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Radiology Board Exams - Are Doctors Really Cheating??
quovadis13
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Registered User regular
So this popped up on CNN just today
Important parts
Basically, for quite some time now, doctors-in-training would go into their board exams and when they finished writing them, they would meet and write down as many questions as they could remember and pass that info along to doctors who have yet to take these exams. But now, the committees responsible for writing these tests are starting to crack down on this behaviour and claims that this is cheating. Some groups have even gone so far as to punish people who do this:
However, for the most part, even though this practice is explicitly stated to be illegal when the doctors agree to take the test, most radiology programs are very open about using these recalled exams to study for the boards. In fact, with how busy most residents are, it would be very difficult, if not impossible, to pass these exams without using these exams as study guides. Part of the problem lies with the fact that for these standardised tests, a large percentage of the questions are recycled from year to year:
So what do you feel about this topic? I for one, feel that this in no way, shape or form is anything close to cheating. First off, there is no guarantee to the accuracy of the recalled questions. Second, the answers are also recalled and are not guaranteed to be correct. Third, even if the doctors do use these recalled questions, they are still learning the material and the content of the question. They are not learning that "the answer to number 5 is A", they are still actually learning the science they need to become good doctors.
I have taken a board exam (not in the medical field) and have used recalled questions as a study guide. I used them to learn the content that I was expected to know. I did not use them as a shortcut to actual knowledge. If I did not know the material, then no amount of recalled questions would have helped me pass, and I feel the same way for these doctors too.
So, do you think this is cheating or is this just being way overblown?
Important parts
CNN wrote:For years, doctors around the country taking an exam to become board certified in radiology have cheated by memorizing test questions, creating sophisticated banks of what are known as "recalls," a CNN investigation has found.
The recall exams are meticulously compiled by radiology residents, who write down the questions after taking the test, in radiology programs around the country, including some of the most prestigious programs in the U.S.
"It's been going on a long time, I know, but I can't give you a date," said Dr. Gary Becker, executive director of the American Board of Radiology (ABR), which oversees the exam that certifies radiologists.
Asked if this were considered cheating, Becker told CNN, "We would call it cheating, and our exam security policy would call it cheating, yes."
Radiology residents must sign a document agreeing not to share test material, but a CNN investigation shows the document is widely ignored. Dozens of radiology residents interviewed by CNN said that they promised before taking the written test to memorize certain questions and write them down immediately after the test along with fellow residents.
"Our real mission is to the public," said Dr. James Borgstede, the ABR's president-elect. "Our real mission is to say that your certified radiologist has demonstrated, acquired and maintained the requisite skills and knowledge to practice with skill and safety on the public."
To become board certified, a virtually essential step to obtain hospital privileges, residents have been required to pass two written exams and an intensive oral test during five years of residency training.
The practice of sharing exam answers is so widespread and considered so serious in the medical community that the ABR has put out a strongly worded video warning residents that the use of recalls must stop
Basically, for quite some time now, doctors-in-training would go into their board exams and when they finished writing them, they would meet and write down as many questions as they could remember and pass that info along to doctors who have yet to take these exams. But now, the committees responsible for writing these tests are starting to crack down on this behaviour and claims that this is cheating. Some groups have even gone so far as to punish people who do this:
CNN wrote:The issue of test sharing arose in 2010 when the American Board of Internal Medicine suspended 139 doctors for sharing test questions with an exam review company.
In a statement, Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine, said, "Sharing test questions from memory is a serious problem that threatens the integrity of all standardized testing. Test takers need to know that this kind of 'brain dumping' is grossly unethical and the American Board of Internal Medicine will not tolerate unethical behavior from physicians seeking board certification. ABIM will take appropriate action against anyone who seeks to compromise the integrity of our examinations.
However, for the most part, even though this practice is explicitly stated to be illegal when the doctors agree to take the test, most radiology programs are very open about using these recalled exams to study for the boards. In fact, with how busy most residents are, it would be very difficult, if not impossible, to pass these exams without using these exams as study guides. Part of the problem lies with the fact that for these standardised tests, a large percentage of the questions are recycled from year to year:
CNN wrote:About half of the questions on the radiology test are the same each year. "The half of the exam that is not new comprises questions from a variety of previous exams, not from the prior year," Becker told CNN.
So what do you feel about this topic? I for one, feel that this in no way, shape or form is anything close to cheating. First off, there is no guarantee to the accuracy of the recalled questions. Second, the answers are also recalled and are not guaranteed to be correct. Third, even if the doctors do use these recalled questions, they are still learning the material and the content of the question. They are not learning that "the answer to number 5 is A", they are still actually learning the science they need to become good doctors.
I have taken a board exam (not in the medical field) and have used recalled questions as a study guide. I used them to learn the content that I was expected to know. I did not use them as a shortcut to actual knowledge. If I did not know the material, then no amount of recalled questions would have helped me pass, and I feel the same way for these doctors too.
So, do you think this is cheating or is this just being way overblown?
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quovadis13 on
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It is often the case that the idea of a test is to take a random sampling of what you know, as an indication of the entirety of what you know. Access to any information that gives you a good idea of what specific questions might be on the test defeats this facet of the testing.
Gooseshit. The board needs to stop being a bunch of lazy geese and write new examinations every time, or follow the approach of the FAA and build a system that deals with recall directly.
This. My high school teachers did this and there's no reason a board of fucking doctors can't afford someone to do this for them at the least.
My teachers also released doctored cheat sheets to test students too. (Also, that word is quite a pun!)
If you want to cut down on the use of this kind of stuff, it better come with an equal wrangling in of the ridiculous hours residents are asked to keep, so they actually have time to study.
Some of the stories my cousin can tell you would probably horrify you, in terms of what residents are asked to do and the hours they are expected to keep.
e: You are also talking about a ridiculously competitive field, where 1 or 2% test score difference can be the difference between getting accepted to specialty training (aka making money), and being a family physician the rest of your career (aka not making money). Radiology is probably a bit different, but the environment is the same.
These recalled questions should therefore give you a good indication of whether your knowledge is good enough, yes? And which parts you need to work on and which parts you already get.
If the problem is that these questions feature so frequently on the new exam that you gain a skewed view of your ability then obviously the fault lies with the person making the exams.
Wait, it's not cheating if your crib sheet might be wrong? Where did you take your ethics classes?
Additionally, the test isn't to see if the takers can spit out prepared trivia, it's to see if you understand the systems well enough to answer and unexpected question.
Ah they're supposed to be learning so it's the hazing ritual!
The only way to be able to "spit out trivia" here is completely understanding the system that the question involves. That's why the accuracy thing is an important point. If you don't know why the answer is what it is (i.e. if you don't find out that the question/answer is certainly correct) then you're going to fail the exam usually.
The problem is that if the tests do not feature a significant amount of new questions then you're not getting a good guarantee that the person knows about the things that were not asked on the test.
Yes, it's a complex form of hazing. That's actually a good way to put it. It's very much the "I went through this living hell to become a respected doctor, now you will too" mentality.
Which explains a lot of medical education, actually.
the "no true scotch man" fallacy.
This seems to be the most easily identifiable, fundamental cause behind skyrocketing healthcare costs in US as compared to so many other countries, no?
Is there no 3rd party agency that actively tries to hold the radiology board, AMA, etc., accountable for questionable situations like these?
I know when I was going for certification I went through the same thing. Questions were often trivially specific and favored people who were more capable of memorization. Some of my classmates even complained to the administration about questions they answered being technically correct while the test marked them wrong (a free retake was offered if a strong enough case was made). These kinds of things led to people verbally sharing test questions and answers, and a couple guys I remember were passing around a dvd of a copy of the previous years test.
Call it unethical or call it cheating, but I know I personally won't be too upset considering how ridiculous and counterintuitive to education these tests can be.
Agreed. I can see their utility in that "Hey we want to make sure you know the basic stuff. . ."; however as has been mentioned in this thread, some folks are too busy doing their job, to sit back and attempt to cram (and see what they can recall) as much information as possible. Or they are just awful test takers.
I am as unsurprised at this as I was when the GMAT "scandal" broke.
The LSAT is actually exceptionally good at minimizing cheating.
In fact, I sat for the October LSAT and they switched the experimental section to the first half of the test, which hadn't been experimental in the last few decades, so thousands of people who tried to game the system by skipping over the "experimental" section and secretly (against the rules) spending more test time on previous sections were punished pretty severely for it.
Am I misinterpreting something or are you advocating cheating on professional MD certification processes because studying is hard and it unfairly favors people who remember stuff they learn?
e: At the very least shouldn't the focus be on making the tests more meaningful and less game-able, and not how to just get it over with?
e2: Sorry if the post seems confrontational, just somewhat thrown off by the italicized notion, specifically.
This being said, there are only so many questions that you can actually ask on a certification board. While the pool of knowledge is vast, it is still limited to the board certification requirements of the exam (in this case, Radiology questions... you won't be asked proper dosages of anesthesia or standard antibiotic treatment for a walk-in patient, for example). Resident boards are a bit more generalized because most Radiology residency programs have one or two "general intern" years before they specialize the education. For some reason.
The "whistleblower" in this case (Webb) apparently had problems with the Army residency program: "Meanwhile, Webb has had his own problems with the Army. He was reprimanded last year for making "sexual comments" to another doctor and for "other conduct unbecoming an officer." That led to his firing from the radiology program. Webb said the issue was a personality dispute that escalated."
He was fired. And decided to strike back by pointing this out as "all radiologists are cheating!!!" I'm not saying that is point is invalid, but his motives for doing so seem a bit suspect.
Here's a sample of the SAUSHEC recall bank (also from the article):
http://i2.cdn.turner.com/cnn/2012/images/01/09/saushec.pdf
I'm not a radiologist, but I'm medically trained. I can tell you that I can answer these questions, and that they aren't really about radiology for the most part. Then again, resident boards are more general than the ones done for Radiologists for board certification later on. They certainly won't test for who will be the better diagnostician when presented with imaging. If it was a bank of images with possible answers for the diagnoses... well, congratulations, they just memorized something that would help in their later careers. But it seems more like medical trivia that isn't relevant for the actual practice of radiology.
My dad always talked about how he went through 7 day weeks of 18 hour days and thought it was hell and these kids are being coddled with their required 6 hours of rest... but that the doctors when he was a resident would bitch about how the damn kids went home sometimes, instead of sleeping on cots like they did.
I mean it's a ridiculous hazing that they are barely, slowly correcting without admitting that it's stupid.
I would hope so. Anecdotal, but an old professor of mine liked to tell a story about a peer of his in a doctoral program who managed to fail most of the exams the took; when it came down to making the decision to force this candidate to take his final exam he went before his committee and plopped down about a dozen peer-reviewed and published papers as well his job experience within the field. His argument was simply "I've already been doing what this exam says I will be qualified to do."
The resident boards are probably more relevant for surgery and internal medicine, but they spend a lot more time on those aspects of care covered in the boards on a daily basis.
Also from the article:
"If they had a test where you could study relevant radiology knowledge and they tested on it, that would be fine," Dieber said. "Part of the problem is the test and the questions that they ask. Because some of the questions are so obscure, that unless you know that they like to ask questions about that topic, you're not going to study it because some of them are completely irrelevant to the modern practice of radiology."
So much so I'm not sure how it's questionable.
Of course, while the people who did so should be punished, the doctors who made such an easily cheated exam need to get their shit straight too.
It sounds like there's a bit of an arms race, where the test makers keep making the answers harder to memorize to combat the cheating and the cheating gets progressively more flagrant. Alternately, they're testing to see if you have the chops to reason it out instead of memorizing a couple of common facts.
As for whether we should test, the test is over whether you can do it without supervision. If you can't pass the test, maybe you haven't had enough experience to be trusted without the supervision. Honestly, some people not being able to pass the test is the point. If you can't pass the test without cheating, maybe it's because you can't hack it as a doctor (yet, maybe). It doesn't matter how long you've been trying your hardest if you don't have the skills to not kill the patient.
Maybe the tests SHOULD be virtual patients and virtual procedures, with case study images for the radiology resident to accurately describe and dictate. *shrugs*
As far as reasoning it out, let's take the first question from that sample recall bank, shall we?
What is the most common Primary intracranial tumor in an adult?
a. Pilocytic astrocytoma
b. Oligodendroglioma
c. Anaplastic astrocytoma
d. Glioblastoma multiforme
ANS: d
This is pure medical trivia. There's no way in hell that you can reason out that it's GBM. You have to read it from some medical statistic in some random book somewhere about intracranial tumors.
Morbidly (but somewhat off-topic), it's untreatable medical trivia. You couldn't ask a question about how to treat a GBM because there's no effective way to do it.
I think the main issue is not the use of past exam questions to study for a current exam. For most of these boards, past exam questions from previous years (typically 5 years or so back) are available for studying from the testing organization itself. The main issue is the implication that Radiologists are memorizing questions for the CURRENT year's exam, and using the internet to disseminate them faster than the testing organizations can administer the exam. The solution, of course, is to have different exams on different days.