The Pathology Board Exam Impractical

[NuckingFuts]

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One of our quite capable residents who took the AP/CP board a few weeks ago was expressing how frustrated and irritated he was to this day about how he felt the board was in terms of testing everyday "useful" knowledge. He is a boarded surgeon, who says he felt his surgery boards were tough indeed but hardly required the regurgitation of esoteric facts in the manner the AP/CP did. I've heard of an internist-turned-pathologist make a similar complaint and comparison. Of course, we're all wired differently, we come from many diverse academic backgrounds, walks of life, and mindsets- and so we're certainly going to have our own opinions of the board. But it got me thinking- is most of the stuff the board asks practical, and furthermore, is the manner in which the test is executed, right down to the language/syntax employed, fair?

What does it mean to be a board-certified pathologist?

I have seen on my consult service errors ranging from outdated terminology to downright incorrect/missed diagnoses- all from board-certified pathologists (academic and private), and I've seen as-of-yet non-boarded pathologists (fellows and clinical instructors) nailing the majority of their diagnoses (frozen and permanents) yet cannot spit out the translocations associated with soft tissue tumor x or breast cancer y.

 

[yaah]

Funny enough, since I have taken the boards and gotten a real job, there have been many times when I have encountered a real life situation and thought to myself, "That was on the boards, and I thought it was a stupid question at the time."

That being said though, it is a lot of esoteric stuff.

Part of being board certified though is essentially proving that you have the ability and the patience to be able to get through the certification process. That is significant.

 

[hesperion]

I bet 80% of my attendings would fail the exam I took. And it's not because they're stupid or incompetent, it's because they're practical and realistic. The 20% that would pass are the outliers who would probably do well on Jeopardy.

To me being board certified will mean that I paid $2200 and successfully jumped through the ABP hoops.

 

[MirkoCrocop]

I bet 80% of my attendings would fail the exam I took. And it's not because they're stupid or incompetent, it's because they're practical and realistic. The 20% that would pass are the outliers who would probably do well on Jeopardy.

To me being board certified will mean that I paid $2200 and successfully jumped through the ABP hoops.

I would agree with this. It's really a test of how well you play the game, how well do you connect and interact with peers to figure out what to study, how resourceful you are to gain access to special resources, and finally, whether or not you put in the study time.

I might hypothesize that there is probably a correlation between how well you excell at that and how good a "pathologist" you'll be. Someone that excels at that is, perhaps, more likely to express the 3 As of a good pathologist.

Having said that, the ABP's test statistics are likely terribly skewed by many programs' efficient use of special resources.

 

[wild0ne]

Having said that, the ABP's test statistics are likely terribly skewed by many programs' efficient use of special resources.

Curious what you mean by 'special resources'?

 

[LADoc00]

Funny enough, since I have taken the boards and gotten a real job, there have been many times when I have encountered a real life situation and thought to myself, "That was on the boards, and I thought it was a stupid question at the time."

That being said though, it is a lot of esoteric stuff.

Part of being board certified though is essentially proving that you have the ability and the patience to be able to get through the certification process. That is significant.

I had Maslow's Hierachy of Needs on my boards, seriously. I burst out laughing at the time but now constantly refer to it when Im dealing with difficult employees.

 

[mlw03]

Curious what you mean by 'special resources'?

special resources = rememberances

 

[ermonty]

I might hypothesize that there is probably a correlation between how well you excell at that and how good a "pathologist" you'll be. Someone that excels at that is, perhaps, more likely to express the 3 As of a good pathologist.

Affability, Availability, Ability

I would argue that while the final 'A' (ability) might be well represented by ABP certification, the first two 'A's' (affability and availability) are in no way related to one's performance on a test. And as was pointed out in a previous post, 'real-world' daily work flow management and signing out cases is truly a skill set...it is the practice of pathology (not just the knowledge of pathology)...some do it better than others. Just like some people excel and pass the ABP by a wide margin...while others might just get by with a narrow margin (myself included im sure 😀, although we never find out, just pass/fail).

 

[lipomas]

Hmm..., almost sounds like an argument to support the stupid MOC process. Maybe I will have to reconsider my opposition to that.

Personally I think the boards is just a proxy for making sure you can be dedicated and roughly intelligent enough to reason your way through 15 hours of esoteric nonsense. Kind of like the MCAT.

If residency programs actually did a better job at weeding out incompetent pathologists there probably wouldn't be a reason for the board exam.

 

[KCShaw]

This applies to essentially all certifications which rely on a standardized exam. It's an obstacle to be overcome, which shows that you can overcome obstacles, and that's about it. The same goes for MOC, which is much more an encouragement to maintain the puerile instincts of academic survival over learning how to do a good job, live long, and prosper than it is a way to ensure high standards of practice as we age. But frankly there don't appear to be any good alternatives that the politicos think are cool and keep the governing bodies relevant. Easier to climb the obstacle than fight a cultish belief system.

 

[sohsie]

Hmm..., almost sounds like an argument to support the stupid MOC process. Maybe I will have to reconsider my opposition to that.

Personally I think the boards is just a proxy for making sure you can be dedicated and roughly intelligent enough to reason your way through 15 hours of esoteric nonsense. Kind of like the MCAT.

If residency programs actually did a better job at weeding out incompetent pathologists there probably wouldn't be a reason for the board exam.

Actually I thought the MCAT (which I took in 1996, I think) was a very reasonable exam. While you had to remember a lot of facts for the biology part, the reading comprehension was just that and the physics part was essentially a problem solving/reading comprehension test, namely the test taker had to figure out the simple physics/chemistry question disguised/hidden within the passage.

AP/CP and dermapth boards, however, was a lot of esoterica that you either knew or you didnt. Thank God for the quick compendium of clinical pathology, I don't know what I would have done without it. (well, I could have read henry, but I generally dont like learning in the most inefficient way possible nor hitting my head against a wall).

 

[lipomas]

Yeah MCAT was reasonable but still, getting one verbal question wrong brought your score down to an 11 (which happened to me). And it was still a lot of stuff that was esoteric, it's just that after preparing for it for months it started to seem less esoteric.

Every question on the boards was NOT esoteric to the expert who wrote it. I remember thinking that when I was taking it. I got some horrible micro question to identify a bug and ALL FIVE CHOICES were things I had never even heard of. If that isn't esoteric I don't know what is. But then the week after I was on my micro rotation and some bug I had never heard of turned up and did something apparently classic which everyone needed to learn about so we wouldn't miss it. Some heme question I was like, "why would I ever have to know this?" and then when I looked it up later I found out why. I know what you mean though.

I think you can call it esoteric but what it really is is just an insane amount of information on too many different topics.

 

[KCShaw]

There's a difference between an exam being comparable to what you learn in class, and an exam being proof of ability to do well in a real world setting. Unless that real world setting is sitting more similar exams in similar restrictive controlled environments, the correlation is always going to have tenuous threads.