New report about the ABIM-Arora board review flap raises questions

---in my mind anyway.

It's from HealthLeaders Media.

So why do board questions have to be a trade secret? Is it about money? After all, according to the report the ABIM

...was forced to have workers spend day and night crafting new tests, spending countless hours and money to undo the damage.

Countless hours and money. But no, according to ABIM's CEO the reason is:

Each question crafted for the American Board of Internal Medicine board certification exam "is like a precious jewel," says Christine K. Cassel, MD, ABIM's President and CEO. It sometimes takes two years to form the questions, with the right precision and nuance that elicits medical knowledge sought, she says.

Wow.

She went on to say that there was an 88% pass rate in 2009, which makes you wonder about Medstudy's 97% pass rate.

Around 2000 people were identified as having taken the prep course and no one, not one person, notified ABIM, Cassel said, expressing disappointment that all those people saw unethical behavior and didn't report it. She maintained that the ethics breach was “not subtle.” If that's so how come none of 2000 attendees reported it? How bright was the line? Well, I don't know how explicit the pledge that candidates have to sign really is but here's the standard as described on the ABIM web site:

Each physician who signs up for an ABIM examination is directed, in writing, not to discuss exam content. In addition, before each test, physicians sign a ‘pledge of honesty’ to not disclose, copy, or reproduce any portion of the material contained in the examination and are warned that ABIM will impose severe penalties on any physician involved in efforts to provide examination question content to others.

Prohibiting discussion of “exam content” casts a pretty broad net. By that standard, comments like “they hit drug interactions pretty hard” or “you better know the screening guidelines inside out” would be prohibited. Granted that Arora was more aggressive and systematic in harvesting exam content and may be an egregious exception (we really don't know at this point), almost every “reputable” board review resource I've ever seen teaches about exam content in one way or another. How do they learn about the content? It may be mainly word of mouth, but they must get feedback. For that matter, many of the faculty of those courses have no doubt taken boards themselves.

I wonder what effect this will have on all the good courses and review publications out there. Will they be scrambling to revise their content? If nothing else, watch for the disclaimers.