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I started coming to SDN 15+ years ago and have used it to help prepare for virtually every career milestone ever since. Since I’ve benefited by reading everyone’s experiences/opinions, I figured I’d post about studying for radbio/physics boards. To me, they feel like a “weed out” point for us...the O-Chem of RadOnc. What happened in 2018 put the fear of God into me about these exams, and I have been stressed about them for years.
As far as I know, this style of exam is unique to Radiation Oncology. No other specialty board requires their candidates to take “basic science” exams as part of the board certification process, especially exams which have so little relevance to the day-to-day training and practice of a Radiation Oncologist. While I can understand testing us on radiation physics - something not taught in medical school - it escapes me why we need to have a separate radiation biology exam. Biochemistry and Molecular Biology are courses taken by most medical students in undergrad, are tested on the MCAT, are usually courses in the pre-clinical medical school curriculum, and are tested on USMLE Step 1 (and can show up on Step 2 and 3). While having some questions on BED or EQD2 make sense, it escapes me on why I’m memorizing the AKT signaling pathway as a senior resident.
But I digress - this post is a knowledge dump/resource review written with future residents in mind. Maybe someone will benefit?
Background:
I think it’s important to know where I’m coming from so you can decide if my point of view is helpful or not. I am very good at multiple choice exams. However, I am absolute GARBAGE when it comes to math and physics. It doesn’t come naturally to me at all, and I’ve struggled with them since, well, elementary school. Conversely, I have a PhD with an extremely RadOnc-centric dissertation topic, so I would say I have an above-average baseline understanding of radbio.
Through my PhD, I had already read Hall and had significant experience with commonly tested Molecular Biology/Biochemistry techniques (i.e., flow cytometry consumed my life for 6 straight months at one point). I finished my PhD 6 years before taking these boards, so I had forgotten the bulk of the gritty details (signaling pathways etc). I would say that this experience helped me in two ways. First, a lot of the details came back easily to me when studying. Second, day-to-day lab techniques have been burned into my soul. I will be able to walk someone step-by-step through yH2AX foci staining on my deathbed.
Pre-dedicated studying, combo resources:
Since it’s an ACGME requirement, my department obviously has radbio/physics didactics. I think the radbio lectures were average, basically based on Hall, so nothing fancy but at least exam-relevant. The physics lectures, conversely, were dumpster fires. The course director and other lecturers often said they had no idea what was on our boards, no clue what was relevant to our boards, etc. It was basically a free-for-all and totally unhelpful. But hey, my department can check the box that they provide physics instruction.
Given my weak physics background and weak department instruction, I made sure to read McDermott during my PGY-3 year, cover to cover. The McDermott textbook is great. It’s comprehensive and written in an approachable style. The downside is that it’s (relatively) dense, so I don’t think I was able to retain much on a single pass. I also skimmed Hall during PGY-3, but as I was already familiar with it, I didn’t see the need to read it thoroughly.
Take home for my starting position: while the NHEJ proteins felt like old friends, I struggled to spell “electrons”, let alone understand them.
Ramp up to dedicated studying, combo resource:
The Osler Course:
I convinced my department to buy me a subscription to the digital Osler Radbio/Physics course, which I hadn’t heard much about. It’s...alright. It’s a recording of their 2016 live course. It comes with a 500+ page syllabus, which is basically a compilation of all the slides used by the presenters. The slides are of varying quality, and it’s not written with a narrative thread. Of the 30+ lectures, I would say maybe ~20 actually recorded properly with both audio and video. ~10 lectures had broken audio and were useless. The lectures that did have audio were actually pretty good. I listened to these lectures a lot to ease into hardcore studying. If I had to pay for them, would I buy this again? Maybe. I like having lectures playing while I’m doing other things (chores, gym, etc). There’s a lot of potential here, so hopefully they record a live course again AND MAKE SURE THE AUDIO ISN’T BROKEN.
Dedicated studying, combo resources:
RadOncQuestions:
The UWorld of Radiation Oncology. After the 2018 debacle they apparently tried to really step up their game (I didn’t get a subscription till 2019 so I don’t know what it was originally like). Currently, there are ~1100 radbio/physics questions (500 radbio, 600 physics). I’m a huge fan. The interface is great, the questions are well written, the explanations are often in-depth, and it all seems targeted towards not only boards but clinically-relevant topics. If they continue to expand, perhaps ROQ’s will one day be a “primary” source for radbio/physics boards. However, I don’t think they’re quite there just yet, but this is an indispensable resource. RadOncQuestions, I love you, will you send me a T-shirt? Also, for the good of all residents everywhere, please continue to expand this section.
The “David Chang Book”, Basic Radiotherapy Physics and Biology:
(authors: David Chang, Foster Lasley, Indra Das, Marc Mendonca, Joseph Dynlacht)
Published in 2014, this is, perhaps, the greatest book ever written in our field (hyperbole...somewhat). One of my biggest regrets is not finding this book as a PGY-2. Clocking in at around 320 pages, it’s written in a conversational tone with no BS. It’s how I actually learned physics. Previous SDN posters have said that this book covers ~70-80% of the exam content. That might have been true a few years ago, but I don’t know if it was true for my exams. I would say probably closer to 55-65% (the book is light on things like protons, which was ~10% of my physics exam). However, this is how things really “clicked” for me, both in understanding physics and building back my biology knowledge. In a perfect world, someone would take this book and make a second edition, expanding it with more particle/proton physics, imaging modalities (MRI, ultrasound, etc), and beefing up the brachytherapy section. I think this book was key in me passing these board exams.
Old in-service exams:
I went through and did probably the last 10 years of in-service radbio/physics questions. Were they helpful? Maybe. I will say that a topic popped up on my actual boards that I hadn’t seen anywhere else but in-service, so I know for a fact I got at least one question right I would have otherwise been unsure about. Is 1 factoid out of a thousand questions a good return on investment? Maybe. Regardless, I think I would definitely do this again since it was good for consolidating knowledge.
Physics-specific resources:
Old RAPHEX exams:
The gold standard for decades. The RAPHEX questions are very similar to the style/content of the actual physics boards. I think the consensus is that RAPHEX gets “harder” every year. I would generally agree, looking at like, the 1999 vs 2020 exams. I think prevailing wisdom is to do 7-8 of the most recent exams to get comfortable. Some people do 20 years of exams. I personally did 2014-2020, and wish I did significantly more but just ran out of time.
Caggiano:
Obviously, the king. However, there’s no commercially available version of his course, so you either need to find bootleg versions of his syllabus/presentations or find a way to bring him to your department (or bring yourself to one of his regional events). If you memorize his 500+ page syllabus cover-to-cover you will (likely) destroy physics. However, this is very time consuming. Personally, I was handed down flash cards made from the Caggiano stuff by people who took the exam in years past which I used heavily. I wish I had spent significantly more time with the actual source material, but with my COVID-modified schedule it didn’t work out that way.
The new Eric Ford book/videos:
This is commercially available. It came out this summer (2020), and I purchased a copy, but I had already decided to go with other resources for the bulk of my studying. I would make the argument that this is probably the most similar to Caggiano except you don’t need to bootleg it (Caggiano/Ford are very in-depth but not McDermott in-depth). If I had needed to retake physics I was planning on spending a lot of time with this book and the videos. I think this will likely become a foundational resource for those not willing/able to use the Caggiano stuff.
Biology-specific resources:
The Gayle Woloschak reviews from ARRO:
These are so beyond incredibly clutch. Personally, I listened to the 2019 and 2020 presentations multiple times and compared/contrasted the two (what was emphasized on both the first and second versions, what she added to the second one because it’s a little longer, etc). You should try to memorize all the details from her slides (I think the 2020 PPT is 110-120 slides). Her review was great for picking up a lot of those BS “trivia” questions which go beyond concepts and are borderline absurd if you’re trying to memorize textbooks from the “ABR Study Guide”. Dr Woloschak will hopefully become legendary for future residents - the Goljan of RadBio.
The ASTRO Study Guides:
These are also great for picking up trivia questions (especially since Dr Woloschak is the Editor-in-Chief for at least the 2019 version). Personally, I had flashcards from the 2019 and 2017 versions, but I have friends who used many more of them (I honestly don’t know how many exist, I think the first one came out in 2006 but they could go back further). There was another post on SDN which suggested there are multiple different “versions” for a single year, which I haven’t personally verified (I’m curious how many of these things exist). Regardless, I would consider completing at least the most recent 2-3 versions as indispensable preparation.
Timeline:
Like most residents at large programs, I was on research elective during my PGY-4 year. My original, pre-COVID plan was to start dipping into studying in January-March, and then progressively step it up from March to July. This obviously went totally sideways. However, my experience felt instructive in terms of what’s important to know for concepts (long-term memory) vs trivia (short term memory). It was also...interesting...to have to adapt my study plan from being on elective back to clinical rotations. I had no option to change my schedule around, and knew that I would be on intensive clinical rotations in the months leading up to December boards.
January-March 2020:
I started doing the Osler lectures, as well as using some of the “hand-me-down” flashcards/study guides from my more senior friends. When COVID started to show up in the US, it was very difficult for me to focus on studying because I wasn’t sure what was going to happen.
March/April 2020:
Once Oral Boards became postponed, I think we all knew it was inevitable that Written Boards would also be postponed. Therefore, I stayed in a holding pattern of “light studying” until the delay was announced and I knew we wouldn’t be taking boards in July.
April-July 2020:
I kept studying on the “lighter” side during this time, focusing more on trying to find a job (which, at this stage, was eating up about 10-20 hours per week). I used the Osler Course, did some RAPHEX, used the flashcards/study guides, and tried to survive the pandemic.
End of July - December 7th, 2020:
This is when I switched into dedicated studying. I would estimate I tried to log 1-2 hours per day of studying in the ~4 months before boards, using the above resources. We all have different studying techniques, and for me, that’s basically pure repetition.
What I tried to memorize entirely:
The David Chang book
RadOncQuestions
The ARRO Woloschak review
Flashcards based on Caggiano/RAPHEX (about 1,000 cards in total)
I used all the other resources as well to varying extents. Starting ~6 weeks before boards I began to ramp up my study time, going from 10-20 hours per week to probably close to 80 hours in the final week. This was extraordinarily difficult because I was on regular clinical rotations with regular clinical expectations. I feel like I didn’t sleep for weeks. I would estimate, in the 4 months leading up to the exam, I logged at least 200-250 hours of studying (low-end estimate, I didn’t keep precise records, obviously).
Because of COVID I had to travel out-of-state to find a seat and stay in a hotel the night before, wear a mask the whole time I was in the testing center, etc. Basically, there were a lot of distractions/difficulties that were COVID-induced.
The boards experience:
Again, let me emphasize my sheer terror, borderline phobia, of these boards because of 2018 and the ABR’s response. Step 1 felt like a warm massage compared to how I felt walking into Prometric on December 7th, 2020.
Physics I found to be very challenging, perhaps not as challenging as I feared but I definitely wish I had spent a couple extra hundred hours studying. I probably felt “good” on ~50-55% of the exam, and “unsure-to-awful” about the other ~45-50%. On the plus side, many of my colleagues seemed to feel the same way, so it seemed like a tough version of the exam and not something I did particularly wrong. Of the people who felt “good” walking out of this exam, the secret seemed to be “memorize Caggiano and 20 years of RAPHEX”, which, if you have the time and discipline to do, seems like a great idea.
Radbio I felt great about, and I attribute A LOT of that to ARRO/Woloschak and the ASTRO Study Guides. Those seem to be the “secret sauce” to getting the trivia questions. I felt confident on about ~75-80% of the exam, which I knew would likely be enough to pass.
I would say each exam is probably 50% of what I would consider “core” concepts, which is what I feel the David Chang book and RadOncQuestions do an excellent job explaining. The other 50% of each exam felt like “I hope you studied the right resources, kid”. A friend of mine once explained studying for RadOnc boards as “a video game level where you run around collecting random, hidden gold coins and when you get to the end you just hope you collected enough”. Honestly, it’s not like any of the questions are impossible/unsolvable, it’s just that the resources we have aren’t great. ARRO has gone a long way to fixing that, at least for biology, after the 2018 Massacre. While physics has Caggiano, there isn’t yet a corollary to the ~2 hour 110 slide Woloschak review. I also don’t know if there can be? But maybe ARRO can work on that next.
Obviously, we never learn what the passing score was, what questions were thrown out, what your score was, etc. For this amount of preparation, all I know is that I passed both exams. From the “score breakdown” (given a score of 1-4 based on your subcategory performance compared to your peers), I would guess I did average? My subcategory scores were all over the place. Without knowing how many questions were in each category, it’s impossible to get a sense of what it even means (i.e. getting a 3 in a category with only 10 questions is different than a category with 30 questions).
Also, in 2018, the ABR noted that the programs with the fewest number of residents had the highest fail rates. Speculation on SDN is that these residents likely had less elective time to dedicate to studying, and suffer for it. I generally agree with this hypothesis. My program, to my knowledge, has had very few radbio/physics failures in the last 5-10 years. However, we’re big and have 12 months of elective, and I know that most residents spend 2-3 months of elective time dedicated to studying for boards (sometimes much more). It was GRUELING to try to study what I felt like was an appropriate amount to take these exams while on full-time clinical duties. Even if the ABR took “COVID pity” on us and artificially increased the pass rate...I totally feel like I deserved it. To clock hundreds of hours of studying for these exams during the worst pandemic in a century (not to mention everything else that happened in 2020) has been one of the most difficult things I have ever done.
But hey...I can do MU calculations by hand now, which is a skill I totally needed.
Random factoids I learned along the way:
Anyway, if you read this ridiculous post and have any questions, let me know. If anyone else has any thoughts or reviews about the resources they used, I’d love to hear it. We’re all in this together!
February 14th, 2021 Edit:
Evidently, David Chang et al released a second edition of their book in January 2021!
It seems to include everything I wish the first one had. THANK YOU GUYS!
As far as I know, this style of exam is unique to Radiation Oncology. No other specialty board requires their candidates to take “basic science” exams as part of the board certification process, especially exams which have so little relevance to the day-to-day training and practice of a Radiation Oncologist. While I can understand testing us on radiation physics - something not taught in medical school - it escapes me why we need to have a separate radiation biology exam. Biochemistry and Molecular Biology are courses taken by most medical students in undergrad, are tested on the MCAT, are usually courses in the pre-clinical medical school curriculum, and are tested on USMLE Step 1 (and can show up on Step 2 and 3). While having some questions on BED or EQD2 make sense, it escapes me on why I’m memorizing the AKT signaling pathway as a senior resident.
But I digress - this post is a knowledge dump/resource review written with future residents in mind. Maybe someone will benefit?
Background:
I think it’s important to know where I’m coming from so you can decide if my point of view is helpful or not. I am very good at multiple choice exams. However, I am absolute GARBAGE when it comes to math and physics. It doesn’t come naturally to me at all, and I’ve struggled with them since, well, elementary school. Conversely, I have a PhD with an extremely RadOnc-centric dissertation topic, so I would say I have an above-average baseline understanding of radbio.
Through my PhD, I had already read Hall and had significant experience with commonly tested Molecular Biology/Biochemistry techniques (i.e., flow cytometry consumed my life for 6 straight months at one point). I finished my PhD 6 years before taking these boards, so I had forgotten the bulk of the gritty details (signaling pathways etc). I would say that this experience helped me in two ways. First, a lot of the details came back easily to me when studying. Second, day-to-day lab techniques have been burned into my soul. I will be able to walk someone step-by-step through yH2AX foci staining on my deathbed.
Pre-dedicated studying, combo resources:
Since it’s an ACGME requirement, my department obviously has radbio/physics didactics. I think the radbio lectures were average, basically based on Hall, so nothing fancy but at least exam-relevant. The physics lectures, conversely, were dumpster fires. The course director and other lecturers often said they had no idea what was on our boards, no clue what was relevant to our boards, etc. It was basically a free-for-all and totally unhelpful. But hey, my department can check the box that they provide physics instruction.
Given my weak physics background and weak department instruction, I made sure to read McDermott during my PGY-3 year, cover to cover. The McDermott textbook is great. It’s comprehensive and written in an approachable style. The downside is that it’s (relatively) dense, so I don’t think I was able to retain much on a single pass. I also skimmed Hall during PGY-3, but as I was already familiar with it, I didn’t see the need to read it thoroughly.
Take home for my starting position: while the NHEJ proteins felt like old friends, I struggled to spell “electrons”, let alone understand them.
Ramp up to dedicated studying, combo resource:
The Osler Course:
I convinced my department to buy me a subscription to the digital Osler Radbio/Physics course, which I hadn’t heard much about. It’s...alright. It’s a recording of their 2016 live course. It comes with a 500+ page syllabus, which is basically a compilation of all the slides used by the presenters. The slides are of varying quality, and it’s not written with a narrative thread. Of the 30+ lectures, I would say maybe ~20 actually recorded properly with both audio and video. ~10 lectures had broken audio and were useless. The lectures that did have audio were actually pretty good. I listened to these lectures a lot to ease into hardcore studying. If I had to pay for them, would I buy this again? Maybe. I like having lectures playing while I’m doing other things (chores, gym, etc). There’s a lot of potential here, so hopefully they record a live course again AND MAKE SURE THE AUDIO ISN’T BROKEN.
Dedicated studying, combo resources:
RadOncQuestions:
The UWorld of Radiation Oncology. After the 2018 debacle they apparently tried to really step up their game (I didn’t get a subscription till 2019 so I don’t know what it was originally like). Currently, there are ~1100 radbio/physics questions (500 radbio, 600 physics). I’m a huge fan. The interface is great, the questions are well written, the explanations are often in-depth, and it all seems targeted towards not only boards but clinically-relevant topics. If they continue to expand, perhaps ROQ’s will one day be a “primary” source for radbio/physics boards. However, I don’t think they’re quite there just yet, but this is an indispensable resource. RadOncQuestions, I love you, will you send me a T-shirt? Also, for the good of all residents everywhere, please continue to expand this section.
The “David Chang Book”, Basic Radiotherapy Physics and Biology:
(authors: David Chang, Foster Lasley, Indra Das, Marc Mendonca, Joseph Dynlacht)
Published in 2014, this is, perhaps, the greatest book ever written in our field (hyperbole...somewhat). One of my biggest regrets is not finding this book as a PGY-2. Clocking in at around 320 pages, it’s written in a conversational tone with no BS. It’s how I actually learned physics. Previous SDN posters have said that this book covers ~70-80% of the exam content. That might have been true a few years ago, but I don’t know if it was true for my exams. I would say probably closer to 55-65% (the book is light on things like protons, which was ~10% of my physics exam). However, this is how things really “clicked” for me, both in understanding physics and building back my biology knowledge. In a perfect world, someone would take this book and make a second edition, expanding it with more particle/proton physics, imaging modalities (MRI, ultrasound, etc), and beefing up the brachytherapy section. I think this book was key in me passing these board exams.
Old in-service exams:
I went through and did probably the last 10 years of in-service radbio/physics questions. Were they helpful? Maybe. I will say that a topic popped up on my actual boards that I hadn’t seen anywhere else but in-service, so I know for a fact I got at least one question right I would have otherwise been unsure about. Is 1 factoid out of a thousand questions a good return on investment? Maybe. Regardless, I think I would definitely do this again since it was good for consolidating knowledge.
Physics-specific resources:
Old RAPHEX exams:
The gold standard for decades. The RAPHEX questions are very similar to the style/content of the actual physics boards. I think the consensus is that RAPHEX gets “harder” every year. I would generally agree, looking at like, the 1999 vs 2020 exams. I think prevailing wisdom is to do 7-8 of the most recent exams to get comfortable. Some people do 20 years of exams. I personally did 2014-2020, and wish I did significantly more but just ran out of time.
Caggiano:
Obviously, the king. However, there’s no commercially available version of his course, so you either need to find bootleg versions of his syllabus/presentations or find a way to bring him to your department (or bring yourself to one of his regional events). If you memorize his 500+ page syllabus cover-to-cover you will (likely) destroy physics. However, this is very time consuming. Personally, I was handed down flash cards made from the Caggiano stuff by people who took the exam in years past which I used heavily. I wish I had spent significantly more time with the actual source material, but with my COVID-modified schedule it didn’t work out that way.
The new Eric Ford book/videos:
This is commercially available. It came out this summer (2020), and I purchased a copy, but I had already decided to go with other resources for the bulk of my studying. I would make the argument that this is probably the most similar to Caggiano except you don’t need to bootleg it (Caggiano/Ford are very in-depth but not McDermott in-depth). If I had needed to retake physics I was planning on spending a lot of time with this book and the videos. I think this will likely become a foundational resource for those not willing/able to use the Caggiano stuff.
Biology-specific resources:
The Gayle Woloschak reviews from ARRO:
These are so beyond incredibly clutch. Personally, I listened to the 2019 and 2020 presentations multiple times and compared/contrasted the two (what was emphasized on both the first and second versions, what she added to the second one because it’s a little longer, etc). You should try to memorize all the details from her slides (I think the 2020 PPT is 110-120 slides). Her review was great for picking up a lot of those BS “trivia” questions which go beyond concepts and are borderline absurd if you’re trying to memorize textbooks from the “ABR Study Guide”. Dr Woloschak will hopefully become legendary for future residents - the Goljan of RadBio.
The ASTRO Study Guides:
These are also great for picking up trivia questions (especially since Dr Woloschak is the Editor-in-Chief for at least the 2019 version). Personally, I had flashcards from the 2019 and 2017 versions, but I have friends who used many more of them (I honestly don’t know how many exist, I think the first one came out in 2006 but they could go back further). There was another post on SDN which suggested there are multiple different “versions” for a single year, which I haven’t personally verified (I’m curious how many of these things exist). Regardless, I would consider completing at least the most recent 2-3 versions as indispensable preparation.
Timeline:
Like most residents at large programs, I was on research elective during my PGY-4 year. My original, pre-COVID plan was to start dipping into studying in January-March, and then progressively step it up from March to July. This obviously went totally sideways. However, my experience felt instructive in terms of what’s important to know for concepts (long-term memory) vs trivia (short term memory). It was also...interesting...to have to adapt my study plan from being on elective back to clinical rotations. I had no option to change my schedule around, and knew that I would be on intensive clinical rotations in the months leading up to December boards.
January-March 2020:
I started doing the Osler lectures, as well as using some of the “hand-me-down” flashcards/study guides from my more senior friends. When COVID started to show up in the US, it was very difficult for me to focus on studying because I wasn’t sure what was going to happen.
March/April 2020:
Once Oral Boards became postponed, I think we all knew it was inevitable that Written Boards would also be postponed. Therefore, I stayed in a holding pattern of “light studying” until the delay was announced and I knew we wouldn’t be taking boards in July.
April-July 2020:
I kept studying on the “lighter” side during this time, focusing more on trying to find a job (which, at this stage, was eating up about 10-20 hours per week). I used the Osler Course, did some RAPHEX, used the flashcards/study guides, and tried to survive the pandemic.
End of July - December 7th, 2020:
This is when I switched into dedicated studying. I would estimate I tried to log 1-2 hours per day of studying in the ~4 months before boards, using the above resources. We all have different studying techniques, and for me, that’s basically pure repetition.
What I tried to memorize entirely:
The David Chang book
RadOncQuestions
The ARRO Woloschak review
Flashcards based on Caggiano/RAPHEX (about 1,000 cards in total)
I used all the other resources as well to varying extents. Starting ~6 weeks before boards I began to ramp up my study time, going from 10-20 hours per week to probably close to 80 hours in the final week. This was extraordinarily difficult because I was on regular clinical rotations with regular clinical expectations. I feel like I didn’t sleep for weeks. I would estimate, in the 4 months leading up to the exam, I logged at least 200-250 hours of studying (low-end estimate, I didn’t keep precise records, obviously).
Because of COVID I had to travel out-of-state to find a seat and stay in a hotel the night before, wear a mask the whole time I was in the testing center, etc. Basically, there were a lot of distractions/difficulties that were COVID-induced.
The boards experience:
Again, let me emphasize my sheer terror, borderline phobia, of these boards because of 2018 and the ABR’s response. Step 1 felt like a warm massage compared to how I felt walking into Prometric on December 7th, 2020.
Physics I found to be very challenging, perhaps not as challenging as I feared but I definitely wish I had spent a couple extra hundred hours studying. I probably felt “good” on ~50-55% of the exam, and “unsure-to-awful” about the other ~45-50%. On the plus side, many of my colleagues seemed to feel the same way, so it seemed like a tough version of the exam and not something I did particularly wrong. Of the people who felt “good” walking out of this exam, the secret seemed to be “memorize Caggiano and 20 years of RAPHEX”, which, if you have the time and discipline to do, seems like a great idea.
Radbio I felt great about, and I attribute A LOT of that to ARRO/Woloschak and the ASTRO Study Guides. Those seem to be the “secret sauce” to getting the trivia questions. I felt confident on about ~75-80% of the exam, which I knew would likely be enough to pass.
I would say each exam is probably 50% of what I would consider “core” concepts, which is what I feel the David Chang book and RadOncQuestions do an excellent job explaining. The other 50% of each exam felt like “I hope you studied the right resources, kid”. A friend of mine once explained studying for RadOnc boards as “a video game level where you run around collecting random, hidden gold coins and when you get to the end you just hope you collected enough”. Honestly, it’s not like any of the questions are impossible/unsolvable, it’s just that the resources we have aren’t great. ARRO has gone a long way to fixing that, at least for biology, after the 2018 Massacre. While physics has Caggiano, there isn’t yet a corollary to the ~2 hour 110 slide Woloschak review. I also don’t know if there can be? But maybe ARRO can work on that next.
Obviously, we never learn what the passing score was, what questions were thrown out, what your score was, etc. For this amount of preparation, all I know is that I passed both exams. From the “score breakdown” (given a score of 1-4 based on your subcategory performance compared to your peers), I would guess I did average? My subcategory scores were all over the place. Without knowing how many questions were in each category, it’s impossible to get a sense of what it even means (i.e. getting a 3 in a category with only 10 questions is different than a category with 30 questions).
Also, in 2018, the ABR noted that the programs with the fewest number of residents had the highest fail rates. Speculation on SDN is that these residents likely had less elective time to dedicate to studying, and suffer for it. I generally agree with this hypothesis. My program, to my knowledge, has had very few radbio/physics failures in the last 5-10 years. However, we’re big and have 12 months of elective, and I know that most residents spend 2-3 months of elective time dedicated to studying for boards (sometimes much more). It was GRUELING to try to study what I felt like was an appropriate amount to take these exams while on full-time clinical duties. Even if the ABR took “COVID pity” on us and artificially increased the pass rate...I totally feel like I deserved it. To clock hundreds of hours of studying for these exams during the worst pandemic in a century (not to mention everything else that happened in 2020) has been one of the most difficult things I have ever done.
But hey...I can do MU calculations by hand now, which is a skill I totally needed.
Random factoids I learned along the way:
- From the prior SDN threads talking about the 2018 Debacle, per the ABR/Lisa Kachnic, the % correct needed to pass these exams seems to range from 61-71%. From my personal conversations with people who have been involved with exam creation and scoring in the past, questions are thrown out with post-exam analysis (if they scored funny), and experimental questions are part of the exams. So, it’s impossible to know how many questions really “count” in a given version of the exam. 95? 75? Your guess is as good as mine.
- For the 2020 RAPHEX exam (if you actually took it and had it officially scored), getting ~63-64% correct was the ~50th percentile. I know other people on SDN have said that you should aim for getting ~70% correct to “comfortably pass” the actual boards, so that seems to hold true? Making the assumption that 1) the majority of people pass boards and 2) scoring in the 50th percentile means you’re average, therefore, 3) getting 70% correct should put you at an above average knowledge level and likely to pass. I’m aware I’m making a lot of logical leaps there.
- While it’s impossible for you to know your actual boards score/percentile (i.e. a “3” means you could be in the 51st percentile or 74th percentile), looking at my score breakdown I actually think my percentile from my first pass of RadOncQuestions was reflective of my actual exam performance (compared to my peers). I don’t know how to feel about that, because my first pass of ROQ’s was done maybe halfway through my studying, and I managed to learn a lot more since then. Perhaps it means that everyone improved a similar amount? Perhaps it means nothing? Applying the same voodoo math as with the RAPHEX percentiles: given the pass rates are usually at least 70%, you probably want to be in at least the 25th-30th percentile of ROQ’s. Again...I’m making a lot of assumptions there.
Anyway, if you read this ridiculous post and have any questions, let me know. If anyone else has any thoughts or reviews about the resources they used, I’d love to hear it. We’re all in this together!
February 14th, 2021 Edit:
Evidently, David Chang et al released a second edition of their book in January 2021!
Basic Radiotherapy Physics and Biology | David S. Chang | Springer
This book is a concise and well-illustrated review of the physics and biology of radiation therapy intended for radiation therapists, dosimetrists, radiation oncology residents, and physicists. It presents topics that are included on the radiation therapy physics and biology board examinations....
www.springer.com
It seems to include everything I wish the first one had. THANK YOU GUYS!
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