Why is the PRITE so bad?

[Evidence Based]

I'm not trying to just complain, I'm just genuinely confused about why the PRITE is the way it is. I'm just a PGY-1 and took it recently, and I was baffled by how little clinical relevance most of the questions seemed to have. We have maybe 10 questions on GWAS and SNP research methodology, and maybe like 3 on anti-depressants (one or two of which were historical trivia). Lots of neuroscience factoids without any clinical context whatsoever (which subunit of this receptor binds this common molecule?). Confusingly few questions about differential diagnosis and management of common (or rare!) psychiatric conditions.

I guess I would have felt differently if I had left feeling like I didn't know many of the questions but would learn the answers in time, but I left feeling like I would have been better off taking this exam after taking an undergrad biology or neuroscience course years ago. Didn't help that most of the PGY-3s and 4s felt exactly the same as the 1s.

Any insight as to why the PRITE seems so divorced from clinical practice?

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[whopper]

The people working on it are in a bubble.

Also the personality types of medical science people are often that they aren't extroverted complainers who'll demand change.

I was at Columbia for a forensic fellowship interview and saw the PRITE fellows and felt like giving them a piece of my mind. I didn't. I didn't want to look ticked off during an interview.

 

[FlowRate]

It's funny, there were some questions that I picked up or that I knew were briefly presented at one point in our curriculum (as a PGY-3). We often have at least one PRITE fellow and one of our administrators is on the PRITE board, so I'm sure that info is interspersed through our curriculum.

Does this stuff (neuroscience mostly) come up on boards?

 

[Stagg737]

Couldn't agree with this more. There were a ton of questions that were completely irrelevant to Psych or neuro altogether as well. Not sure why there were 3 questions on HIPAA and several on administrative policies when the exam is supposed to test our neuropsych knowledge...

I guess I would have felt differently if I had left feeling like I didn't know many of the questions but would learn the answers in time, but I left feeling like I would have been better off taking this exam after taking an undergrad biology or neuroscience course years ago.

This was my problem with it. I felt like there was a significant chunk of questions on it that were almost completely irrelevant to my future as a psychiatrist. I knew a few of the molecular science questions that no one else knew because of my graduate school background, but there were a couple that made me chuckle a bit at the irrelevance of them.

 

[Liquid8]

Sounds like it’s no different to written psychiatry papers around the world.

In general, those setting medical exams tend to be insulated in the ivory towers of academia. Interesting and obscure questions excite and titillate them, whilst mundane, run of the mill stuff that occurs and is managed every day does not. From an exam perspective, the latter is also seen as serving no useful purpose as it doesn’t discriminate between candidates.

This means that over time exam questions tend to become more and more complicated or obscure. When I supervise medical students, I would expect them to know something about common psychiatric conditions by the end of their placement and the standard I would expect would be the same year after year. If I submit what I think is a relevant exam question to the medical school, perhaps in the first year it’s used 50% of students might get it correct, but with each subsequent year the pass rate goes up by say 10-20% as students collate questions and knowledge gets passed down. By the time the pass rate for the question reaches say 80%, those who put together the exam decide that the question is too easy and no longer able to discriminate between whether a student passes or fails. So they either scrap the question, or rework it to make it more difficult. Over time this process continues meaning that while the level of knowledge at the day to day clinical interface remains the same, this starts to diverge from the questions being designed to test this.

The same applies when I am supervising junior psychiatry trainee. There’s a level of clinical competence I expect for a first year, which is fixed. But when they end up sitting their written exams, the above also applies. Questions my trainees encounter are more difficult than when I went through, just as questions I encountered as a trainee were harder, more complex and more obscure than those past questions I had prepared with.

I’ve never done the PRITE, but our format used is the Extended Match Question, which are basically MCQs with 15-20+ answer options and lends itself to this as the scale of the answer key makes using process of elimination techniques inefficient. It’s an unpredictable paper: some years they would have a biological focus and target neuroanatomy or CYP450 interactions. In the early years they’d have questions about Famous names in psychiatry which generally had no clinical relevance. Another favourite topic is the culturally bound syndrome – things like Amok, Piblotoq, Koro, Hikikomori etc. In my neck of the woods, it not something we’d ever see or be exposed to and knowing about them would not make one a better clinician.

 

[clausewitz2]

It's funny, there were some questions that I picked up or that I knew were briefly presented at one point in our curriculum (as a PGY-3). We often have at least one PRITE fellow and one of our administrators is on the PRITE board, so I'm sure that info is interspersed through our curriculum.
?

Our PD has been on the PRITE board in some capacity several years running and it is always a good time figuring out which questions reflect his particular hobby horses.

 

[whopper]

Sounds like it’s no different to written psychiatry papers around the world.

And adding to what you aptly wrote...

Why are there no papers or formalized education on dealing with some of the common things that really tick us off in the real world of clinical practice? E.g. frequent flyers (not due to Axis I but due to Axis II disorders), malingerers, the disconnect with the law and ERs (e.g. police dump a guy who says he's suicidal right after they arrest him for assaulting someone, who really is not suicidal, pure antisocial (no Axis I other than say substance abuse), and when you discharge him the police won't pick him back up cause "he's your problem."

The people in the ivory towers are blind to this phenomenon and more into the idea of what sounds like it's more scientific vs what's going on in the real and present problems of clinical practice.

One of the only highly clinically relevant papers I've seen was one where it showed that those that are conditionally suicidal are actually much less likely to commit suicide and that it was actually a protective factor. E.g. "I'm going to kill myself if you don't give me a chicken dinner!"

 

[Stagg737]

Sounds like it’s no different to written psychiatry papers around the world.

In general, those setting medical exams tend to be insulated in the ivory towers of academia. Interesting and obscure questions excite and titillate them, whilst mundane, run of the mill stuff that occurs and is managed every day does not. From an exam perspective, the latter is also seen as serving no useful purpose as it doesn’t discriminate between candidates.

I don't mind interesting and obscure as long as it's still relevant to the field, which more than a few questions were not imo (nor were they relevant to neuro).

One of the only highly clinically relevant papers I've seen was one where it showed that those that are conditionally suicidal are actually much less likely to commit suicide and that it was actually a protective factor. E.g. "I'm going to kill myself if you don't give me a chicken dinner!"

Can you link it? I'd be interested in reading that.

 

[whopper]

Characteristics and six-month outcome of patients who use suicide threats to seek hospital admission. - PubMed - NCBI

The same author replicated the study later on and had very similar results.

Seven-year outcomes of patients evaluated for suicidality. - PubMed - NCBI

Despite these findings in a very well-done study with more than 100 patients, the author still wrote that more data should be obtained before making it a norm to kick out contingently suicidal patients. While it's possible and I suspect he did it to play CYA medicine I can't blame him. Some idiot psychiatrist with a vengeance against homeless people might've used his work to start going a little overboard.

Later work did come out further expanding on Lambert's work a bit but IMHO it'd still a research gold-mine.

Discharging your patients who display contingency-based suicidality: 6 steps

I was going to pursue this one actually much further while I was at U of Cincinnati replicating Lambert's study but I ended up moving before it got off the ground.

 

[Evidence Based]

Whopper that's some great data, thanks for sharing that! I had one question about the CATIE that tested useful concepts, but besides that we had no other questions directly from important clinical trials that I'm aware of. Would have been great (and good learning) to have come across questions from STAR*D or some of the other seminal NIMH trials if test makers were trying to make the test both "scientific" and clinically relevant.

I don't mind interesting and obscure as long as it's still relevant to the field, which more than a few questions were not imo (nor were they relevant to neuro).

Right, I agree with this. I might roll my eyes at the presentation of some rare culturally bound syndrome or what antibodies I should order for a paraneoplastic encephalitis, but at least it's something that I might come across in my career. Playing "guess that copy number variant" or "let's talk about the Golgi apparatus" just reeks of trying to make the test "scientific" with no connection to clinical practice.

 

[deleted736562]

The answer is easy: there's no money that comes from the exam.

Also, the stakes are pretty low so one feels invested in it. Can't say I'm complaining though, cause after 4 years of continuous MCQs, I've had enough.

Having said that, it seemed like there were more psychotherapy questions than usual which I liked given the current state of psychiatry.

 

[Stagg737]

The answer is easy: there's no money that comes from the exam.

Also, the stakes are pretty low so one feels invested in it. Can't say I'm complaining though, cause after 4 years of continuous MCQs, I've had enough.

Having said that, it seemed like there were more psychotherapy questions than usual which I liked given the current state of psychiatry.

Except at my program PRITE scores are used to determine when we're allowed to moonlight, so we do feel invested in it...

 

[futuredo32]

The Prite was such a waste. I did really well on 3 of 4 and just took the board for the third time. Unless your PD cares, I wouldn't worry.

 

[Liquid8]

And adding to what you aptly wrote...

Why are there no papers or formalized education on dealing with some of the common things that really tick us off in the real world of clinical practice? E.g. frequent flyers (not due to Axis I but due to Axis II disorders), malingerers, the disconnect with the law and ERs (e.g. police dump a guy who says he's suicidal right after they arrest him for assaulting someone, who really is not suicidal, pure antisocial (no Axis I other than say substance abuse), and when you discharge him the police won't pick him back up cause "he's your problem."

The people in the ivory towers are blind to this phenomenon and more into the idea of what sounds like it's more scientific vs what's going on in the real and present problems of clinical practice.

One of the only highly clinically relevant papers I've seen was one where it showed that those that are conditionally suicidal are actually much less likely to commit suicide and that it was actually a protective factor. E.g. "I'm going to kill myself if you don't give me a chicken dinner!"

These are the kind of presentations I encountered frequently as a junior doctor in ED. One patient I remember well was an antisocial guy brought in by the police after bashing his girlfriend and then claiming to be suicidal in the police van (When did you start feeling suicidal? 5 minute ago, doc). Doing it right involves getting a good history, noting significant negatives, and highlighting differences between what has been said and what can be objectively observed on their mental state.

But there’s the also the art of knowing what questions to ask, how to ask them, and when not to ask them. Regarding suicidal risk for instance, if I don’t feel a patient has any ulterior motives, I might ask them questions about their plans, whether they have stockpiled medications or written out a goodbye note or will if they haven’t disclosed this already. With the antisocial PD you don’t want to give them any leads, so you have to ask a broad question and document the lack of those features. Then we conclude that although the patient says they are suicidal it’s likely to be more about avoiding jail-time and send them on their way. All the while I suspect the cops already know this is the case, but they’re not trained to assess this kind of thing and don’t want to risk any more deaths in custody.

Although you'll never read any of this kind of stuff in the journals or textbooks, it’s one of the cases I would run through with students to stress the important differences between clinical depression and personality and managing risk issues, as in our system when students finish their first year of work is a general year covering rotations in medicines, surgery and ED. In the ED job they tend to get less acute presentations to manage, which often includes psychiatry cases.

In another place I worked the barriers on inpatient entry were not very robust, so we’d typically get frequent flyer borderlines always managing to sneak in. I can remember one of my bosses had a great response to a PD who threatened to just cut again and come back the next days when they were about to be discharged. His reply was on the lines of, “Fine – you do that. And when you come in again I’ll be here, as will our junior doctors and nurses. Tonight we’ll all go home and be back again tomorrow morning - it’s what we do for a living. But what kind of life is that for you?” There was a stunned silence, she didn’t have a reply and didn’t come back.

 

[whopper]

Something that highly frustrated me while I was a resident was over 1/2 the patients coming into the PES were malingerers or borderlines having some type of emotional meltdown that didn't warrant hospitalization but were determined to get in thinking hospitalization would somehow fix their problem.

With no attendings offering clear guidance on what to do and nothing in the usual medical literature providing guidance, seeing attendings and nurses vehemently disagreeing, I kept thinking to myself why is this not something addressed with formal guidelines from the APA and more literature?

Ridiculous. Something that's a major problem and psychiatrists were just looking and giving the smirk or rolling of the eyes facial expression.

Never have I seen something that so strongly pointed to our field as being complete BS as this type of situation. No I don't think our field is BS but this aspect, which is better addressed these days but still not adequately so, still lingers.

And the PRITE is symbolic of this disconnect. With it's Ivory Tower/bubble questions filled with grammatical errors that have almost no correlation with real world practice, made by some nerd (not in the good sense, there's the type of nerd who because he's so smart he's awesome, no not this type of nerd) who's basing questions on esoteric data that usually has no practical value....

I have yet to have even ONE FREAKING PATIENT WITH KORO, yet I've dealt with thousands of malingers and got no questions on the latter. The training itself on malingering in general psych residency is pathetic. I only got a decent level of training in it that IMHO met clinically effective levels in forensic fellowship.

The only use so far I got out of Koro is I can now use it as an insult/joke when someone thinks at a party that I can instant analyze them.

I often times respond, "well it's easy to see you're suffering male pattern baldness, erectile dysfunction, koro, and narcissism." Then after letting that sink in for a minute I tell them I'm joking.

 

[FlowRate]

"I'm going to kill myself if you don't give me a chicken dinner!"

Patient is future oriented, self-advocating, and adequately caring for himself.

The ED once consulted me on a guy who had just been cleared by the ED and psychiatry, walked out of the ED into the triage area, and re-registered with triage, saying he had SI. I don't think his clinical status has changed, he never even left the building. I made it clear to him that we would not be hospitalizing him (thanks to lots of prior supporting documentation for malingering / antisocial PD) and made it clear to the ED attending that he should be consulting OGC/Admin, not me, about how to set limits while not running afoul of EMTALA.

 

[whopper]

Off on a tangent but something that really ticked me off at my last job, many of my colleagues were too chicken to discharge malingerers. Some of them even told the residents the patient should be discharged but because they were too chicken to do it, because I wasn't, and because the inpatient unit rotated attendings every few weeks they'd dump it upon me.

And what made the problem 1000x worse was to keep the patient in the hospital that they even believed was malingering they'd write a note saying the patient was truly suicidal.

I approached some of them and told them up to their face that #1 it's totally not acceptable to write a diagnosis you don't agree with and that this is literally insurance fraud, #2-if you really want to dump it on me you just sabotaged me because now the record has contents with statements that contradict me if I happen to believe they too are malingering, #3 there is a reasonable argument that you want a second opinion and you could've simply asked me to consult on the case instead of allowing the malingerer another week in the hospital, #4-why did you not take me up on my offer to teach you how to use an M-FAST (I did that repeatedly and these people never showed any interest or effort).

I also brought it up at the department meeting and all I got was a lot of people staring at the ground while I brought this up. I told my clinical boss who also didn't do anything to address the issue.

Another reason why I left my last job. My prior to last job, all the attendings and residents (except the brand new ones) were on top of how to handle this problem. That job I left cause I moved because my wife got an out-of-town offer. Not the last job. That one...I couldn't take it anymore.

 

[DisorderedDoc417]

Something that highly frustrated me while I was a resident was over 1/2 the patients coming into the PES were malingerers or borderlines having some type of emotional meltdown that didn't warrant hospitalization but were determined to get in thinking hospitalization would somehow fix their problem.

With no attendings offering clear guidance on what to do and nothing in the usual medical literature providing guidance, seeing attendings and nurses vehemently disagreeing, I kept thinking to myself why is this not something addressed with formal guidelines from the APA and more literature?

Ridiculous. Something that's a major problem and psychiatrists were just looking and giving the smirk or rolling of the eyes facial expression.

Never have I seen something that so strongly pointed to our field as being complete BS as this type of situation. No I don't think our field is BS but this aspect, which is better addressed these days but still not adequately so, still lingers.

And the PRITE is symbolic of this disconnect. With it's Ivory Tower/bubble questions filled with grammatical errors that have almost no correlation with real world practice, made by some nerd (not in the good sense, there's the type of nerd who because he's so smart he's awesome, no not this type of nerd) who's basing questions on esoteric data that usually has no practical value....

I have yet to have even ONE FREAKING PATIENT WITH KORO, yet I've dealt with thousands of malingers and got no questions on the latter. The training itself on malingering in general psych residency is pathetic. I only got a decent level of training in it that IMHO met clinically effective levels in forensic fellowship.

The only use so far I got out of Koro is I can now use it as an insult/joke when someone thinks at a party that I can instant analyze them.

I often times respond, "well it's easy to see you're suffering male pattern baldness, erectile dysfunction, koro, and narcissism." Then after letting that sink in for a minute I tell them I'm joking.

It is refreshing to see that other people’s residency was filled with dealing with antisocial, malingering, and borderline d/o that didn’t meet criteria. It’s enough to burn a person out...

 

[DisorderedDoc417]

It is refreshing to see that other people’s residency was filled with dealing with antisocial, malingering, and borderline d/o that didn’t meet criteria. It’s enough to burn a person out...

Not to mention it’s bogging down a system that is already frightfully low on resources and funding.

 

[Shufflin]

commenting on your own comment. reminds me of my day at work lol. i kid i kid.

 

[hallowmann]

Couldn't agree with this more. There were a ton of questions that were completely irrelevant to Psych or neuro altogether as well. Not sure why there were 3 questions on HIPAA and several on administrative policies when the exam is supposed to test our neuropsych knowledge...

This was my problem with it. I felt like there was a significant chunk of questions on it that were almost completely irrelevant to my future as a psychiatrist. I knew a few of the molecular science questions that no one else knew because of my graduate school background, but there were a couple that made me chuckle a bit at the irrelevance of them.

Don't worry about it, and be glad the results don't mean anything at most programs. Its a ridiculous test. Just don't worry about it and move on.

 

[ilikepsych09]

I can't seem to post a link, but if you do a Pubmed search for "therapeutic discharge" in General Hospital Psychiatry, you'll come across a couple articles that may be useful.

Off on a tangent but something that really ticked me off at my last job, many of my colleagues were too chicken to discharge malingerers. Some of them even told the residents the patient should be discharged but because they were too chicken to do it, because I wasn't, and because the inpatient unit rotated attendings every few weeks they'd dump it upon me.

And what made the problem 1000x worse was to keep the patient in the hospital that they even believed was malingering they'd write a note saying the patient was truly suicidal.

I approached some of them and told them up to their face that #1 it's totally not acceptable to write a diagnosis you don't agree with and that this is literally insurance fraud, #2-if you really want to dump it on me you just sabotaged me because now the record has contents with statements that contradict me if I happen to believe they too are malingering, #3 there is a reasonable argument that you want a second opinion and you could've simply asked me to consult on the case instead of allowing the malingerer another week in the hospital, #4-why did you not take me up on my offer to teach you how to use an M-FAST (I did that repeatedly and these people never showed any interest or effort).

I also brought it up at the department meeting and all I got was a lot of people staring at the ground while I brought this up. I told my clinical boss who also didn't do anything to address the issue.

Another reason why I left my last job. My prior to last job, all the attendings and residents (except the brand new ones) were on top of how to handle this problem. That job I left cause I moved because my wife got an out-of-town offer. Not the last job. That one...I couldn't take it anymore.

 

[psychattending]

I'm not trying to just complain, I'm just genuinely confused about why the PRITE is the way it is. I'm just a PGY-1 and took it recently, and I was baffled by how little clinical relevance most of the questions seemed to have. We have maybe 10 questions on GWAS and SNP research methodology, and maybe like 3 on anti-depressants (one or two of which were historical trivia). Lots of neuroscience factoids without any clinical context whatsoever (which subunit of this receptor binds this common molecule?). Confusingly few questions about differential diagnosis and management of common (or rare!) psychiatric conditions.

I guess I would have felt differently if I had left feeling like I didn't know many of the questions but would learn the answers in time, but I left feeling like I would have been better off taking this exam after taking an undergrad biology or neuroscience course years ago. Didn't help that most of the PGY-3s and 4s felt exactly the same as the 1s.

Any insight as to why the PRITE seems so divorced from clinical practice?

The job of the PRITE broadly is not to assess your ability to practice psychiatry. The job of the PRITE is to assess your medical and scientific knowledge. This job is becoming more important as we have Milestones that force us to score residents on medical and scientific knowledge.

 

[Mad Jack]

It's funny, there were some questions that I picked up or that I knew were briefly presented at one point in our curriculum (as a PGY-3). We often have at least one PRITE fellow and one of our administrators is on the PRITE board, so I'm sure that info is interspersed through our curriculum.

Does this stuff (neuroscience mostly) come up on boards?

One third of the boards is neurology and neuroscience is my understanding

 

[psychattending]

I doubt it is one third of the Boards. Neuro might be something more like 20%. I don't know if there is any neuroscience on the Boards. Such questions would only be there if it directly impacted patient care. The Boards in contrast to the PRITE is aimed at assessing, as best as one can on a computer test, your ability to practice safely.

 

[whopper]

It is refreshing to see that other people’s residency was filled with dealing with antisocial, malingering, and borderline d/o that didn’t meet criteria. It’s enough to burn a person out...

Which is why this should really be part of the academic aspect of psychiatry, and discussed more in formal training-to better understand, research, and improve upon an aspect of real-world psychiatry that is often times neglected in the academia.

Imagine our profession having established guidelines, principles, solid foundations of practice based on methods that have been extensively studied on issues that we have to deal with everyday instead of being a resident, telling your attending you think the patient is malingering and the attending simply rolls his eyes and doesn't have an answer for you, then even telling you to put a diagnosis neither you or he agrees with and then prescribing a medication not appropriate for the disorder you or he thinks is really going on.

 

[deleted736562]

Boohooo, so there were a dozen questions about epigenetics and GWAS (mostly with the same answers over and over) which are completely unrelated to actual practice, and now we can all pretend that psychiatry is more scientific.

 

[Stagg737]

Anyone else think part 2 was a much more relevant and better exam than the first part? I actually felt like I was taking a test about psychiatry (and neuropscyh) for most of it.

Don't worry about it, and be glad the results don't mean anything at most programs. Its a ridiculous test. Just don't worry about it and move on.

Except it does mean something at my program (mostly in later years). I'm not worried about it right now, just annoyed because I was actually kind of excited to take an exam that was supposed to largely test my psych knowledge but seemed to have a large quantity of irrelevant crap with psych and neuropsych sprinkled in. Felt a lot better about part 2, but still wish part 1 wasn't such a disappointment.

I doubt it is one third of the Boards. Neuro might be something more like 20%. I don't know if there is any neuroscience on the Boards. Such questions would only be there if it directly impacted patient care. The Boards in contrast to the PRITE is aimed at assessing, as best as one can on a computer test, your ability to practice safely.

I obviously have no experience taking the boards, but I've actually heard the same thing about it being 30-40% neurology. I've also heard the Neuro boards is roughly 30% psychiatry questions. It's anecdotal, but I've heard this from almost every attending I've spoken to about it.

 

[whopper]

I found the actual psych board exam much better with relevant questions, no grammatical errors, and if I didn't know the answer to a question, I still thought the question was fair and well written for the most part. Only complaint I had was many of the questions seemed like they were written 15 years ago and could've been updated.

Just wanted to add, somewhere along the way, some people got some notion that cause it isn't involving chemicals, lasers, bosons, quarks, what have you, it's not scientific.

Behavioral science is science. Social science is science. The science of studying several things in clinical practice is still science.

Here's the definition of science:

the intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observation and experiment.
"the world of science and technology"
synonyms: branch of knowledge, body of knowledge/information, area of study, discipline, field
"the science of criminology"

• a particular area of this.
  plural noun: sciences
  "veterinary science"
• a systematically organized body of knowledge on a particular subject.
  "the science of criminology"
  synonyms: physics, chemistry, biology; More
  
  
• ARCHAIC
  knowledge of any kind.

The idea that science must be reduced to purely biochemical/physiological and anything along those lines is reinterpreting the word and idea to something it is not.

If someone knows more about CRISPR vs a guy who knows more about the evidenced-based practice of a specific type of psychotherapy, neither is more scientific than the other.

 

[clausewitz2]

I found the actual psych board exam much better with relevant questions, no grammatical errors, and if I didn't know the answer to a question, I still thought the question was fair and well written for the most part. Only complaint I had was many of the questions seemed like they were written 15 years ago and could've been updated.

Just wanted to add, somewhere along the way, some people got some notion that cause it isn't involving chemicals, lasers, bosons, quarks, what have you, it's not scientific.

Behavioral science is science. Social science is science. The science of studying several things in clinical practice is still science.

Here's the definition of science:


The idea that science must be reduced to purely biochemical/physiological and anything along those lines is reinterpreting the word and idea to something it is not.

If someone knows more about CRISPR vs a guy who knows more about the evidenced-based practice of a specific type of psychotherapy, neither is more scientific than the other.

The PRITE this year seemed to have more therapy questions than last year, so that is part of the scientism of it.

 

[Evidence Based]

Anyone else think part 2 was a much more relevant and better exam than the first part? I actually felt like I was taking a test about psychiatry (and neuropscyh) for most of it.

Yeah I definitely felt this. Initial post was between parts 1 and 2, the second half was much better (if still silly at times).

The job of the PRITE broadly is not to assess your ability to practice psychiatry. The job of the PRITE is to assess your medical and scientific knowledge. This job is becoming more important as we have Milestones that force us to score residents on medical and scientific knowledge.

I guess this makes sense if those are the goals, but it's still odd that this is how we track progress through residency. I certainly am not getting lots of didactics about the Golgi apparatus or mRNA translation.

 

[psychattending]

It's use varies among the programs (all we are required to do is test for knowledge and rank rescinders on the Milestones). Some programs use it both the score Milestones and to help judge the suitability of a resident to be promoted. Others just give the test out and then hand the results to the residents.

I think the PRITE is very useful in informing a resident how his/her knowledge compares to other trainees at the same level in the different content levels . Having such information tells the resident which information he/she should be reading (most knowledge in residency is gained by reading and seeing patients; not in sitting in lecture). The resident's ability self assess and do self learning is scored in the Milestones and is a skill MDs need to learn so that they stay up to date with knowledge after completing residency. Since the ABPN only fails around 10% of the people, if a resident can consistent score >30th percentile, then he/she stands a high likelihood of passing the Boards.

When it is used to track, it is used to track progress of knowledge gain. The PRITE is face valid in this regards. Scores increase over time.

 

[hallowmann]

I found the breakdown of this year's PRITE results a bit better than last year's. It could still be more useful, but I feel it gave me a better idea of where I stand and where my weaknesses are.

 

[Sushirolls]

The PRITE is a useless exam. It does not correlate with Board scores. I hope residents on here don't have any Program Directors that place any sincere value on it, or even linking it to the consent to moonlight.

One thing to look forward to from resident to attending is no more PRITE.

 

[mymembernames]

The PRITE is a useless exam. It does not correlate with Board scores. I hope residents on here don't have any Program Directors that place any sincere value on it, or even linking it to the consent to moonlight.

One thing to look forward to from resident to attending is no more PRITE.

At some programs I interviewed at was told that you gotta score above 50%ile in order to moonlight

 

[lyla]

It sucks. But yeah I think at our program if you take a huge dump on the prite you can’t moonlight.

 

[Animal Mother]

The PRITE is a useless exam. It does not correlate with Board scores.

Every study I’ve seen has shown a moderate correlation between PRITE psychiatry scores and boards. Seemed like a pretty good prediction for my graduating class.

 

[Stagg737]

At some programs I interviewed at was told that you gotta score above 50%ile in order to moonlight

Yup, I'm at one of those programs. Although we do have some internal opportunities that I believe anyone can do, but if you want to moonlight externally you have to score 50th or above.

 

[Stagg737]

I found the breakdown of this year's PRITE results a bit better than last year's. It could still be more useful, but I feel it gave me a better idea of where I stand and where my weaknesses are.

After getting my score/breakdown back today I'm feeling significantly better about both my own knowledge and my program in general (even if it is a worthless test Imma ride this high all week, lol).

 

[Espadaleader]

It's use varies among the programs (all we are required to do is test for knowledge and rank rescinders on the Milestones). Some programs use it both the score Milestones and to help judge the suitability of a resident to be promoted. Others just give the test out and then hand the results to the residents.

I think the PRITE is very useful in informing a resident how his/her knowledge compares to other trainees at the same level in the different content levels . Having such information tells the resident which information he/she should be reading (most knowledge in residency is gained by reading and seeing patients; not in sitting in lecture). The resident's ability self assess and do self learning is scored in the Milestones and is a skill MDs need to learn so that they stay up to date with knowledge after completing residency. Since the ABPN only fails around 10% of the people, if a resident can consistent score >30th percentile, then he/she stands a high likelihood of passing the Boards.

When it is used to track, it is used to track progress of knowledge gain. The PRITE is face valid in this regards. Scores increase over time.

But, a program director will say "oh, don't worry about it. The exam doesn't matter, just focus on your clinical work", when the resident should be studying, reading primary material (textbooks etc.) and doing practice questions. People should tell residents, interns especially that the PRITE, Step 3 etc. is very important and you should begin studying at the end of 4th year if you have time because 3 months after you start intern year you will have the admin down your throat with PRITE and Step 3.

 

[Espadaleader]

Thanks seniors for demonstrating how serious these exams are for promotion and moonlighting etc.

 

[Sushirolls]

I blew off the PRITE, and my scores went down with each year as I progressed. Last two years I had just finished a 30-40 hours straight moonlighting/residency shift just before the exams. Tanked the PRITE those two years. Studied 2 weeks before boards with only FOCUS questionnaire and passed just fine. PRITE is a useless exercise and tying it to anything of real value is just sad and another example academic bloat and bureaucracy weighing people down.

Same concept is shelf exams or end of rotation exams as a medical student having no real correlation with license exams. So completely different. One does not prepare for the other.

 

[FlowRate]

Thanks seniors for demonstrating how serious these exams are for promotion and moonlighting etc.

This is program specific but, as you point out, important to know for those programs that require PRITE (and step 3) for promotion and moonlighting.

Our program requires Step 3 for promotion to PGY3 but doesn't really care about PRITE beyond its limited usefulness as an education tool.

 

[MacDonaldTriad]

I have been looking at PRITEs for over 30 years and there is no doubt that recently it has fallen into some kind of molecular neuroscience rabbit hole. This worked against some students and it worked for students with this back ground. Maybe it is milestone driven, maybe it just reflects the interests of people at the college who are willing to do the work. What I don't know is if this is true of the board exam. My guess is not so much, but of course I haven't had any first hand exposure for a very long time.

 

[SourceOfDenial]

At least it’s better than the Columbia psychotherapy exam!

 

[MacDonaldTriad]

I agree, but that went away a few years ago. That test would have made a good thesis on characterizing what that test measured exactly.

 

[thoffen]

The problem with asking questions about these things is that there has to be a right answer. To the extent that real life clinical dilemmas exist in the evidence base, it's with a lot of caution and uncertainty expressed and topics that are not formally taught in residency education.

You can argue certainly that the PRITE and board exams are part of setting that curriculum, but by no means are they the center of this problem.

Separately, though, it would make sense for these exams to be a lot more clinically relevant in ways we are more formally taught.

 

[NickNaylor]

I'm currently on the PRITE editorial board and think I can shed some insight into this.

As with all exams, the exam is divided into content areas, all of which must be represented on the exam, though the degree to which they are represented is variable. The challenge here is that, in general, answers to questions must be able to be cited and be uncontroversial. In other words, you should not be able to do a literature review and successfully challenge the answer to a question unless a particular study or argument is clearly an outlier.

For many content areas, this isn't necessarily a problem. For other areas, it's a huge problem. It's extremely difficult to craft questions for some content areas with non-controversial, objectively "correct" answers. The result is that there is a relatively small pool of questions that can be written and topics that can be addressed. Some of these questions have absolutely zero relevance to the clinical practice of psychiatry, but they can be substantiated on the basis of evidence, so they're included. Other potential questions may be more clinically relevant, but it can be difficult if not impossible to translate them into actual questions with objectively "correct" answers on a standardized exam.

There's the further issue of the members of the board having different opinions about what should be on the exam and what should be important to test. I think this gets more at the actual construction of the exam and choices with respect to what content areas will be covered and how heavily they'll be weighted, but this also comes up during the individual discussions of specific questions. My own view as someone who writes questions and votes on which questions to approve is to focus on content that is clinically relevant to the practice of psychiatry. I don't care about the history of psychiatry in the context of this exam, and given that, by definition, the content covered will be limited, I would much rather eliminate these questions and, instead, include more questions about diagnosis and treatment. However, this is not a universally shared opinion... and it seems that the people who disagree tend to "win out."

I think the exam could be much more useful and clinically relevant, but, as with all things, making large changes like that is challenging.

 

[arthmpsn]

Having been a former PRITE fellow, I can say that the PRITE fellows (residents and CAP fellows) are given a seat at the table to be the ones to ask "Is this even taught in residency? Is this information a resident should know?" Sometimes the fellows do a great job at this and others are less rigorous. I found that when I said something was totally outside of the realm of residency knowledge, most of the time I was heard and the question was thrown out. In other words, they are making an effort. Occasionally they had an argument of some kind for why it was (peripherally) clinically relevant. I think they are still feeling out how to incorporate neuroscience and biological correlates of psychiatric illness in a clinically meaningful way because this is new(er) to the exam itself as a topic.

My 2c.

 

[MacDonaldTriad]

I think they are still feeling out how to incorporate neuroscience and biological correlates of psychiatric illness in a clinically meaningful way.

Aren't we all.... too bad we mostly fail.