Monday, June 14, 2010

ABIM exam controversy

Bob Wachter reports this:

As a member of the executive committee of the American Board of Internal Medicine, I can’t provide too much of the inside scoop, so I’ll mainly point you to the published descriptions of a remarkable case: that of one Dr. Arora, who ran an ABIM board review course with a difference.

The difference was that attendees of the Arora Board Review were allegedly shown actual questions from past exams, fed to Dr. A from prior test takers – who shared dozens, and, in some cases, hundreds of questions.

So, the ABIM is sanctioning some docs and suing a bunch of people.

Understand that these questions were harvested from past exams. It's not as if someone hacked into the system and provided, ahead of time, questions that were going to be on the exam.

I'm struggling to understand this but it appears that there were three issues here: ABIM considers its questions to be proprietary; discussing exam content is a violation of terms and conditions to which candidates agree when taking the test; and, in the minds of some, cheating.

The last one is the hot button issue. But is it really cheating? College kids do it all the time and it's not considered inappropriate. In fact, some profs encourage it by posting old exams on the web. (For example, here's where MIT posts a lot of its old exams).

Even assuming they should have known better, given the terms and conditions of the ABIM exam, did Arora and all its course attendees really know they were doing anything wrong? You have to wonder, given the fact that they were so open about what they were doing. The WSJ Health blog, for example, reports (my italics):

The physicians were identified from paperwork and emails collected from a board review course sued by the ABIM last year; the organization alleges instructors bragged that the questions covered in the course were real — acquired from previous test-takers — and then encouraged class participants to send in their own recollections of what was asked after their exams.

This sounds to me more like a case of “teaching for the test” than out right cheating. Granted Arora's efforts may have been uniquely deliberate and open compared to most (Bob says we don't know the inside scoop!), but all board review resources I've seen do this to one degree or another. (By the way, Arora isn't the only outfit ABIM has taken to court over this issue----more on that in another post). ACP's MKSAP, for example, has a companion resource for board prep. I've browsed one of my colleague's copies and it teaches the test in no uncertain terms. It's full of pointers about right and wrong answers, traps that commonly show up on exams, and testmanship. In fact it stretches ones imagination to believe its content has not been influenced by experience with ABIM exams! This might be a good time to point out that the ABIM has a somewhat cozy relationship with ACP and MKSAP when it comes to certification and maintenance of certification. More on that later, too.

Grunt Doc weighs in here.

Disclosure: I passed the ABIM exam in 1978. Like others who sat for boards in that era I'm grandfathered in. To prepare for the exam I spent a year plodding through Cecil's and picking up as many pearls as I could from my residency mentors. I did not attend any review courses or use any board review products before I certified. Since that time, in order to keep up in Internal Medicine, I've attended several courses and used MKSAP along with many other resources.

1 comment:

Anonymous said...

I think you have a misconception about the ABIM examination and assume that a brand new test is developed each year. In fact, the ABIM creates each examination by selecting from a large pool of questions, and a question may be re-utilized in multiple years. This is necessary because of the time it takes to test and validate each question before it is used officially. Thus, physicians studying off an old ABIM exam will see some questions that will be on their actual exam.

Regardless of the above, the individuals sanctioned by the ABIM signed a pledge of honesty and then violated it. It doesn't matter whether they viewed their actions as dishonest.