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What are your programs doing in place of the inservice?

Discussion in 'Emergency Medicine' started by NinerNiner999, May 7, 2007.

  1. NinerNiner999

    NinerNiner999 Senior Member

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    Ours is giving us a mandatory 30-question exam, made by the department, to take the place of the 220 question test we took three months ago. Is is possible to represent 220 questions in a 30-question format, and make it statistically reasonable to discrimate by examinee? They are going to use these test scores to consider next year's chiefs...
     
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  3. BKN

    BKN Senior Member

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    Yes it's possible, but the questions would need to be already validated. Since made up by department, I doubt that it will be valid.
     
  4. bulgethetwine

    bulgethetwine Banned
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    Is this just because your department wants an index by which to choose the chief? Or has there been another announcement delaying yet again (or cancelling all together) the 2007 inservice results?
     
  5. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD
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    What kind of a program chooses its chiefs based on their inservice score? That's like picking residents using their USMLE score. It has little to do with how well they will do their job, only whether or not they will pass the written boards.
     
  6. GeneralVeers

    GeneralVeers Globus Hystericus
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    Has anyone heard anything about the inservice scores? As far as I know ABEM has been silent recently on this issue.

    Our program went ahead and picked chiefs without the scores. They were desperate for chiefs to help out with the administrative stuff needed for a brand new program.
     
  7. Northeaster

    Northeaster PGY-2 Maine Med

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    I thought we were getting the scores but they are going to be late? Sounds like others think we are not getting them at all.
     
  8. southerndoc

    southerndoc life is good
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    Don't say that. That would suck to have to take another in-training exam!

    BKN, have you heard when the scores will be released? (Since you're the only PD we know on SDN.)
     
  9. EctopicFetus

    EctopicFetus Keeping it funky enough

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    yeah whats going on?
     
  10. NinerNiner999

    NinerNiner999 Senior Member

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    Both...
     
  11. roja

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    I can't imagine using scores to pick chiefs. While the inservice is a moderately important test, all it has been validated towards is its predictive value in passing the written boards. It says nothing about your skills as a clinician, your ability to teach, to be organized, do a scedule, etc etc.


    :)
     
  12. Hercules

    Hercules Son of Zeus

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    Please elaborate. I hadn't heard anything yet about further delays.:thumbdown:
     
  13. rndmguy21

    rndmguy21 Junior Member

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    You cant make this up. Niner, with all due respect there should be WAY more posts questioning the fact that there is a program that uses INSERVICE exams to pick their chiefs???????

    This is SO wrong on so many levels. Think about what it says of the atmosphere of the program. They value a residents performance on a written test so much that they have to MAKE UP their own test, and put the residents through additional stress just so they have an arbitrary number from which to judge them? And thats to say nothing of the fact that your written knowledge base means nothing about your ability to be chief. It just is truly ridiculous. I'm sorry.

    It is exactly this type of undue pressure that probably influenced the improprieties that have been suggested which are stalling the release of the scores.

    Here's a closed circuit to all you fourth years: The inservice should be a marker of your own personal knowledge base and thats it. If you interview at a program who uses the inservice for yearly promotion, picking chiefs, or places any more significance to it other than a benchmark for individual residents. DONT PUT IT ON YOUR MATCH LIST! You dont need the increased stress in your life.
     
  14. NinerNiner999

    NinerNiner999 Senior Member

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    The statement we recieved from ABEM was that they are still witholding scores and they have not yet determined whether they will be released. As for using the scores - these are only one of several criteria used to compile the chief resident "score." The inservice score is not weighed heavily when evaluating candidates for chief - evaluations, resident, and faculty vote play a larger role.

    mdmguy21 - consider that medicine is a field based on performance indicators (as is real practice outside of residency) and that the only numerical performance indicator provided in residency is the inservice score. I agree that programs who use this arbitrary number to allow (or restrict) privledges such as shift choice, moonlighting, etc risk creating an environment of stress, but our program does not do that at all. Our program does not do this, in fact, the inservice is used as a way to individually gauge a residents' liklihood of passing the real board exam. Poor performance at Hopkins does not equate to punitive action, but allows faculty to explore individual resident's study habits and help them improve their test-taking ability. This does not mean remediation or punishment. This does not mean more shifts or less oppurtunity. This is simply a measure of performance, and a chance to improve on weaknesses.

    Several Chiefs now and in the past have "Failed" the inservice exam by our standards, yet they do well throughout residency and the real exam...
     
  15. GeneralVeers

    GeneralVeers Globus Hystericus
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    If ABEM decides to withhold all scores this year, does that mean they will be refunding all of the test-taking fees that programs pay to participate in the exam? I think not.
     
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  17. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Be careful what you wish for (as you are friends with the "suspects"). From what I understand there are PDs out there who are "out for blood" regarding this issue in that they are advocating lifetime bans from taking boards etc. for the individuals involved. They are also demanding transperency (the release of the names of those involved) and fines to refund the costs. Civil suits have been mentioned!

    - H
     
  18. GeneralVeers

    GeneralVeers Globus Hystericus
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    Those who have been implicated are responsible for their own actions, and will suffer the consequences if any. Why ABEM should make everyone suffer for the irresponsible actions of a few is beyond me.
     
  19. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    The concern raised was that these "previous question banks" might have been passed around by the KD residents seeking to ingratiate themselves to new programs.

    It's B.S. as you know, but it seems that the drama has far outpaced the reality!

    - H
     
  20. GeneralVeers

    GeneralVeers Globus Hystericus
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    I will let ABEM try to prove their allegations. There is proof against two of the individuals, but nothing for the rest of the MLK residents. If they initiate action against any of those who were not inolved, there will be a civil suit against ABEM. The fact is that most MLK residents studied hard for that exam. I studied for that exam between November and February 27th, and others spent even longer.
     
  21. Seaglass

    Seaglass Quantum Member

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    Then why take a test again at all? And I guess the third years won't have to take it then . . .

    I'm with rndmguy- we picked our chiefs without scores and there has been no talk of taking another test. I would think twice about a program that feels compelled to test you again instead of waiting for the scores.
     
  22. rndmguy21

    rndmguy21 Junior Member

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    Niner, I wont debate that medicine has become all too consumed with numbers. I would though, debate that I dont think its right. RVU's, waiting room times, time to patient, time to antibiotic and a litany of other numbers have way to much influence on our lives as physicians.

    My point for upcoming fourth years was very simply that residency is pretty stressful. In most cases more stressfrul than medical school (but way more fun) You want to pick a program that creates an environment that fosters your learning without placing undue pressure and one that does not create additional stress.
    To put so much stock in the inservice that would require creating a 30 question extra test because ABEM is withholding scores, in my mind indicates the creation of an OPPOSITE environment and says something about the overall atmosphere of a program. My 2 cents.
     
  23. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Simmer down. I'm with you. I don't agree with the sentiment or the accusations. I'm just putting the comments of other out there without endorsement. Personally, I think they should release the raw scores, without national comparisons (or with last year's numbers for a "roundabout" look). Those who were honest with the test know it, and can use the numbers as a personal progress guide. Those who cheated, in any form, will know it and the experience will be wasted for them...

    But then again I disagree with using the numbers for anything other than personal measurement of progress, and my program does not use them for anything other then that.

    - H
     
  24. GeneralVeers

    GeneralVeers Globus Hystericus
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    Sorry about that, I am interpreting a lot of things as attacks these days which aren't. I just hope that other residency programs don't judge and blacklist MLK residents because of the actions of a few.

    I definitely agree about not using the inservice within programs. It should be a personal marker to gauge one's progress and preparation for the board exams. Any other use betrays the exam's intent.
     
  25. Apexdigital

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    that is absolute garbage. just posting that nonsense, even if you don't believe it: you are creating rumors that will taint completely good, honest, smart, likeable human beings that were simply unfortuante to be residents at mlk in the mist of all this drama. you should be ashamed or yourself.

    i wrote a piece in another king-drew post. i was a resident in the EM program their when the roof fell on us.

    trust me, we weren't pathetically cheating on some stupid inservice exam to have programs look at us positively. i never once heard of fellow residents sharing previous inservice exam and i was never once offered such questions. from what i understand, one idiot in our class after taking the inservice a year or so ago wrote down topics they remembered and shared it with another idiot. that's the bottom line. it wasn't a king drew EM residency thing, it was a two person "really bad judgement thing".

    no one wanted to help king drew residents, particularly l.a. county and california programs because they are a bunch of whimps including harbor-ucla, ucla-oliveview, and usc, uc irvine, ucsd, ucd, stanford etc. etc. our emails to these programs went ignored, like we were the plague. generalveers will tell you it was L.a. county by itself, but in the end, no california program stood up for us and we for damn sure not trying to get their attention by cheating on some dumb test.

    thanks to N.Y. programs and a new program in texas that we were all placed.
     
  26. BKN

    BKN Senior Member

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    All I have recived from ABEM is a letter stating the problem and suggesting that the scores would be about a month late. I have not received communication suggesting that they will not release the scores.
     
  27. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    I have nothing but sympathy for the residents at King-Drew. I believe what happened to all of you was awful and that the profession, as a whole, should be ashamed for the extremely poor and uncoordinated response to the crisis at one of our training sites. But I won't be ashamed for my post.

    There is a disconnect here. The information we have right now (according to you and Veers) is that there are two individuals, whose identities are known to ABEM, who may have violated the rules concerning the ABEM in-service exam. As a result of these two known individuals' actions, literally thousands of inservice exam scores are being held, if not invalidated. I'm sorry, but if there were no credible suspicion that the cheating extended beyond these two individuals, there would be no drama here. I have to believe that a limited, local event (as you suggest occurred) would not have these huge repercussions nationally. Now, if we have these same two individuals actively seeking, if not begging for, new positions at the time of the exam it isn't a stretch to believe the suggestions that this might not be a local concern but instead a national one.

    But as I have no direct knowledge of what went on, I am confused. Either you and Veers are correct and ABEM has flown overboard and is holding up everyone's scores rather than invalidate these two exams (or even all of the MLK scores) or there are valid concerns the cheating was more widespread. I won't apologize for discussing this logic gap. {Either way, it sucks for all of the innocent people involved.}

    - H
     
  28. NinerNiner999

    NinerNiner999 Senior Member

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    No debate needed - I hate quantifying service and acumen with numbers, I never said this was right... or wrong...
     
  29. GeneralVeers

    GeneralVeers Globus Hystericus
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    Why take an additional exam? If a program is confident about their picks as chiefs, do they really need an exam score to confirm their choices? What if one of their chief-elects is a great clinician who loves teaching interns and students, but does poorly on the inservice? Are they going to withdraw the title?

    Much like the USMLE (a pass-fail exam), programs have put too much emphasis on a number, rather than evaluating the competence of the individual.
     
  30. NinerNiner999

    NinerNiner999 Senior Member

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    What if I told you folks that we have a departmental requirement of 80% on the inservice to graduate, and if you didn't score 75% last year, you needed to take the 30 question exam and score 80% to graduate the program? Some of the seniors in my program are dealing with this as well...
     
  31. Seaglass

    Seaglass Quantum Member

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    I would say that's pretty lame . . .
     
  32. GeneralVeers

    GeneralVeers Globus Hystericus
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    I agree.
     
  33. Quimby2

    Quimby2 Member

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    Agreed...Super Lame!

    Interesting note, at King/Drew where the incident occured, the score on the exam was emphasized to a huge extent. The now ex-PD based Cheif resident status solely on the exam score and would often threaten to "remediate" (i.e. not graduate) residents with low scores; he also used the scores to promote the program to potential applicants. This sort of over emphasis on the inservice breeds badness.

    My two cents: With that said, I see no reason not to use the inservice as PART of the criteria for cheif resident postions. Clearly a resident who consistently scores low (say <70-80%) might need to spend a bit more time on the academic portion of his education and should not be weighed down by the extra responsibliites of the chief postion. My other observation: inservice scores do not seem to correlate well with clinical skills.
     
  34. rndmguy21

    rndmguy21 Junior Member

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    I would pray for your program, your PD, the faculty and especially all the residents for whom the program values so little. Then I would demand the resignition of the PD who thinks this is neccessary or even humane. Dramatic enough?

    Niner, I suggest you go back and erase all posts from which you ever mentioned your affiliation! This information could potentially cause your program to never again fill! Disaster.

    In all seriousness, this just doesnt seem to make sense on so many levels. How many programs place this sort of emphasis on the in-service? I'm just beside myself. We should put it to a poll.
     
  35. Quimby2

    Quimby2 Member

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    just to clarify: the PD that stressed the inservice exam was terminated last year for several allegations such as threatening to fire residents for minor issues, etc. (though, many people believe he was forced out by "the powers that be" to decrease resistance to down sizing the hospital).

    Also, there may have still been perceived pressure to perform well on the inservice since these residents knew they would be hung out high and dry while looking for a new residency spot with little to no real assistance. (This in NO WAY justifies cheating though). It is my best guess that those residents who used pooled old exam questions did not understand the severity of the issue.
     
  36. NinerNiner999

    NinerNiner999 Senior Member

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    The ones with 100% pass rate on the real board exams...
     
  37. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Pretty bold statement. Do you really think there is a correlation? I not sure that there is. Given the relatively high first time pass rate on the boards, I'm not sure that any statistical inferences can be drawn.

    Interestingly enough, your program doesn't list their pass rate on the SAEM website...

    - H
     
  38. Apexdigital

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    Dude, just stop. You weren't there. I was there, and there was no "perceived pressure to perform well because we would be hung out high and dry while looking for a new residency". believe it or not, alot of my classmates had good applications out of medical school.

    You're getting it here from the horses mouth. i didn't use previous test question topics, i was never offered such a thing, I don't know of any other resident in the program who did past or present. what i understand is that two isolated residents are under investigation for possibily remembering some of the previous inservice exam test question topics and sharing it between the two of them. that was all a surprise to all of us. if it occured, that was bad judgement on their part. and most likely, they didn't realize what they were doing was wrong.
     
  39. Lola713

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    Back to the question-has anyone heard anything one way or the other recently? I think it is ridiculous to do anything to repeat the initial in-service, and I think it is just hurting the rest of us that prepared for the exam to refuse to give us our scores. I was really hoping to receive my scores and compare them to my previous scores in order to see how I had (hopefully!!) improved and I find it very immature that they are holding back our scores since apparently some residents somehow cheated-which I don't understand in the first place because you are just hurting yourself-regardless the people who cheated know they did so when they get the scores-how can you be pleased with yourself and know that you'll do well on actual boards?
    Anyway just had to rant for a bit...
     
  40. southerndoc

    southerndoc life is good
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    I emailed my PD asking about something I read here (possibly not releasing scores at all) and she said she hasn't heard anything other than scores will be delayed. ABEM is remaining silent on the issue. Hopefully they will release them soon. Like you, I too am anxious to see how well I did.
     
  41. GeneralVeers

    GeneralVeers Globus Hystericus
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    While no one was officially "pressuring" us to perform well on the inservice, logic holds that one wouldn't want to go to a new program and then get a terrible inservice score. It was a difficult situation, as we were without a hospital, were looking for jobs, and were in the process of moving, all while trying to study for inservice. As with all things, some people handle stress better than others. I personally felt that I could get through the inservice on my own merits, and don't think the exam is all that important. Others felt differently. In particular the two people in question studied hard for the exam, and were very serious about doing well. In allegedly using questions they didn't realize what they were doing was wrong. They didn't intend to cheat on the exam. It's easy to retrospectively look back on their actions and view them as wrong. I would wager that many resident programs have unofficial "inservice-type questions" floating around.
     
  42. GeneralVeers

    GeneralVeers Globus Hystericus
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    Any news yet from anyone? We're nearing the 2 month late mark. It seriously shouldn't take 2 months for them to figure this out. It's a simple matter of either releasing the scores, or not.
     
  43. EctopicFetus

    EctopicFetus Keeping it funky enough

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    I think they should be released regardless. I want to know how poorly I did.
     
  44. bulgethetwine

    bulgethetwine Banned
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    Wanna use it as your own measuring stick to see how much you need to do for the real deal? Great! More power to you! But all this melodramatic crap, stressing over it, wrestling with the politics and ethics of the whole damn rigmarole.

    IT'S A MOCK EXAM! PRETEND! Next time one of the gunners asks about the best programs, instead of giving them the FMFP answer, I'm gonna say they should simply ask what program places an undue emphasis on the inservice (either to determine chief, or other privilege) and identify that program as a malignant one with serious morale and leadership problems.

    And the KD people are getting screwed.
     

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