTOG 93-05 re: SRS boost at 36:08
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and then also cites RTOG-1205 at 36:47 for reirradiation with avastin.


Ironically, none of the studies that the examinee quoted were in association with tumor treating fields, but putting that discordance aside...

The ABR video's feedback seems opposite to the general advice for not quoting studies for oral boards.

Has this expectation changed in recent years? Are we supposed to be quoting studies to pass oral boards? If we cite them, does it increase the chances of passing? Or does the risk of citing such a study negate the benefits that may arise from doing so?

Thanks in advance to the wiser community at large.

 

[drowsy12]

you do NOT need to mention studies at all to pass. dont mention them unless you feel very comfortable with them.

there is a scoring system what from what I understand where you can 'excel' in a section and get a 71 or 72. in theory, getting that high score can help bump you up to a general pass if you fail a particular section. you will never see your subsection scores (unless you ask your program PD who does get them) and thus dont otherwise matter. so if you excel in one section (CNS) by showing you know a lot, in theory it can help you if you fail GU, as when the committee discusses you overall, it may bump you up to a pass in GU.

 

[medgator]

"Available data". How to quote every study lol

 

[evilbooyaa]

If you quote a study PROPERLY, it will help you to potentially do better than 70.

If you quote a study INCORRECTLY or in a way that is not in direct line with how the examiner has interpreted that study in relation to the current clinical situation, it may derail your examiner so thoroughly that you cannot proceed through enough cases to demonstrate the knowledge necessary to pass you for that session.

If you know enough to pass, the safer option is to NOT quote studies, because the expected value is not in your favor. You don't have to justify your decisions. You just have to do the right thing.

Perhaps the examinee is a CNS attending at her current job. Maybe she trained at CCF (since this is just a mock and not a real person's examination) and knows how much Dr. John Suh will Asian dad his disappointment if you're unaware of the intracacies of anything even potentially tangentially related to CNS Radiation Oncology.

The correct answers to the selected times noted above:
John Suh: "Is there any role to the use of SRS boost in GBM"
Examinee: "No."

Of note, the above answer saves 25 seconds of demonstrating unnecessary knowledge by the mock examinee. Answer the questions you are asked. Keep **** concise. Your goal is to get through 4 if not 5 cases, in every section. You may not get a 71 or 72, but you will maximize your chances of getting a 70.

The second embedded link:

John Suh: "Is there any role for re-irradiation?"
Examinee: "Yes, I would recommend 35/10 with concurrent Avastin."

*EDIT* - Just watched the beginning of the video. The mock examinee is Dr. Shauna Campbell, who did her residency at CCF. So, yeah, she's well trained in CNS malignancies.

The case in total took just under 9 minutes. Each section is (IIRC) 30 minutes. A more concise examinee could have potentially completed this section in 5-7 minutes. Do that for 3 consecutive cases and now you have extra time for a 4th or even 5th case. As is dogma - if you hit a 5th case, you're passing the section. No idea if that's true for all but a good rule to seemingly live by.

 

[deleted1217978]

I have mixed thoughts on this. I had a nightmare breast examiner (it really is the worst), and was sure I failed that section. However I got a 71 and 72 in other sections (which I believe you have to cite data to get). My feeling is that my performance in other sections pulled me across the finish line for breast in committee review.

I would not voluntarily try to bring up data, but if they ask you for it and you know it, say it.

 

[RSAOaky]

Do not offer anything that will open you up to scrutiny. If you are asked, you answer, but you do not offer. You say "there is evidence that...XYZ" not "According to NRG bla bla bla, this patient would benefit from omission of radiation." If the examiner wants to pimp you further, they will say "what study is that evidence from?" and hopefully that will be it, as oppose to saying "what was the randomization in NRG bla bla bla" or "what was the survival benefit in NRG bla bla bla."

 

[fiji128]

The exam is about practical knowledge. How do you treat this and that under various circumstances. It is not about trial data. If you are talking about trial data you are doing it wrong. This general advice has been true for years/decades.

The ABR is not above gaslighting candidates via releasing poor quality preparatory materials, which is also something that has also been true for years/decades.

 

[Palex80]

Quote only your trials. 🙂

 

[neo3872]

I rotated at CCF and sat through some John Suh resident pimp sessions when I was a med student. The expectation in these sessions is to quote trials and in great detail. This is just part of the resident culture at CCF. I would not recommend quoting trials much at the real oral boards. I know I didn't and really didn't get pushed much by examiners to quote trials or provide details on them (maybe one or two times max)

 

[OTN]

I rotated at CCF and sat through some John Suh resident pimp sessions when I was a med student. The expectation in these sessions is to quote trials and in great detail. This is just part of the resident culture at CCF. I would not recommend quoting trials much at the real oral boards. I know I didn't and really didn't get pushed much by examiners to quote trials or provide details on them (maybe one or two times max)

I trained at a place where we were pushed similarly to know minutiae of trials. Waste of time compared to the teaching we could have received (but did not) in treatment planning, imaging, dosimetry, simulation, patient management, etc. I did not mention a single trial during my oral boards and it went fine.

 

[TheWallnerus]

I quoted trials in my orals. I didn’t really want to but after years and years of having to do it in residency and it sort of becoming a cultural thing (“what? You’re not quoting data? Do you even quote data bro?”) it spilled out of my mouth involuntarily under the interrogator’s light. So I really respect people who had the mental will not to quote trials in orals.

 

[Doctorer]

I trained at a place where we were pushed similarly to know minutiae of trials. Waste of time compared to the teaching we could have received (but did not) in treatment planning, imaging, dosimetry, simulation, patient management, etc. I did not mention a single trial during my oral boards and it went fine.

Sometimes, I wonder if you and I were co-residents and/or trained at the same program.

 

[Dare2Dream]

Sometimes, I wonder if you and I were co-residents and/or trained at the same program.

Yeah, what are the chances there could have been 2 programs like that?

 

[Chartreuse Wombat]

I trained at a place where we were pushed similarly to know minutiae of trials. Waste of time compared to the teaching we could have received (but did not) in treatment planning, imaging, dosimetry, simulation, patient management, etc. I did not mention a single trial during my oral boards and it went fine.

This a common complaint about training programs. The problem is that many of the subjects you list that were not taught are without clear unequivocal single answers. This is the problem with relying on tests. Allow me make an unrelated (but germane) example. In US history we can "test" for the date of the Emancipation Proclamation but it is much harder (and time consuming) to "test" for the politics surrounding this date.

There is no one best way to plan, treat, sim a specific patient with a given condition. There are incorrect methods (which is what the boards are testing for). For example 60 Gy for Stage IIa seminoma is wrong but there are many ways to treat a IIa seminoma correctly.

 

[drowsy12]

residency is about learning how to think and how to make decisions. Evidence isn’t the be all end all but I do think it’s part of it. That helps you take in new information and understand how to adapt. Don’t need to talk about it for boards though

 

[OTN]

This a common complaint about training programs. The problem is that many of the subjects you list that were not taught are without clear unequivocal single answers. This is the problem with relying on tests. Allow me make an unrelated (but germane) example. In US history we can "test" for the date of the Emancipation Proclamation but it is much harder (and time consuming) to "test" for the politics surrounding this date.

There is no one best way to plan, treat, sim a specific patient with a given condition. There are incorrect methods (which is what the boards are testing for). For example 60 Gy for Stage IIa seminoma is wrong but there are many ways to treat a IIa seminoma correctly.

Sure, I get that, but getting taught at least one way to do something is probably better than trying to figure it out yourself.

 

[deleted1217978]

Sure, I get that, but getting taught at least one way to do something is probably better than trying to figure it out yourself.

No, you're completely correct. The training system is ridiculous and a perversion of vocational training due to vestigial academic tradition. Can you imagine spending 2 years in an electrician apprenticeship, getting your union card, then showing up on your first day of work and having no idea how to install a circuit breaker? Our work is not just theoretical. Physicians are in a way blue collar workers. We work with our hands and need practical training, not just textbook memorization and formula derivation. This is offensive to academics because of the historical elitism. I am personally enjoying watching their whole university system blow up and young people abandon college for vocational training in the face of outrageous cost for marginal if any intellectual and career benefits. I just talked to a radiologist here whose son is becoming a plumber and couldn't be happier about it.

 

[TheWallnerus]

Since we are talking about teaching I want to point out some rad oncs who I think were/are great teachers and do the field proud in that regard.

Ian Crocker was a great teacher. He was a coronary brachy, IMRT, and IGRT pioneer and SRS pro. He was a neurologist in Canada before becoming a rad onc.

Arnold Paulino is a fantastic teacher. One of the few rad oncs I’ve known who prepares and gives long formal didactic teaching sessions.

Andrew Turrisi was a great teacher. He was a med onc before becoming a rad onc.

I think Nicholas Zaorsky is a great teacher and seems to really enjoy doing so.

Not every rad onc is a great teacher but I think you can kind of pull it out of ‘em as a resident. Being a resident on a service I always sort of looked at as like “how can I butter my attending’s biscuit from time to time to get them interested in teaching me.”

 

[communitydoc13]

I guess nearly all of us have detailed experience with no more than a handful of programs. I do believe the above critique that technical education is often lacking at the resident level. It was at my program.

However, there is a positive aspect to our field's cultural emphasis on literature. (Which I cynically believe is largely due to the fact that, unlike many other fields, we are not constantly inundated with new therapeutics).

We often (or at least should) think in non-binary terms about patients and interventions.

We can counsel patients about expected benefit of an intervention...and the evidence based expectations for differential value (in terms of survival, local control, etc) compared to observation or less intensive therapy.

In the community, cancer is largely a disease of senescence. A great portion of patients are not representative of study populations. Having been forced to actually read studies and think about details does provide a foundation for treating vulnerable patients properly.

To the poster's point. I would not quote studies for boards unless absolutely necessary. But it's good to have a sense of the differential value of standard of care vs less intense intervention based on trials. (Have it in your pocket).

90 year old comes in with muscle invasive bladder cancer...you should have a sense of the relative added benefit to concurrent therapy based on a trial result. You should have a sense of what the outcomes are if you give 55/20 without chemo so you can discuss with patient and family.

 

[medgator]

The exam is about practical knowledge. How do you treat this and that under various circumstances. It is not about trial data. If you are talking about trial data you are doing it wrong. This general advice has been true for years/decades.

The ABR is not above gaslighting candidates via releasing poor quality preparatory materials, which is also something that has also been true for years/decades.

Need those bootleg recalls only available at select institutions