RISE exam*

[listeriaismfb]

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Any program that says that should be immediately shuttered.

Yahh, I disagree with your position on this. Furthermore it kind of runs contrary to what you said in the other thread. I'll quote "Are there grads who don't really warrant recruitment? Yes."

A program can offer the very finest training opportunity and still get a dud of a resident. It happens, and if a program makes a policy to expel bad apples (as defined by RISE, +/- other criteria) in order to maintain their overall quality I can't say I blame them.

 

[yaah]

Yahh, I disagree with your position on this. Furthermore it kind of runs contrary to what you said in the other thread. I'll quote "Are there grads who don't really warrant recruitment? Yes."

A program can offer the very finest training opportunity and still get a dud of a resident. It happens, and if a program makes a policy to expel bad apples (as defined by RISE, +/- other criteria) in order to maintain their overall quality I can't say I blame them.

Yes, they (programs) can. But you don't base it on your RISE score. You base it on overall performance (for which RISE score may be a proxy but not the best indicator). The fact is that many programs go out of their way to help out poorly performing residents and get them to graduation. Perhaps there should be less assumption that beginning a residency automatically leads you to graduation unless you do something illegal. If a program is that intellectually lazy and afraid of confrontation such that they have to set an arbitrary RISE score for advancement, then perhaps they should be shuttered.

There are grads who don't warrant recruitment, and there are programs that do a good job but get a dud. So, it is up to them, as they are the training institution, to certify whether this person is truly qualified to practice. It shouldn't be based on the RISE. If a qualified resident can't pass the RISE, the program needs to do a better job. If an unqualified resident can't pass the RISE, the program needs to either (1) recruit better residents, or (2) not allow unqualified residents to graduate.

Many years ago, med schools failed out people all the time. There was the old story of being told when you started med school, "Look to your right, now look to your left. One of these people will not be here if you graduate." That doesn't happen anymore. Things are more friendly (which is good and bad). The only way people don't finish med school now is by personal choice or major behavioral or legal issue. Maybe residencies should think about it. It's difficult and creates other problems, but isn't it better for the field?


p.s. if a resident is scoring at the 10% level, that might indicate a problem. If that is the first sign of the problem, however, the program has major issues.

 

[Gyric]

I think PDs should be more aggressive in terminating incompetent or lazy residents; in my experience there is one every couple of years and they are truly dangerous to patients. That being said there is a whole spectrum of surgical pathology and subspecialty skill levels, after just a few years of training, and it is not necessarily fair to hold everyone to the same standard; many of these less clinically competent residents could go on to perform research and autopsies, could run an academic immunology lab, etc… What I have seen happen though is a more careful choice of wording on evaluations. Instead of saying “Dr. X is able to competently sign out most cases on his own.” They say something like “Dr. X is performing at an acceptable level for someone completing X amount of training.” That kicks it back to the PD to decide on advancement. I think that if a program graduates an incompetent pathologist they are somewhat responsible for the damage that individual causes.

One consideration that I have heard tossed around is a “research track” that minimizes clinical responsibilities (and expectations) of future scientists. They have no interest in busting there ass on surg path and the attendings have no interest in working with someone who does not give 110%; since these folks are never going to sign out surgicals anyway, everyone wins as long as the program is structured to take enough clinically focused people to handle the work.

 

[SLUsagar]

Programs give it open book? That's lame. QUOTE]

yeah no kidding. what the hell is the point of that? to ensure their lame ass residents don't fail? to demonstrate a complete mockery of their competency? it really jacks up the curve for the rest of us sane folks trying to gauge ourselves. In fact, I would pay folks to list programs that allow residents to "take it at home" or such idiosyncratic methods of RISE administration. I recall this topic being brought up at a CAP resident forum, but dunno what resulted. I hope programs that do this aren't just given a slap on the hand and told to stop.

last year, we were given our login info ahead of time but had to actually take the exam in our proctored med school lab (which i admit, didn't entirely make sense), and this year we were only given the login AT the actual proctored lab, further assuring and helping to establish a standardized test environment.

i know it might be the boards anxiety in me talking, especially after a long day of RISE questions today, but I'm all up for crucifying those programs that allow open book RISE. My guess is those that do are already mid to low tier, sh*tty-ass programs to begin with, but again until folks post these irregular institutions we'll have to hold onto our stakes and wait. I urge folks to ball-up and let the truth come out.

 

[pathgrrl]

Cytopath was like this relentless hammer that kept pounding me on the head to make me feel stupid, and it seemed to never end.
DBH

I'm a PGY1, took the RISE yesterday... I just used it to gauge what I need to be paying attention to in order to memorize such trivia in future. Why stress out over it? I can only improve my score from this point. It seemed to me that if you memorized the "translocations" list that comes up in Wikipedia, you would score at least 80% on the Hemepath sections.

I agree the Cytology questions seemed over-represented. I used the only I retained from the one hour of cytology training I've had so far "large, irregular, overlapping=cancer". We'll see how far that took me.

 

[exPCM]

I have heard stories of residents being terminated due to low RISE exam scores. I really have to wonder if this is just another urban legend. I have never personally met and I do not have knowledge of a single person that was terminated due to a low RISE exam score.
Perhaps programs should be terminating residents who are not up to par. However I doubt we will see this happen to any significant degree because every terminated resident cuts down on a program's pool of cheap labor and programs lose that GME money for each unfilled spot.
I also think that some programs might be afraid if they got a reputation for regularly terminating residents the program's ability to recruit might be adversely affected.
So instead we end up with pathology training programs that are like some of our deficient public school systems: the difference is the pathology programs graduate residents who can't read slides while the school systems graduate students who can't read books.
It sure would be nice if the ACGME starting pulling accreditation from programs who graduate significant numbers of residents who cannot pass the boards. However I do not think we will see this happen because the ACGME is a joke IMHO. There are still a number of residency programs (particularly in general surgery) where the 80 hour work rules are regularly ignored so why are we not seeing accreditations pulled? My answer is that the ACGME is in hear no evil, see no evil, speak no evil mode.

 

[listeriaismfb]

quote=yaah;7907726] Programs give it open book? That's lame. QUOTE]

I thought this was not allowed.

 

[dockart]

The translocation questions were unbeleivable!! I have not done any heme yet, so that was mostly guesswork. I thought forensics were pretty ok considering i have not done a rotation yet.. I had some issues with the higher magnification AP images but overall they were pretty good.

 

[HbyHA]

Just took the CP portion today. Blarg. I'm sure the AP portion will make me feel even more stupid. and it teases me with lots of forensics questions to make me feel like i actually know something and have a chance of passing my boards someday.

just for kicks i looked back at my old scores. i did one point better my second year than i did my first year. how's that for internal consistency?

 

[deschutes]

My bullet-list impressions from taking RISE as a 4th year:

- Wow there's that same question that I got wrong last year! And that one, and that one...

- The AP images have improved A LOT, especially for cytology.

- I noticed more questions that seemed intended to recapitulate boards questions (what I've heard of them anyway).

- Forensics seems even more overrepresented than in the preceding 3 years.

- I am so going to fail CP.

 

[SLUsagar]

My bullet-list impressions from taking RISE as a 4th year:

- Wow there's that same question that I got wrong last year! And that one, and that one...

- The AP images have improved A LOT, especially for cytology.

- I noticed more questions that seemed intended to recapitulate boards questions (what I've heard of them anyway).

- Forensics seems even more overrepresented than in the preceding 3 years.

- I am so going to fail CP.

i wouldn't sweat it. again, totally different folks making the RISE ?s vs boards ?s.
and at the end of boards i've been told there's a hella long survey asking if the ?s were kosher with what you'd expect to be doing in real life as a pathologists/etc. etc. etc., so i think they're really trying to make it practical. Folks that took it recently told me that any older remembrances are basically worthless b/c the newer exams are less minutia-based and again, attempting to be more practical.

 

[deschutes]

Thanks for the positive interjection. 🙂 But the endless memorization of details - mostly without visual cues - just kills me. Particularly since I don't plan on ever using my CP training (least of all what with recertification being required) apart from lymph node pathology, bugs in tissue sections and some aspects of molecular path.

Just venting my spleen.