CNN Look at Radiology Exam "Cheating" Misses the Mark

January 24, 2012

In reality any radiology resident or radiologist who has taken the oral or written board examinations knows the use of recalls occurs.

I read CNN’s article, Exclusive: Doctors cheated on exams, with some amusement. It sounds like someone just woke up a couple of weeks ago and asked, "Have you ever heard of this, did you know this was going on?" When, in reality any radiology resident or radiologist who has taken the oral or written boards examinations in the last millennium, or in this millennium, knows this occurs.

And, what was particularly amusing was that some of the individuals from the American Board of Radiology (ABR) who were speaking to the media and others, almost flatly denied or at least implied they had never had any direct knowledge or involvement in any of this. I can tell you that if there is a professor of radiology in this country who does not know that this occurs or has not actively and aggressively participated in this process, I would like to know who it is.

As a resident at a new radiology program 25 years ago, I did feel a little bit behind or at a disadvantage from residents across town at the more prestigious residency who had years of these types of recollections available to them. In fact, when I attended the six-week course on radiology and pathology correlation at the Armed Forces Institute of Pathology (AFIP) I found out this was common in nearly every program, and in most programs the professors knew about the practice and/or took active parts.

For example, in preparing residents for their oral boards examination, radiologists who also participate as oral board examiners will use and/or have used exact or nearly exact board cases for that preparation. And, when doing case teaching conferences for radiology residents and fellows, questions are quite frequently directed at ensuring they have the right answers and right differential diagnosis to pass the oral board examination.

In many college courses throughout the United States, old tests are frequently available directly from the professors or from other students to help prepare for the examinations. The age old practice of "recalls" stems from this. So, this is not something that was invented by radiologists, radiology residents, professors of radiology, or for that matter, physicians of any other specialty.

The real question is, "Does this practice in any way decrease the efficiency, effectiveness or the ability of any radiologist to provide a diagnosis or treatment to any patient at any time?"

I can tell you emphatically and absolutely the answer to that question is, "NO!"

The study of radiology includes a four-year residency almost always preceded by a one-year internship. This initial training process is nearly always followed by a one or two year fellowship program. In fact, I have participated in and/or been responsible for the hiring of radiologists for three large radiology groups (the smallest group had 88 radiologists at the time I left and the largest nearly 450 radiologists) and I would have to say that with uncommon exceptions, candidates for our positions were fellowship trained. This means the typical radiologist has had a minimum five years - and more commonly six to seven years - of training prior to entering practice.

So, the CNN "investigation" uncovered something that was about as secretive as the movie schedule at the local theater. And, overall this is a relatively uninteresting story about a relatively obscure field of medicine.

I say uninteresting because by itself it really says nothing about the quality of the education of the physicians who have been trained with this style of teaching for as long as recollection serves. I say relatively obscure field of medicine because typically radiologists aren't in the news.

So, why now? Is it just sour grapes from a few radiologists who felt they had to work harder? As I mentioned, being from a new residency we did not have these types of questions and assistance generally available. I do not feel this decreased other radiology residents’ quality and I do not question their ability to provide radiology and imaging services because of this difference. I also do not feel ill used for having had to work a bit harder to get where I am.

Or, is it an additional attack on radiology from the standpoint of the cost of medical imaging? Is it a left-handed pronouncement of, "Imaging costs too much, radiologists make too much money and by the way they cheated to get where they are."? I don't know the answers to these questions but it does make one wonder.

For me, I have known hundreds of radiologists during my career. The practice of radiology is sound and if I may say so, radiologists in the United States provide the best imaging and interventional services in the world. Biased?, you ask. Yup! And not afraid to say so.