Why do Radonc need to have oral exams anymore?

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Seems like most specialties are moving away from oral exams. Any one think we still need an oral exam?

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It makes no difference what we think. If the ABR thinks we do then we do. $$$
 
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It's even more ridiculous this year considering the exam-takers will have been treating patients in the real world for nearly 2 full years by the time we even get to take the exam.
 
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Seems like most specialties are moving away from oral exams. Any one think we still need an oral exam?

No. I think they're a relic from a different era, and a thin disguise of making sure someone is "fit for the Good Ole Boys Club".

The specialty would benefit from combining all three written exams into one (75% clinical, 25% fundamentally important radbio+physics concepts) and eliminating the oral. If you can complete an accredited residency and pass a written board exam - you know, the metric for the vast majority of medical specialties in the United States - that should be enough.

People keep talking about how we're similar to surgery and that's why we need the oral - I strongly disagree. I actually do think the oral is important with surgery because it's an "in the moment" sort of thing. A slip of the hand, a single fundamentally incorrect point of judgement - someone is dead. This is in stark contrast to Radiation Oncology, where you can just keep editing and revising volumes until you're happy. Not sure about margins or structures? Pull up a resource - you've got time! DVH looks bad? Adjust your CTV a few times, see what you can do.

A Radiation Oncologist is never making a life and death decision in the moment.

(that being said, I'm very pessimistic that the oral will go away. I would very much be in favor of switching the format to an "open-book" sort of thing where you're asked to contour cases and evaluate plans...which seems a more relevant assessment of our skills vs memorizing scripts)
 
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If RadOnc/ABR was as woke as they think they are or want to be, they would eliminate the oral exam as their examiners cannot be rid of their subconscious and implicit biases to accurately and fairly score examinees.
 
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Undeniably sexist and racist origins. Graduated residency and trying to join ASTRO? I remember even just recently TWO people have to “sponsor” you or you cannot join your own professional specialty org. TOTAL NONSENSE. Good ole boys club golden handshake country club culture all around in this field. It is disgusting. This is why nobody wants to be in this field. It is elitist and just backwards. A corrupt vituperative guy runs our boards and threatened lactating women.
 
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I think it's borderline hazing but it probably made me a better doc, certainly more so than radbio or physics written exams ever did.

Should be one written, one oral and that's it. Going forward it should be zoom/virtual, no more dreaded trips to Louisville/Tuscon
 
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I was told by my internists professors that the ABIM (Int Med) got rid of their oral exam in the 1970s or 1980s (can't remember exact year)
bc FMGs complained about bias (old boys club). In other words,many FMGs passed written but failed oral, so either bias or racism was
a factor. So the ABIM got rid of the oral exam.

Re Oral: I don't buy the concept life or death (surgery). Radonc is life or death too, one wrong decision, one wrong tumor volume, the pt is doomed, looking up contour guidelines does NOT warranty perfection as you guys/girls know. It is the skill set + the art of practice of medicine that matters. I think surg can safely get rid of oral.

Who is the best to judge a candidate, whether it is radonc or gensurg? It is the faculty at training program and the PD. When a resident is no good, the program knows. I have dismissed radonc residents before: we sat down and discuss his/her performance, and gave some remedial time to correct deficiencies, and after some time has passed, if not up to par...we dismiss them; rare but necessary.

Food for thought re exam in general...For years, some psychologists say final exam is not needed. Let's say you take Calculus I course, you have done test #1, test #2 (mid-term) and test #3 and do very well. What is the point of the final exam, to create stress? In other words, if you take the ABR in-service exam yearly and do well, you should be board-certified lol...

PS: Your compassion, empathy, professionalism (all the good stuff necessary to practice medicine) is NOT tested in any exam. Only the training program knows you and your behavior (whether it is good or bad)...
 
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If oral boards were realistic, you would have a few cases per disease site to plan over 48 hours and are allowed to use any resource you wish. Then your contours would be scrutinized by experts -like a pretreatment review on a cooperative group protocol. Then perhaps you answer some questions, explaining your volumes and evaluate A few plans. If you can produce and explain reasonable contours and identify bad plans, who cares who you had to ask or how you get there?
 
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I actually think the oral was a good exam. My experience was it was not about scripts at all but often meant you had to think through real world situations using your knowledge of the literature, planning and disease processes. It felt to me more of testing how you apply your knowledge to cases rather than picking one of four choices.
 
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I actually think the oral was a good exam. My experience was it was not about scripts at all but often meant you had to think through real world situations using your knowledge of the literature, planning and disease processes. It felt to me more of testing how you apply your knowledge to cases rather than picking one of four choices.

Take out peds and the obscenely disproportionate amount of time I spent memorizing risks groups and other crap that I promptly dumped out the brain hatch and I mostly agree.
 
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I think most of medical specialties can remove the oral exam.

There is one profession I think "oral exam" is very important: it is aviation.
All pilots have to go through schooling like we do.
Then before they are allowed to fly, they have to do "check ride". Basically an instructor sits on the right side,
and the candidate sits on the left: everything you do as a pilot is scrutinized: from instrument rating to engine thrust to flap settings.
They even practice one engine out if appropriate.
This weeds out the bad pilots.


However, some loopholes allow bad pilots to fly amazon cargo package Boeing 767 that crashed a few years ago. Life is such...

 
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I was told by my internists professors that the ABIM (Int Med) got rid of their oral exam in the 1970s or 1980s (can't remember exact year)
bc FMGs complained about bias (old boys club). In other words,many FMGs passed written but failed oral, so either bias or racism was
a factor. So the ABIM got rid of the oral exam.

Re Oral: I don't buy the concept life or death (surgery). Radonc is life or death too, one wrong decision, one wrong tumor volume, the pt is doomed, looking up contour guidelines does NOT warranty perfection as you guys/girls know. It is the skill set + the art of practice of medicine that matters. I think surg can safely get rid of oral.

Who is the best to judge a candidate, whether it is radonc or gensurg? It is the faculty at training program and the PD. When a resident is no good, the program knows. I have dismissed radonc residents before: we sat down and discuss his/her performance, and gave some remedial time to correct deficiencies, and after some time has passed, if not up to par...we dismiss them; rare but necessary.

Food for thought re exam in general...For years, some psychologists say final exam is not needed. Let's say you take Calculus I course, you have done test #1, test #2 (mid-term) and test #3 and do very well. What is the point of the final exam, to create stress? In other words, if you take the ABR in-service exam yearly and do well, you should be board-certified lol...

PS: Your compassion, empathy, professionalism (all the good stuff necessary to practice medicine) is NOT tested in any exam. Only the training program knows you and your behavior (whether it is good or bad)...
The in-service is created by ACR and has never been validated. Historically it is a horrible exam. I have tried for two decades to get the ACR and ABR to look whether scores are in any way correlated but of course neither is interested as it may lay bare how bad the exam(s) are.
 
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Let’s not forget that the exam takes on more significance as the field becomes less competitive.
 
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as their examiners cannot be rid of their subconscious and implicit biases to accurately and fairly score examinees.

I honestly think you are confusing the process of scoring the oral and written exams. The written exams are essentially determined behind closed doors by a small number of people who never have to look you in the eye and can pull crap like they did two years ago. The vast majority of the oral examiners are very motivated to deliver a fair exam with the intention of helping you pass. They also have to publicly defend why they want to fail someone and can be overridden by the other examiners if their assessment is too disparate from the others.

I know when I took my oral exams a few years ago, I straight up told my peds examiner I knew the path slide they wanted me to assess was one of two common brain tumors but that I would have to consult with a pathologist to be sure. They told me to commit to a diagnosis, I got it wrong, they laughed and said, well, at least you would never have to interpret this on your own and you are comfortable asking for help. Oral exams give far more opportunity to assess how you actually think than minutia-centric written exams. I also told them I'd manage a type C medulo like a high risk patient because I (wrongly) thought they were doing that on the open protocol at the time. I was given the opportunity to explain my thinking and fix the error. I'd sign up to take the oral exam over the written exams any day of the week. Easy to say on this end of them but the above comments suggest I am far from the only one.
 
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I favor one oral exam (without Peds—-Peds should be fellowship based) and one written with physics and radbio incorporated. I found studying for orals to be helpful and found the test to be the most fair of the 3 board exams I took. The separate physics and radbio was not necessary. Could easily be (and should be) incorporated into written clinical exam.
 
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The orals are the most relevant and useful exam I’ve taken throughout all of medical training. Also the most stressful, and no reason they cannot be virtual.

it also helps no party (patients or rad oncs) to make entrance into this field any easier or less rigorous.
 
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The oral exam was also the most useful examination in my experience. Mostly, it was the preparation involved, which definitely improved my abilities in tumor board and the clinic. I did not enjoy preparing and I certainly did not enjoy the exam. I do agree that there is an element of luck involved, unfortunately, which should be addressed (how?). I feel that medical oncology would actually benefit from an oral board, based on what I see at tumor board. The bar appears to be quite low and I feel that medonc is often quick to deviate from the standard of care (workup, regimen, dose, surveillance, etc.) due to a lack of discipline and respect for the data.
 
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What is the point of an oral exam if it lets people who fail 3 to 5 times in a row still be practicing doctors? What does it mean anyway when you allow that many failures and stilll board certify the person? It means nothing. I know people who failed that many times and I would not choose to have them as my radiation oncologist. Not everyone who fails this many times is bad...but you know statistically.
 
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What is the point of an oral exam if it lets people who fail 3 to 5 times in a row still be practicing doctors? What does it mean anyway when you allow that many failures and stilll board certify the person? It means nothing. I know people who failed that many times and I would not choose to have them as my radiation oncologist. Not everyone who fails this many times is bad...but you know statistically.
Better than having an exam where most people pass the first time since it isn't as effective as picking out the good from the questionable residents?
 
If you fail the boards repeatedly than its a red flag and the world should know that you kept failing and failing...I really don’t see the point of an exam that let’s someone be be certified after so many failures. It’s no different from an exam that lets everyone pass the first time because in any one graduating class eventually everyone except for one person will pass anyway. In which case just shut down the exam altogether.
 
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Although I agree that the preparation for the exam is the most important- but my point still is if you were unable to prepare 3-5 times- then it brings into question how you are able to go through a practice (in particular a busy practice) day after day after day. These are the people that get protected by family or friends (if they have them in the field) and these are the practices the unrelated will be miserable to join.
 
Rather than getting rid of the boards I believe that you should be given fewer chances to pass. 3 times and you’re out in my opinion. It weeds out the questionable attendings, gives more gravity to the most useful exam. I just think the oral boards’s usefulness is weakened by allowing someone to take it so many times. If we want we can say you have up to 6 years to take it 3 times- so this allows people with extenuating life circumstances to say hey I’m not prepared to take it this year. I’ll try next year....
 
Some of the points mentioned are addressed North of the border

-In Canada they do all their exams at the end of residency. Including the oral exam (except this year since oral is cancelled). If you don't pass you can't get a full license and therefore can't practice independently. The full license in all provinces is tied to passing the LMCC exams (Canadian USMLE counterpart) and having a Royal college certificate.

-You get 3 shots at the Royal college exam. Once that's over you're out. Unless you can find a different program to take you and remediate you then you'll never be certified. I know two people who are effectively unable to work as radiation oncologists because of this (crappy job market in Canada notwithstanding).

- someone with a CV that includes a discrepancy between the year they finished residency and gotten their Royal college certificate is unlikely to get a job in a desirable locale even if they graduated from a premiere Canadian cancer center.
 
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Some of the points mentioned are addressed North of the border

-In Canada they do all their exams at the end of residency. Including the oral exam (except this year since oral is cancelled). If you don't pass you can't get a full license and therefore can't practice independently. The full license in all provinces is tied to passing the LMCC exams (Canadian USMLE counterpart) and having a Royal college certificate.

-You get 3 shots at the Royal college exam. Once that's over you're out. Unless you can find a different program to take you and remediate you then you'll never be certified. I know two people who are effectively unable to work as radiation oncologists because of this (crappy job market in Canada notwithstanding).

- someone with a CV that includes a discrepancy between the year they finished residency and gotten their Royal college certificate is unlikely to get a job in a desirable locale even if they graduated from a premiere Canadian cancer center.
I wholly and fully believe we should have a similar system. Our system allows too many incompetent doctors to be out in practice. It indirectly supports nepotism. And it would also help just a tiny bit with the job market. Why should there be competent newer doctors out there without a job when someone who graduated several years ago should not be practicing independently to begin with. And you know what? Patients don’t know the system. They don’t know to ask 1.) when did you graduate residency 2.) when did you get board certified and to calculate the discrepancy. I fully believe that people who fail the most important and applicable section of our boards 3 times in a row should be out of the game - which is a game of people’s lives.
 
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I also don’t believe in grandfathering older physicians. This is a technology heavy field and absolutely no physician who can’t contour, doesn’t understand IMRT or margins, or doesn’t understand volume based treatment should be allowed to work. We make old people retake driver’s exams to keep their licenses- the same should be for these physicians. It is not age-ist- it’s basic safety and competency. Once you require this- lots of physicians would retire on their own because they know they would fail the exam. And suddenly you have 5 years worth of jobs opening up. I just cannot understand how in modern US medicine we are so okay with a 65-70 year old who can’t contour, never bothered to learn properly- maybe relies on dosimetry or residents to do it - practicing cancer medicine. It’s heartbreaking for the patients, embarrassing at best for the field, and these physicians obviously have ample money saved and if they haven’t ample money saved that’s on them. A vulnerable patient shouldn’t suffer because an older man can’t drive IMRT. This includes all those older academic doctors who have their residents do all the contouring and never look at the contouring.
 
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I'll just add that I felt the oral board exam was by far the most relevant exam I've ever taken. Eliminating Peds and replacing it entirely with CNS makes sense. There is something about consolidating the knowledge from training (and learning different ways to practice from study groups etc) that is invaluable once you are in practice and seeing patients. If you cannot pass the oral board exam in 3 tries, I agree that is a red flag and I do worry about consequences for patients seeing those doctors (realizing obviously no one is perfect). My (limited) understanding of the oral boards has become much more democratic in recent years and less arbitrary and is truly just a final test of "do you get it or not."
 
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Agree with some of the takes above - I think it made me a better rad onc. Especially studying with people trained at different places.

Im no ABR fan but I also think the OLA is a step in the right direction too.
 
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I agree with all the points about the orals being the most useful exam, as I'm sure they are. It always seemed like they would be. It sure helps that two (maybe even two and a half) of the other exams are completely worthless. I shouldn't need the spectre of some future test to stay up to date for my patients.

However, it doesn't take away from the fact that my Class of 2019 has been needlessly jerked around by the ABR for now going on nearly three years by the time this is hopefully over. We are ready for them stop lording over us. We want to go forward with our personal/professional lives and treat our patients, which we have been doing for nearly two years by the time we are assessed. It's easier to say these things when this test is in your rearview mirror; that's just how we all operate. Yes, this is whining, it's the RadOnc way right? You just don't understand unless you're involved and I'm sure now the Class of 2020 can relate.
 
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I also would add that when I did the Osler PreTest course I was little worried about some of the answers coming out of people’s mouths who couldn’t think on their feet. When I finished I was thinking 20% of these people shouldn’t be on their own in practice in the middle of no where and without peer review. No reason it can not be virtual.

Can we really think about eliminating the exam when the majority of us are complaining about the opening of new programs with disinterested faculty, cultivating cheap labor, and a decline in the talent of the application pool. The oral exam should continue and have an increasing failure rate.


It also needs to be repeated at 10-15 year intervals to maintain the integrity of the specialty. One of my 65 year old partners continues to treat at 1.8 Gy per fraction for all head and necks for no reason despite weekly peer review. Maybe this would incentivize retirement for those that probably better off not working anyways. We need to be promoting more oral exams not less.
 
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FWIW I think in Australia they don't do oral exams. And they produce very good rad oncs. I think their final exam is something called "vivas" where it's essentially 4 or 5 essay questions and you're expected to write a half page or so each question. Like, "How is prostate cancer graded and what is the significance" and "go through the treatment options for Stage III NSCLC" and "what risks do you consent a post-lumpectomy XRT patient for." So like a "written oral."
 
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For those who want to know more about training exams down under see attached. They really are a best practice
 

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  • Description and Passing Standards RO Phase 2 Exam - July 2019.pdf
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People must remember a few things

1) many specialties do not have them anymore. Even radiology got rid of them.

2) some modern countries do not have them

all of these specialties/countries put out competent physicians. We have to stop getting off on nonsense and complexity, overtesting nobody cares about or gives us respect for it. We are screwing ourselves. It does not matter to me if it is a “good exam” or not. Perhaps the radiology exam is the most relevant. Im sure same arguments were made, “we have to make sure they can read an MRI pelvis!!!” Blah blah. Guess what? The reasonable heads prevailed. It is time they do in our field.
 
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To clarify, I am in complete agreement the other exams were complete wastes of time, effort, stress, and money. What I was attempting to communicate is the oral exam is the one exam (in my experience, n=1, not powered for significance) that did not "get off on nonsense and complexity." Additionally, the inability of the ABR to not be able to offer a virtual exam is laughable. However with the increase of programs, having an ability to check some of these docs isn't in itself a bad thing. To reiterate 99% of all graduating RO's are capable and should be board certified, I am just of the opinion it will be easier to find the 1% (or smaller number or whatever) with an oral exam. The reason many specialities got rid of them is a bias issue but also a logistics issue (i.e. all IM folks taking an oral board each year). I would love to believe that if you graduate from a residency then that should imply you are good to go, but I think we have all seen that <1% that was not. However if this opinion is in the minority of RO's then of course I would be on board with eliminating it.

All that being said though clearly the class of 2019 should be exempt or have some other options available to them given the true lack of respect that the ABR has showed to them during this process. The process is stressful enough when you can at least be sure of the date you will take the thing!

I guess I think we should be able to walk and chew gum at the same time in this 2020 debacle.
 
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People must remember a few things

1) many specialties do not have them anymore. Even radiology got rid of them.

2) some modern countries do not have them

all of these specialties/countries put out competent physicians. We have to stop getting off on nonsense and complexity, overtesting nobody cares about or gives us respect for it. We are screwing ourselves. It does not matter to me if it is a “good exam” or not. Perhaps the radiology exam is the most relevant. Im sure same arguments were made, “we have to make sure they can read an MRI pelvis!!!” Blah blah. Guess what? The reasonable heads prevailed. It is time they do in our field.
3). Too many garbage programs have opened in the last few years and the quality of residents getting in now and going forward will make the oral exam even more important
 
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This is a great discussion.

For anyone who listens to podcasts, Malcolm Gladwell has one called "Revisionist History". Last year he did a two-episode series on a similar topic, basically, how testing is done in the United States using the LSAT as an example. He's Canadian, and in Canada, they don't seem to do a lot of the "timed standardized multiple choice" testing.

The thesis of the episode is that people who do well on the LSAT (and get into the best law schools) are proficient in a certain type of thinking/test taking (can quickly process a question and move on), whereas the ultimate job of certain types of lawyers (Supreme Court clerk) require the opposite type of thinking (slower thinkers who take time to understand a question/problem in depth).

American medicine seems to do the same, with the MCAT/USMLE. In our specialty, we have taken this to an extreme, with 4 garbage in-service exams and 3 timed multiple choice ABR exams which test obscure, non-clinical topics (shoutout to the MRN complex and delta rays, I should brush up on penile brachy). These types of test don't actually reflect the practice of medicine, where you would normally have access to resources and colleagues and are expected to synthesize information to arrive at a correct answer out of all possible answers - not select one of 4 possible answers, one of which is "correct".

The point a lot of people are making (which I agree with) is that the oral exam is much closer to real life. I completely agree with @scarbrtj and @Chartreuse Wombat who brought up Australian/New Zealand training. Since I discovered some of their training resources on the internet when I was a PGY2, I have been convinced their style of training best reflects real-world practice.

I am still concerned about bias in the oral exam, especially given some of the characters I personally know running the show in RadOnc. Maybe the answer is a blinded written exam instead? Free-form essay questions without names attached which require you to think and perform like a doctor and people scoring the exam will have no idea who you are.

These are all pipe dreams of course - the ABR will never alter the structure of exams (at least not while the current generation has power).
 
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At least 30% of current rad onc programs could be classified as garbage programs. Just making your way through one of this programs and passing what is usually a not very hard written exam should not be considered sufficient for BC. In the place I graduated from 3 of the 4 clinic faculty were older and had no idea about how generate volumes for IMRT. All these attendings always have 100% resident coverage. Can't just get rid of the only relvavnt certifying exam in the face of how many bad programs there are, especially in the era of declining resident quality. Maybe if the RRC could actually do something more then just look at check boxes when evaluating and re-certificating programs this wouldn't necessarily be the case.
 
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There are many trash no good programs. I would put that number above 30 pct. Perhaps even 50 pct. Different criteria but basically a combination of terrible resident experience filled with scut and little faculty involvement, zero teaching, zero help getting jobs, high faculty turn over and chaos, doesn’t matter to me if people pass boards or not (thats a low ball criteria IMO, a bare minimum). In these oversupply times, i would close down most places that rely on residents significantly, where the service componenent vastly outsizes education component, clearly predatory places. There are many of these places out there and some are very established old programs. Difficult issue to tackle but must be addressed. I doubt the ACGME is agnostic to the issue. PW himself admitted he became aware how many bad programs were out there through his involvement in ACGME.

Anybody applying should talk to as many people as possible, ask the hard questions, which programs to avoid. This is known. Otherwise, you will end up in a bottomless pit of hell, even if you pass boards, you will hate your experience and dread coming to work daily. I have always offered on here and surely many will do it as well, PM me if you want to know about something and i will try to help you.
 
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Anybody applying should talk to as many people as possible, ask the hard questions, which programs to avoid. This is known. Otherwise, you will end up in a bottomless pit of hell, even if you pass boards, you will hate your experience and dread coming to work daily. I have always offered on here and surely many will do it as well, PM me if you want to know about something and i will try to help you.

Likewise, always happy to talk with students privately.

The information asymmetry is just so absurd. Sometimes I feel like medical students think we're making this stuff up.
 
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I graduated from a mediocre program that chose to treat disease sites based on how they just wanted to...not evidence based. Had I used their contouring system for certain sites I would have failed oral boards, and I would have also mistreated my patients. I did find studying for the oral boards to be the essential aspect of the oral boards. The less aware senior residents would say "oh yeah the way such and such attending treats is perfectly fine" - mostly because they didn't have the awareness that their attending could be super wrong...hopefully these people figured out soon after leaving the residency program.

Just like someone said- while studying, you have time to think about a scenario, go over it slowly rather than rush to a decision, and you have your oral boards study group to discuss it with. Few people would study comprehensively in this way if they didn't have the fear of oral boards- which sure the format is not the best, but the whole point is the studying point, and if you have studied you can answer most of the questions just fine. Fine enough to pass. Again- if you have studied this way 3 times in a row and you fail 3 times in a row- then you are sitting at work everyday, thinking slowly over cases, and probably still coming to the wrong decisions that your dad/mom/best friend is discreetly correcting or you treat wrong and nobody at chart rounds bothers correcting you because hey, it's not under their name! And you can't get into an argument with your colleague can you? You have to stroke their precious egos because if you don't likely there will be retaliation of some kind against you.

So with all the garbage programs out there, the garbage attendings, the lack of interest in teaching, we shouldn't get rid of oral boards. But my goodness, stop giving people six chances- that's stupid.
 
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I graduated from a mediocre program that chose to treat disease sites based on how they just wanted to...not evidence based. Had I used their contouring system for certain sites I would have failed oral boards, and I would have also mistreated my patients. I did find studying for the oral boards to be the essential aspect of the oral boards. The less aware senior residents would say "oh yeah the way such and such attending treats is perfectly fine" - mostly because they didn't have the awareness that their attending could be super wrong...hopefully these people figured out soon after leaving the residency program.

Haha my favorite experience is the looks I get from the junior residents when we start to have these conversations about why certain attendings are doing something a certain way when absolutely ZERO resources describe their method, and it dawns on them that not everyone is practicing evidence-based medicine...
 
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Anonymous post sent to me:

I wanted to share my experience with the oral board examination this past week. I did this post anonymously out of obvious fear of penalty in some way, but I welcome DMs through the moderators.

While the platform and format of the exam were fantastic and I greatly appreciate the ability to take the exam remotely, I was left feeling completely dejected and worthless.

Going in I felt good about my experience and preparation, only to be thrown into oddball scenarios and pinned with questions - without as much as a few moments to think of my response. I had to go onto the mednet afterward to find good answers to some of the cases that were presented. These were not the "last few fun cases" as most people tell you they are going to be, these were many times the first case presented.

After the exam, I had a complete meltdown and panic attack with the recurring thought of having to prepare and take this exam again. The rest of the night was spent fending off some really dark thoughts about my future. Fortunately, I have the best family and support team to get me through it (family I can't be with since I couldn't secure a job to be closer to them, but that's a whole separate issue).

Much of this are my own psychosocial issues and, while I am getting the help I need, I can't help but think that this is not how it should be.

I simply cannot see how that was a test of competence. It's an asinine archaic practice whose only reason for existence is that it has just existed for years. Prove me wrong.

The main reason for me sharing this it let people contemplating this field know about my experience. It has not been pleasant. Ask yourself if you want to be spending your 30s (or beyond) going through a gauntlet of exams and coming out the other end feeling like a piece of **** in some bubble**** place you didn't even know existed until you applied for the job.
 
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Anonymous post sent to me:

I wanted to share my experience with the oral board examination this past week. I did this post anonymously out of obvious fear of penalty in some way, but I welcome DMs through the moderators.

While the platform and format of the exam were fantastic and I greatly appreciate the ability to take the exam remotely, I was left feeling completely dejected and worthless.

Going in I felt good about my experience and preparation, only to be thrown into oddball scenarios and pinned with questions - without as much as a few moments to think of my response. I had to go onto the mednet afterward to find good answers to some of the cases that were presented. These were not the "last few fun cases" as most people tell you they are going to be, these were many times the first case presented.

After the exam, I had a complete meltdown and panic attack with the recurring thought of having to prepare and take this exam again. The rest of the night was spent fending off some really dark thoughts about my future. Fortunately, I have the best family and support team to get me through it (family I can't be with since I couldn't secure a job to be closer to them, but that's a whole separate issue).

Much of this are my own psychosocial issues and, while I am getting the help I need, I can't help but think that this is not how it should be.

I simply cannot see how that was a test of competence. It's an asinine archaic practice whose only reason for existence is that it has just existed for years. Prove me wrong.

The main reason for me sharing this it let people contemplating this field know about my experience. It has not been pleasant. Ask yourself if you want to be spending your 30s (or beyond) going through a gauntlet of exams and coming out the other end feeling like a piece of **** in some bubble**** place you didn't even know existed until you applied for the job.

Oral boards arent real life. I thought it was more like trauma surgery with split seconds decision making than actual oncology management. Treatment decisions are never made based on 1 liners. However, this is what we get on the test.

If you are getting weird cases, you most likely passed. I just find it frustrating that we are told "common" cases are tested; however, there are zebra given all time. I guess they want to see how you buckle under stress, which is silly as a rad onc.

Oral boards this year are even more stressful since there was a two year gap. People had to study twice and your general knowledge does decrease over time, especially if you treat one or two treatment sites.

It is hard to do this, but just take a break from thinking about it. Spend time with your family and have some fun. There is nothing to do to change the outcome. Deal with it when it happens.
 
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Anonymous post sent to me:

I wanted to share my experience with the oral board examination this past week. I did this post anonymously out of obvious fear of penalty in some way, but I welcome DMs through the moderators.

While the platform and format of the exam were fantastic and I greatly appreciate the ability to take the exam remotely, I was left feeling completely dejected and worthless.

Going in I felt good about my experience and preparation, only to be thrown into oddball scenarios and pinned with questions - without as much as a few moments to think of my response. I had to go onto the mednet afterward to find good answers to some of the cases that were presented. These were not the "last few fun cases" as most people tell you they are going to be, these were many times the first case presented.

After the exam, I had a complete meltdown and panic attack with the recurring thought of having to prepare and take this exam again. The rest of the night was spent fending off some really dark thoughts about my future. Fortunately, I have the best family and support team to get me through it (family I can't be with since I couldn't secure a job to be closer to them, but that's a whole separate issue).

Much of this are my own psychosocial issues and, while I am getting the help I need, I can't help but think that this is not how it should be.

I simply cannot see how that was a test of competence. It's an asinine archaic practice whose only reason for existence is that it has just existed for years. Prove me wrong.

The main reason for me sharing this it let people contemplating this field know about my experience. It has not been pleasant. Ask yourself if you want to be spending your 30s (or beyond) going through a gauntlet of exams and coming out the other end feeling like a piece of **** in some bubble**** place you didn't even know existed until you applied for the job.
As if med students needed another reason not to pursue this field
 
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The main reason for me sharing this it let people contemplating this field know about my experience. It has not been pleasant. Ask yourself if you want to be spending your 30s (or beyond) going through a gauntlet of exams and coming out the other end feeling like a piece of **** in some bubble**** place you didn't even know existed until you applied for the job.
Rad Onc: You're Not Gonna Like Friday

A young guy goes to prison, feeling totally dejected and alone. He gets there, an older guy sees him and senses he's feeling completely nervous and depressed about the whole prison thing. "Hey young man! Don't worry, prison is not so bad. It can be good even!"
"Really?"
"Oh yeah. You like Italian food?"
"I love Italian."
"Lemme tell ya, on Monday nights we have pizza and spaghetti and eggplant parmigiana. Best food you ever ate."
"That sounds great!"
"Yeah?! And do you like baseball?"
"I love baseball!"
"Well on Tuesdays we have baseball night, we get out in the yard, pitch, catch, everybody has a great time. And do you like movies?"
"I love movies!"
"Listen to this: on Wednesdays we have movie night and popcorn! And how about cards and playing poker. You like to play poker?"
"Yep."
"All the fellas, we have poker night on Thursdays. It's a blast. Big fun."
"Gee. This actually doesn't sound bad. Maybe I'm going to like it here."
"Yeah. Don't worry 'bout it. They say prison is terrible and it's not."
"Seems so. Guess I was worried over nothing."
"And, hey, are you a homosexual?"
"No."
"Ehh... welllll... uh, you're not gonna like Friday."
 
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Anonymous post sent to me:

I wanted to share my experience with the oral board examination this past week. I did this post anonymously out of obvious fear of penalty in some way, but I welcome DMs through the moderators.

While the platform and format of the exam were fantastic and I greatly appreciate the ability to take the exam remotely, I was left feeling completely dejected and worthless.

Going in I felt good about my experience and preparation, only to be thrown into oddball scenarios and pinned with questions - without as much as a few moments to think of my response. I had to go onto the mednet afterward to find good answers to some of the cases that were presented. These were not the "last few fun cases" as most people tell you they are going to be, these were many times the first case presented.

After the exam, I had a complete meltdown and panic attack with the recurring thought of having to prepare and take this exam again. The rest of the night was spent fending off some really dark thoughts about my future. Fortunately, I have the best family and support team to get me through it (family I can't be with since I couldn't secure a job to be closer to them, but that's a whole separate issue).

Much of this are my own psychosocial issues and, while I am getting the help I need, I can't help but think that this is not how it should be.

I simply cannot see how that was a test of competence. It's an asinine archaic practice whose only reason for existence is that it has just existed for years. Prove me wrong.

The main reason for me sharing this it let people contemplating this field know about my experience. It has not been pleasant. Ask yourself if you want to be spending your 30s (or beyond) going through a gauntlet of exams and coming out the other end feeling like a piece of **** in some bubble**** place you didn't even know existed until you applied for the job.
Clearly, I don't know whether or not you have passed... but I will say that my year (2019), I was convinced I failed, and so were all of my friends. There was only one person with whom I spoke who felt that they had passed... but almost everyone ended up doing just fine. Part of the (awful) process of taking oral boards is studding your *** off only to feel like it was all in vain. Even if you have odd-ball cases early in the series (which I did), I get the sense that they aren't going for the minutia but are more trying to see that you have sound reasoning. A lot of the questions they ask you are not things they care about you knowing -just things to throw you off.

I would also imagine that the timing of board certification is not going to be heavily scrutinized around the pandemic... as there are so many variables at play. Long story short... hang in there -all is not lost.
 
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Rad Onc: You're Not Gonna Like Friday

A young guy goes to prison, feeling totally dejected and alone. He gets there, an older guy sees him and senses he's feeling completely nervous and depressed about the whole prison thing. "Hey young man! Don't worry, prison is not so bad. It can be good even!"
"Really?"
"Oh yeah. You like Italian food?"
"I love Italian."
"Lemme tell ya, on Monday nights we have pizza and spaghetti and eggplant parmigiana. Best food you ever ate."
"That sounds great!"
"Yeah?! And do you like baseball?"
"I love baseball!"
"Well on Tuesdays we have baseball night, we get out in the yard, pitch, catch, everybody has a great time. And do you like movies?"
"I love movies!"
"Listen to this: on Wednesdays we have movie night and popcorn! And how about cards and playing poker. You like to play poker?"
"Yep."
"All the fellas, we have poker night on Thursdays. It's a blast. Big fun."
"Gee. This actually doesn't sound bad. Maybe I'm going to like it here."
"Yeah. Don't worry 'bout it. They say prison is terrible and it's not."
"Seems so. Guess I was worried over nothing."
"And, hey, are you a homosexual?"
"No."
"Ehh... welllll... uh, you're not gonna like Friday."
I've know of only one radiation oncologist who could tell this joke. It's really more like a story. All that work to establish the scene. . . .
 
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