The ABR Comes Around

The American Board of Radiology announced earlier this week that they would indeed be joining the civilized medical world and moving to a virtual exam solution for all future exams and maintaining the current proposed February and June dates for next year’s administrations:

We appreciate the constructive feedback regarding our 2020 exam schedule and recognize the significant impact that test postponements have had on our candidates, their loved ones and families, and their training programs. We have seen and heard legitimate concerns from candidates, program directors, department chairs, and other stakeholders, and have considered many options to safely administer our exams in the least disruptive fashion while preserving their integrity. Our deliberations and decisions were largely based on our obligation to accommodate those most affected by the pandemic. The health of candidates, volunteers, staff, and the public is our highest priority. In consideration of these concerns, the ABR is moving all currently unscheduled and future oral and computer-based exams to virtual platforms beginning in the first half of 2021, which is the earliest we can confidently deliver these exams without potential delays.

Good for them.

Seriously, I mean that.


And I don’t want to be needlessly negative (or do I?), but as I argued back in April, have said multiple times since, and was then subsequently joined by the entire field of Radiology and its many member organizations, this outcome was the only defensible choice. Nationwide travel for an exam is simply an untenable position right now. Hell, doing so for a computerized test was barely defensible before the pandemic.

Despite all the hemming and hawing and the repeated stance that virtual solutions were simply “not practicable,” the ABR will be moving forward with one of those unpracticable solutions anyway in 2021. It was inevitable, which makes the drama and delay wholly unnecessary.

If the ABR had read the writing on the wall back in March when the world shut down, they still may have not been able to keep the original June date. But they likely could have salvaged the initial backup November date for which every residency program in the country already planned around. That date was closer to the usual timeline and was likely fairer for the senior residents, who will now be forced to re-study and potentially re-broaden their practice as they return from early IR specialization or mini fellowships.

Despite the ABR’s official stance, the Core Exam is not a test you could just pass on the merits of radiology skill alone. The evaluations practicing rads take, the Certifying Exam and OLA, are both easier.

On the one hand, good on the ABR for at least planning to do the right thing. I look forward to seeing how they decide to accomplish this mission, one they originally said they simply couldn’t do. There are a lot of self-imposed boxes to check because “the inability to adequately control image quality, the testing environment, and security would significantly threaten the fairness, reproducibility, validity, and reliability of the testing instrument across all candidates.”

So, on the other hand, the situation was ridiculous. There was a bonafide revolt before the ABR came around to what should have been an obvious choice in the first place. Now that we’re here, the move away from centralized testing should be permanent.

It goes to show that while the ABR has added responsiveness to its toolbox, they have not yet independently demonstrated sound stewardship of our field. Stakeholders need to be willing to fight for every important issue.

I hope this is a turning point for the ABR and its testing mandate. I know the radiology community stands ready to provide constructive dialogue to help improve initial certification and MOC.

Explanations for the 2020-2021 Official Step 2 CK Practice Questions

The NBME released a completely new set of questions in March 2020, which is the first major update since basically 2015.

Last year’s set, which is completely different, is available and explained here. Due to the pandemic, the practice materials page has reverted back to the 2019 set for now, but you still have access to and can complete both sets. More free questions!

These are in the order of the PDF linked above.


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The Machinery of Skepticism

Carl Sagan, famous astronomer and author of Contact and Cosmos (among others), writing about “The Burden of Skepticism” way back in 1987:

It seems to me what is called for is an exquisite balance between two conflicting needs: the most skeptical scrutiny of all hypotheses that are served up to us and at the same time a great openness to new ideas. Obviously those two modes of thought are in some tension. But if you are able to exercise only one of these modes, whichever one it is, you’re in deep trouble. If you are only skeptical, then no new ideas make it through to you. You never learn anything new. You become a crotchety old person convinced that nonsense is ruling the world. (There is, of course, much data to support you.) But every now and then, maybe once in a hundred cases, a new idea turns out to be on the mark, valid and wonderful. If you are too much in the habit of being skeptical about everything, you are going to miss or resent it, and either way you will be standing in the way of understanding and progress. On the other hand, if you are open to the point of gullibility and have not an ounce of skeptical sense in you, then you cannot distinguish the useful ideas from the worthless ones. If all ideas have equal validity then you are lost, because then, it seems to me, no ideas have any validity at all.

Some ideas are better than others. The machinery for distinguishing them is an essential tool in dealing with the world and especially in dealing with the future.

That summarizes so much.

Flywheels and Doom Loops

Jim Collins, author of Built to Last and Good to Great, talking on The Knowledge Project:

What we found is that the most durable results happen as a series of good decisions that accumulate one upon another over a very long period of time, that create a massive compounding effect. And just like investing, where it’s buy quality assets you would presume to hold forever, then largely do and let them compound, this is the idea that you get a really good thing and you build strategic compounding over a very long period of time, and then you end up with this spectacular result.

He calls that the “flywheel effect.” And, as you might expect, there’s an opposite phenomenon:

Let me just describe the inverse of the flywheel, which is the doom loop. Something happens that produces disappointing results. And it could be that it was a random event or something just happened that was out of your control or something that you just made a mistake or you bungled something, whatever. You get disappointing results. But unlike really understanding why that happened so that you can correct, what happens is a company reacts without understanding. “Oh my gosh, we had disappointing results,” and often what happens is they panic. They look for a new direction or a new program or a new leader or a new acquisition or a new technology or something, and because that never really produces a great result, it produces a burst of false hope, but it’s like drinking a sugar drink as opposed to getting back to your core training. It doesn’t give you any accumulated momentum, which then creates another negative inflection, more disappointing results, which then more reaction without that understanding. Then another new direction, new fad, new program, new whatever, and then another failure to build momentum, more disappointing results, and then you’re in the doom loop.

If you’re honest, how many quality initiatives have you seen as a true flywheel of progress and not just a spoke in the doom loop?