Tag: boards

Posted on by

What The Core Exam Low Pass Rate Does Not Tell Us About This Year’s Test Takers!

low pass rate

In residency programs throughout the country, you don’t need to go far before you hear some chatter about the low pass rate on the core exam and the change from years before. And, then, you take a look at the article on Aunt Minnie, with headlines stating, the ‘fail’ rate is rising. Or, you check out a forum or two or social media, as they rail against the exam and the test takers. It’s no wonder that many residents are on edge. I know that at my residency, the buzz is palpable.

Similar to other years, I have seen sketchy opinions about this year’s exam and misguided words about the residents who took the exam this year. But, given the increased failure rate, these statements weigh more on the residents who have taken the exam. And, unfortunately, many of the assumptions and statements made about this class of residents taking the exam and the test itself are entirely off-base. So, I aim to dispel any misconceptions by telling you what you should not assume about this group of test-takers and the core exam. Here are some of the more common ones!

This Group Of Test Takers Are Not As Smart

I know many residents who took the exam this year. And, although more residents had trouble passing the boards this year, these residents are just as intelligent as others. Perhaps, many are not great test-takers (reflected in the USMLE board scores used for admission to residency). But, by no means, are they going to make radiologists that are inferior to any other year.

Moreover, residents throughout the country in this class practice radiology competently as judged by faculty, chairman, and program directors. This judgment is in spite of the board score results. So, instead, I am forced to fault the exam itself, and some of the reported esoterica and minutia tested, not the folks taking the exam.

They Are Lazy

The residents of the class who just took these boards have worked very hard, if not harder than in years past. In my program,  some of these residents are the best since I started. Indeed, they have studied very hard for the board examination. But, by no means, should anyone call them lazy!

They Have Been Targeted To Fail The Boards

No, no, and again no. The ABR does not seek to fail more of any particular class in general; however, misguided any exam may be. Instead, I believe they have created a test that does not measure what it claims, minimum competency to practice radiology. The ABR did not specifically target this residency class taking this particular test.

There is No Way To Predict Who Will Pass The Boards

Interestingly enough, the Radexam pre-core exam did predict the outcome of the core exam results very well. Percentages on our pre-core Radexam mirrored the real exam almost perfectly. At least in my residency, it turns out that this test is far superior to the old in-service examination. I would love to hear the experience of other institutions as well since the Radexam is so new. Based on our experience, we will continue to take it more seriously. We will do so to make sure that residents have studied enough (and the right way) to pass the core examination.

Low Pass Rate And The Residents Taking The Exam

An exam is only as good as the material it tests. And, competent residents who perform well in my residency tell me about the many esoteric questions and minutia on it. Therefore, I squarely place the blame of the low pass rate on the core exam, and not the residents taking the examination. As I’ve written before, it’s time to start reworking the test and its questions. We need to change the material tested so that residents will remember useful content for years to come, not just spit empty facts on an examination and quickly forget.

And just as importantly, let’s stop putting all the blame on the residents taking the exam. Based on the judgments of our faculty, we already know that they are competent and will make great radiologists. We do not need a faulty test to tell us otherwise!

 

 

 

Posted on by

Minimal Effort And Maximal Gain: A Targeted Residency Approach

minimal effort maximal gain

Radiology residents, especially, are under the gun to complete their work efficiently. I mean, to learn what you need to know for the boards you have to read through umpteen books and a gazillion films, right?  So, who has the time to go through the motions of a bland long-winded study routine to get you through all the material? That would take way too long. Therefore, I want to give you some suggestions to guide you efficiently through all the subjects you need for radiology residency. So, here are some the basics you need to get through residency with minimal effort and maximal gain!

Targeted Reading

I can’t remember the number of times that I have talked about targeted reading in my posts. But, I will repeat it for the ten thousandth time. It’s that important. Every resident should read radiology books differently from other subjects. Remember. Pictures first, then captions, and then text. If you start from the text and go to the images, much less information will stick. So, please do yourselves a favor and do this the right way.

And, just as critically, make sure to emphasize case review series in your review process. Radiology without cases is like peanut butter without the jam (sorry for those of you that are allergic to peanut butter!). It just does not feel right!

Reinforced Reading

How do you get information to stick around in your brain? Well, you need to look at the same item from different angles. What do I mean by that? If you find a meningioma on a CT scan at work, first of all, make sure to look it up that night. Then, look at the same case on multiple imaging modalities. Perhaps, check it out on an MRI, a contrast-enhanced CT scan, or even a skull series if available. The more ways that you look at the same findings, the more likely you will recall the case when you need it!

Lots Of Questions

Don’t let the texts that you are reading become merely a bunch of random words. Just like any other time that you had to study for tests, make sure to phrase the text into the form of questions. And, I have some great ideas to help you along your way. My residents reported using several test question bank companies for study, especially around board time. But, it may not be a bad idea to use these question banks at any time during your studies to emphasize the materials.

The two companies that I hear assist the residents with fairly comprehensive question banks are as follows: Board Vitals and Quevlar. Both of these companies give you some great questions for the Core Examination. Now, you need to make sure to have learned the basics before. But, both Board Vitals and Quevlar will enable to get through the material that much quicker to get you where you need to be before the boards.

Group Learning

You certainly need to read a lot independently to learn the material that you need to know. However, you should also utilize your colleagues to maximize your knowledge. Going over questions or cases in groups with your fellow residents adds new perspectives on the same information. And, by golly, here you have another neural pathway to maximize what you retain!

Board Review Courses

I believe in learning from numerous different angles. And, therefore, I need to put a pitch in for Board Review Courses. Not all program directors believe in this approach. However, sometimes, it helps to step out of your familiar residency conference world and to get a fresh perspective. Different instructors and different points of view create distinct neural pathways for information recall. That is the reason I believe a board review course can work. I think it’s not a bad idea to attend one or two.

Minimal Effort And Maximal Gain

Don’t get me wrong. To be a great radiologist, you need to put in the hours. However, make sure that you utilize your time as effectively as possible. Why spend time that you don’t have? So, follow this approach to get through the material logically and efficiently. Who doesn’t like minimal effort for maximal gain?

 

 

Posted on by

Radexam- A Bridge To Getting Rid Of The Core Exam?

For years and years, programs throughout the country have been utilizing the ACR in-service exam as a way to find out if residents have been keeping up with the material. And, from my experience, the correlation of the test with the Dow Jones Industrial Average on any given day is higher than that measure. And, many program directors believe the same. Now, for the past year or so, programs throughout the country have been utilizing the new Radexam to drill down on radiology topics to check the same measures. But, is this exam all that it cracked up to be and what do we know about it? What would be the optimal exam if I had my druthers? Should we be using any monthly or annual review to test residents at all? Or, perhaps, we should eventually overhaul the current core exam process in favor of Radexam-like alternative?

What We Know About Radexam Currently

Unlike the previous in-service examination, the ACR created Radexam as a crowdsourced evaluation tool. Academic radiologists are constantly vetting the questions. Also, dissimilar to the in-service, the exam evaluates the resident based on her specific rotation. You will be able to tailor particular question banks to your individualized monthly requirements at your institution, whether modality or topic based. If you have a cardiovascular MR rotation, theoretically, you can create an exam that tests on that rotation. And finally, you can evaluate residents with this tool on a monthly basis.

After I have seen an exam from the batch, the test looks hopeful as a tool for making sure that residents are keeping up with the material. But, the only way to know for sure is to correlate the test with resident evaluations and the core examination. That should be coming to a theater near you soon!

The Optimal Exam

OK. Deciding upon the optimal exam is a tough one. But, let’s give it a whirl. Well, first and foremost, we have to remember the purpose of an examination for residency. And, no the target of an exam is not to correlate with board passage rates. Instead, we should be thinking farther down the road. Is the test evaluating residents on the skills that they will need to become a good radiologist? Test authors often get hung up on creating an exam for the exam’s sake and forget about this end purpose. If I were a test creator, I would have none of that.

What else? Well, I would create an examination such that if you were able to pass it, you could demonstrate to your government, colleagues, and patients that you have the necessary skills to practice radiology. Forget about curves and complicated statistical mumbo-jumbo. I would not care if the pass rate was 87 percent, 100 percent, or 2 percent. All I care about is that our residents have the abilities and skills that they need to practice. In the end, that is all the public should care about too.

Additionally, it would not happen at one sitting. No more travel to Chicago, Tuscon, etc. Instead, you would take it continually throughout your residency at your program as a way to show you have gradually mastered the competencies that you need to practice.

Finally, the exam should be relatively reasonably priced on resident budgets so that they can afford the fees to create it. Theoretically, this is a tough one, I know. But, with large amounts of student debt racked up over medical school and residency, it cannot be more critical.

How Does Radexam Match Up To The ABR Core Exam?

Well, this is the million dollar question that residency directors throughout the country are trying to answer. The success or failure of this exam hinges on this answer. Unfortunately, we don’t know the answer to this right now. But, I suspect that the correlation will be higher than the previous in-service exam. It does not take much. So, in that respect, you would be able to call it a success.

Advantages Of A Monthly Exam Versus Annual Exam

The more often that we evaluate a resident during residency, the more likely that we can closely follow the learning process. On the downside, however, no one likes to be placed underneath a microscope at all times. Additionally, testing creates an artificial environment that differs from the day-to-day practice of radiology and medicine in general. But overall, the more often you test, the better you can check to see if the resident is completing the learning tasks necessary to become a radiologist. And, that brings me to my next and final thought.

Should We Consider Overhauling The Core Exam And Replacing It With Radexam?

If the core exam, as we know it, does not satisfy many of the criteria for an optimal examination, should we consider looking for alternatives? I believe that the curt answer is yes. And, Radexam may fit the bill if we drill down on it a bit.

First of all, it tests residents more often than a core exam, so that it allows a more accurate evaluation of the resident’s medical knowledge and skills throughout residency. Second, you can have residents take it on a home computer in a more realistic setting instead of some impersonal test center of some sort, leading to test-taking anxieties. Third, Radexam is crowdsourced and overhauled continuously throughout the year. Instead, the core exam questions are vetted, but only at a few intervals. And, finally, you can attune the Radexam to your program. Not all programs teach the same material throughout the country. Moreover, not all the content on the core exam will be relevant to your future practice of radiology. Radexam may resolve that issue.

Final Thoughts About The Radexam

We are still not quite there yet when it comes to knowing about exactly how Radexam will play out. In any case, I am hopeful that the outcomes will match up with the medical knowledge and skills that residents need to learn. And, as a bonus, I also would like to see a better correlation of Radexam with the core exam outcomes. (which I think we will) If these correlations are high, perhaps, we should consider Radexam as an alternative to entirely replace the in-service that we use right now and maybe sometime down the road, the core exam. Although no test is perfect, many of its features are significantly closer to my optimal examination than the current ones. Let’s start the debate to consider our best options.

 

 

Posted on by

Cracking the Radiology Residency Application Code

application

Most medical students and residents do not have an insider’s insight into radiology residency and fellowship application and interview processes. Even worse, misleading advice and rumors cloud the process. One needs only to look at the average student or residency forum to see numerous conflicting stories and statements.

Only someone actively involved in the process can understand what you need to know when applying for a radiology residency. So, thankfully, you have come to the right post. I have looked at thousands of applications and interviewed hundreds of residents for positions in our program as associate program director. So, I will help you out by delving into the depths of the radiology residency application process. This article will give you the basics of what you need to know.

The Application

We could go through the application in one of many ways. But, I think the best way is to go through the different parts of the application from most to least important. This way, you will not squander your energy on the small stuff!

The Dean’s Letter

Few sections of the application genuinely differentiate one applicant from another. Dean’s letters happen to be one of those items. The reason for that: you will receive comments from attendings, residents, nurses, technologists, and secretaries that may say something negative. I can’t tell you how often we have parsed an entire application with glowing positives until we arrive at the Dean’s letter. And, then we receive coded messages in the letter, such as: was very shy during the rotation, but did see some improvement. Or, this resident was very independent. However, he did not seek help when presented with a challenging patient care issue. And so forth.

Additionally, the Dean’s letter is the only document (other than the boards) that compares the applicants to their classmates. Most medical schools have buzzwords indicating the residents’ rank in their class. Each one is different, but typically it allows insight into which quartile the resident resides.

Can You Do Anything About The Dean’s Letter?

Ok, so you have your Dean’s letter written in “stone.” And, at some institutions, you may hear that administrators say you cannot change the Dean’s letter. But usually, at the bare minimum, you can check the Dean’s letter. All medical students applying for a residency should scan their Dean’s Letter before sending out the application. I have seen Dean’s letters sent on behalf of medical schools with the wrong applicant’s information!

At other institutions, you can look at your letter before application time and potentially modify the document. If that is the case, you should undoubtedly check it for any hostile or questionable comments. And then, if possible, confront the department/person that wrote the statement. Ask if they could redact or modify it. If the writer is truthful, the person may decide to leave it there. But an attempt should be made, as this one negative comment can make the difference between high, low, or no ranking on a program’s rank list. Not infrequently, the admissions committees will obsess over one questionable comment. They will often spend countless painful hours perseverating over these “minor details.”

The institution may not allow you to look at the Dean’s letter at a few medical schools. But the school may allow your mentor or a faculty member to look at the document and possibly edit it for corrections. I can’t emphasize enough how important it is to increase your odds of being accepted to the residency of your choice.

The Boards/USMLE

Why are the boards important? Well, the boards/USMLE assess the ability of a future resident to pass the radiology certification examinations. We have noticed a strong correlation between lower board scores and difficulty passing the new core exam in our program. So, similar to our program, most programs take the USMLE score very seriously.

In addition, programs use board scores more as a baseline cutoff. Once you score higher than that baseline, it doesn’t factor much into the ranking equations. On the other hand, unless extenuating circumstances exist, failing and low scores usually place the application in the deny pile.

What About COMLEX?

For those of you that are D.O. medical school applicants, I recommend that you take the USMLE in addition to the COMLEX examination. Many radiology programs are unsure of the significance of COMLEX scores and don’t know how to factor the scores into the ranking equations/cutoffs. Applications with COMLEX scores alone may get thrown out of the interview pile entirely.

Gamesmanship

Even with all these factors, you can use some gamesmanship when it comes to the boards. If you have done very well in the step 1 boards, often, you may be able to get away with just sending those scores alone. You may want to delay taking step 2 USMLE. With high USMLE Step 1 scores, USMLE step 2 scores can only hurt you if they are lower. Of course, all this gamesmanship will disappear when the scores no longer exist on Step 1. At that point, Step 2 scores will most likely replace the outcomes on Step 1.

Finally, most programs look for/expect improvement from step 1 to step 2, especially with borderline step 1 scores. So be careful and take the step 2 boards very seriously. Invest in a review course if you need to.

Research

Nowadays, research can become a significant factor in getting an interview in a residency program. What is the reason for that? ACGME guidelines mandate that accredited radiology residencies have specific radiology research requirements for residents before graduating. Knowing that a resident has completed multiple quality research projects means that a resident can work more independently completing research projects. This knowledge of research reduces the burdens upon the department.

Furthermore, radiology research may demonstrate significant interest in the field. And, it provides an avenue for discussion during interviews later on in the process. We often look at an application, saying it’s pretty good, but the resident hasn’t completed any research. That may take the application down a few rungs.

Bottom line, though. It won’t take you entirely out of the running for getting a spot. However, it can be a significant asset in some situations.

Extracurricular activities

We look for two big red flags to avoid on this section of your application: those applicants that emphasize that they have participated in every extracurricular activity under the sun and those applicants who write down almost nothing. A resident who participates in everything suggests that he lacks focus, never investigating or accomplishing tasks in depth. On the other hand, a resident that engages in nothing but school tends not to be well rounded. These residents may not have outlets to disperse their frustrations during their four years of training. A residency director does not like having frustrated residents!

Impressive Extracurriculars

So what are some activities that impress the admission committee? : Interesting extracurriculars that show leadership potential, activities that demonstrate a depth of involvement, and activities that offer an ability to handle stressful situations and function independently. Some of the special extracurriculars that stand out in my mind that meet these criteria would be a student that started a Subway franchise successfully from scratch and made it into a big business, a student that participated in the Olympics, and a student that lobbied for Congress. These are people that tend to climb the rank list higher because their extracurriculars were memorable.

Not So Memorable Extracurriculars

What are some extracurriculars that don’t add much to the application? Those activities that everyone else does and do not suggest leadership potential. In radiology, those would include participating in a radiology club (Big deal!), participating in health fairs (Every medical student does it), and teaching inner-city kids (We see it all the time as part of medical school curricula!) Not that these activities are harmful, but they don’t add much at all to your application. My recommendation to you: find something you enjoy, hopefully, something unique, and stick with it during your four years of medical school training!

Recommendations

Admissions committees like to make a big deal about recommendations. You’ll undoubtedly hear that you need an excellent letter to get into a great program. But honestly, if you ask someone for a recommendation, it is unusual to find someone who will write you a nasty one. Students are going to ask attending physicians that like them. On the other hand, although rare, we see a “bad” recommendation as a significant red flag. It often means the resident that obtained the letter has a poor emotional intelligence quotient. Or she couldn’t find one attending that liked them- both significant issues!!!

Like the rare bad recommendation, great recommendations that raise the application within the pile to a higher rank are also unusual. For the most part, this type of recommendation stems from well-known entities that want the person in their program. Or perhaps, it comes from a close colleague that the radiology admissions committee implicitly trusts.

Recommendations rank relatively low in the application influence equation given the rare ability to change the application disposition.

The Personal Statement

Finally, I would like to talk about the item that medical students often perseverate on the most: the personal statement. The personal statement seldom helps an applicant and can occasionally hurt an applicant. After having read over a thousand of them, there are very few standouts. And, almost all of those that stood out were somewhat disturbing. I still remember an essay that emphasized a dead rabbit. It did not have any correlation to radiology whatsoever. I was concerned about mental illness in that student. We terminated the possibility of acceptance to our program immediately!

If I had to say one thing, I would advise you to be cohesive and relevant to your future career as a radiologist. Also, watch out for typos because typos suggest an inattentive personality, not a characteristic you want in a radiologist. Other than that, don’t fret too much about this part of the application.

Summary

Application for radiology is an arduous process with multiple pitfalls. Make sure you concentrate on those items that give you the most “bang for your buck” to send your application higher on the rank list. In particular, put particular emphasis on the Dean’s letter. Check it if you can. Correct it if need be.

And finally, don’t be that student with marginal board scores, no research, dull or no extracurriculars, poor recommendations, and a personal statement that stands out too much. If you follow my suggestions and try not to rock the boat, you should get into a great residency!

 

 

 


Posted on by

Maintenance of Certification (MOC)- A Controversial Necessity?

MOC

A groundswell of controversy about maintenance of certification (MOC) has been building slowly for the past decade. In truth, no quality evidence-based study has shown a link between quality of care and MOC. Therefore, multiple entities in the United States are abuzz, attempting to create anti-MOC legislation to prevent boards from gaining a legal foothold in states requiring MOC for practicing medicine. Some of you may hear about these issues in the press. (1,2) These issues are not just unique to radiology.

But before we discuss the individual controversies, we need to delve into MOC a bit further, especially for those just starting. What exactly is the maintenance of certification once you complete your residency in the United States? What do you have to do to satisfy the requirements? Why do you need to meet the requirements for MOC? And when do the requirements for maintenance of certification begin? Some of the answers to these questions are not so obvious. So, these are some of the questions I hope to answer in this post.

What is MOC?

According to the “experts,” maintenance of certification is a way to show that you are continuing to keep up with the educational demands of your specialty. Theoretically, it should ensure continued minimal competency to practice medicine. The American Board of Radiology and your state of practice require specific essential documentation for diagnostic radiology. For instance, the ABR requires 25 hours of continuing education credits (CME) per year, passing a test every ten years or completing online email questions correctly to certify competency, verification of state licensure, and quality improvement projects or leadership roles.

Individual states also require their primary means of determining competency to maintain licensure. When I first obtained my license in New Jersey, I had to take a required orientation course. Every year, I need to submit 50 CME credits each year. In addition, the state requires me to satisfy an end-of-life care course requirement every three years. Each state can significantly differ in what is needed to keep a license. Go to the site called mycme.com for more information on your particular state.

How Do I Get CME Credits?

Typically, radiologists can get continuing medical education credits in one of many ways. First, many online radiology society websites, such as RSNA and ARRS, develop education portals for radiologists to complete either articles or lectures. The radiologist then takes a short quiz they must pass at the end of the episode to document that he has completed the task.

Second, you can attend conferences at many locations throughout the country and then collect the CME credits at the end of the course. Usually, the conference presents the physician with a certificate of completed CME at the end of the meeting.

And then, internally within your hospital or practice, you can participate in tumor boards, conferences, etc. Subsequently, you can obtain the CME credits after documenting what you have experienced as long as the creators of the conference have applied for CME.

What Happens If I Don’t Participate In MOC?

Unfortunately, for most radiologists, it is not an option to forgo MOC. Most hospitals require certification by the ABR and state licensure bodies to maintain staff privileges. And individual practices often stipulate that you need MOC to remain in practice.

But, you may hear about other specialty physicians in the news who have not renewed their certification. Many of these folks are leading political and internal movements to eliminate the MOC requirements. Individuals and organizations are suing certification boards who are teaming up with insurance companies and hospitals. Some of these boards aim to make MOC a requirement for radiologists to get reimbursed for the interpretation of images. Usually, the physicians not participating in MOC have been practicing for a while, so they have the clout to abandon the MOC process.

When Do I Need To Start With The MOC Process?

Over time, the ABR requirements about when to start MOC have changed. The MOC process begins on day one since the ABR now considers MOC to be continuous. According to the ABR, you need 75 CME credits over three years of practice to maintain certification. That means you could theoretically begin CME on the first day of practice or wait a bit to start.

On the other hand, each state has different requirements for when to begin MOC. You should look up your state online to determine which rules are correct. Again, refer to the site called mycme.com, which outlines the specific requirements for each state. For the state of New Jersey (my state of practice), they give you a grace period of two years to begin CME after the first renewal of your state licensure.

Former Actions Against MOC

According to a Medscape article from 2017 (1), many state organizations have been banding together to prevent the overreach of MOC. This article documents many of the individual state medical society activities. I thought these activities were particularly fascinating.

To summarize some of the activities in this article, multiple state medical societies have attempted to pass anti-MOC bills in their states. Most of these attempts are in process or have been temporarily tabled. One state, Georgia, became the only state to pass a bill that prevents using MOC as a condition of licensure, employment, reimbursement, or malpractice insurance at certain hospitals.

At the time of the writing of the Medscape article, several states have initially failed in their attempts to pass MOC legislation. Three state medical societies (Arizona, Kentucky, and Michigan) created stipulations stating state medical boards “may not require a specialty certification or maintenance of a specialty certification as a condition of licensure.” However, legislatures did not pass the bills. Oklahoma became the first state to attempt to enact legislation to remove MOC as a requirement for physicians to obtain a license, get hired and paid, or secure hospital admitting privileges. However, at the last minute, the bill failed after significant lobbying by ABMS (American Board of Medical Specialties).

Other state medical associations are in the throes of creating anti-MOC bills. Both Tennessee and the Florida Medical Associations aimed to create bills to defeat efforts by the ABMS and FSMB to impose MOC as conditions for reimbursements and licensure. Finally, numerous other states, including Maryland, Missouri, North Carolina, Texas, Alaska, California, Maine, Massachusetts, New York, and Rhode Island, are trying to enact anti-MOC bills.

More Recent Defeat Against The Anti-MOC Movement

Most recently, in 2021, the federal court of appeals affirmed the dismissal of physicians’ claims against the American Board of Internal Medicine claims that challenged the MOC process. However, other litigation is still ongoing. 

Summary

Regardless of your stance on MOC, it is integral to most radiologists’ practice. It will be present in some form or another for a long time, perhaps in a more weakened state. Follow the current rules when starting, and you will get to practice radiology. Be a revolutionary against the system, and you may have difficulties. Either way, the final decision is up to you!!!

(1) Chesanow, N (6/21/2017) The War Over MOC Heats Up. Retrieved from http://www.medscape.com/viewarticle/881274

(2) Reese, N. (8/3/2016) MOC Exam: Take It Or Not? Retrieved from http://www.medscape.com/viewarticle/864922

 

Posted on by

USMLE Step III- An Impediment For Radiologists?

Over the past few years, we have been witnessing a new phenomenon that I don’t think is unique to our diagnostic radiology residency program. Incoming residents are either delaying or failing their USMLE Step III examinations. Some of this new reality may be related to the decreased competitiveness of radiology. However, what is interesting is that some of the residents that fail or delay the examination are not toward the bottom of their respective classes but rather are high performing residents with a good fund of background knowledge in radiology. That got me thinking. What is going on with the new USMLE Step III examination? And, should the examination be a prequalifying factor for obtaining medical licensure prior to becoming a radiologist?

According to the USMLE Step III website, “Step 3 content reflects a data-based model of generalist medical practice in the United States. The test items and cases reflect the clinical situations that a general, as-yet undifferentiated, physician might encounter within the context of a specific setting. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.”

If you actually take apart the content of this summary statement of the Step III boards, you will see that the goal of the examination is in no way applicable to the intellectual goals/medical knowledge necessary for being a good radiologist. Based on the responses of many of my residents that have already taken the test, the questions, and content of the test have limited applicability to the practice of radiology. Very few questions are radiology related and have clinical scenarios that would ever be useful background information for a radiology resident/radiologist. So, is it really warranted to have radiology residents pass such an exam in order to practice their specialty? What is its utility?

Furthermore, the concept of having an intern that trains for one year and practices independent medicine is outdated, to say the least. Almost no hospital or clinic would ever hire a physician without some sort of complete residency training in a specialty whether it be internal medicine, psychiatry, or radiation oncology, let alone radiology. The liability of a hiring physician without this training would be enormous. I, for one, would never let any of my family members see a physician with one year of internship training who had merely passed the Step III USMLE examination.

More relevant to us, radiologists and other subspecialists never practice independent general medical care. The clinical situations that undifferentiated physicians encounter is very different from the needs of subspecialist radiologists. So, why prepare a physician for an end goal that he or she is never going to realize?

All these issues, bring me to this final conclusion. Maybe we consider creating a new examination that is actually going to be relevant to the goals of the subspecialist and not the general practitioner. Perhaps, we should create two separate exams, one with a general pathway and the other with the subspecialty pathway in mind. At least, you would create a test with increased relevancy and with a practical end goal for the individual subspecialist that would help with their future career requirements.

It is time to rethink the requirements for resident physicians obtaining medical licensure since the present concept of practicing independent care as a physician after one year is outdated and dangerous. And, subspecialists have different needs from general practitioners. With that, the Step III examination should change accordingly.

 

 

 

Posted on by — 1 Comment

A Common Radiology Applicant USMLE Step I Misconception

Ask The Residency Director Step I USMLE Question:

Good evening. My name is Susana, a 3rd-year medical student, very interested in your radiology residency program. I would like to know, if possible, what is the average Step I USMLE score of your PGY1, to know if mine qualifies for your program? Thank you.

Susana

_______________________________________________________________________

Answer To The USMLE Step I Question:

Thanks for the great question! It’s a common misconception about how USMLE Step I board scores are used to rank applicants in the match. The board scores are generally not about the average score, but rather the minimum cutoff. The point of using the board scores to help with the match ranking process is to make sure that the candidate can pass the written core exam taken at the end of the third year. And, that is really the only role of the board scores. Most programs such as ours take into much stronger consideration the Dean’s Letter, interviews, and extracurriculars once the applicant has met that specific cutoff.

At our institution we use a cutoff of 220 for the USMLE Step I. However, we have made multiple exceptions over time. First of all, if you perform poorly on the Step I Boards but do well on the Step II Boards, we will often ignore the Step I board scores or average out the two boards scores. Again, the point of the boards for us is the correlation with passing the core examination. A good step II score proves you can pass the boards. Also, if there are exceptional candidates that have other special activities, have had extenuating circumstances for not doing well on the boards, or have proven themselves already by completing a rotation with us, we will on occasion forgo using the cutoff. As an answer to your specific question, if I was to take the average USMLE Step I score over the past few years, it would probably be somewhere in the 230-240 range. But, again I think the average number is irrelevant.

Hope that answer helps!!! Again, thanks for the great question!

Yours truly,

Director1

__________________________________