Mammogeddon: Yes, the conclusion

This is my fourth (and final) post about the little snafu surrounding the mammography portion of the ABR Core Exam last summer.

• I wrote about what happened here.
• I wrote about what the response was here.
• I wrote about the proposed solution here.

Now, we’ll finish with how that do-it-yourself online module went.

Logistically, it went great. By all accounts I’ve heard, people were able to log in from the comfort of whatever chair they were sitting at and take the module. The content was reportedly pretty much as expected for a Core exam mammo section, with the possible surprise for some of the inclusion of physics and non-interpretive skills (which are, after all, folded into every core exam section).

No surprise there, because as you might recall, ABR Executive Director Valerie P. Jackson had told examinees not to worry (emphasis mine):

The ABR has also heard from several residents who are concerned that they now need to completely re-study for the breast imaging module. As the ABR’s executive director, I (Dr. Jackson) personally reviewed the breast questions on the new module to modify any material that might not be visible on a monitor that is not high resolution. Although I am a breast radiologist, I have not practiced any clinical work or studied for an exam in more than three years. I found the content to be straightforward and inclusive of the important breast imaging concepts that candidates will most likely have retained from adequate initial exam preparation. Extensive re-study should not be necessary.

The invitation email went out July 27 and registration closed August 11. The module was offered on September 7 and 18, and the results were available on September 28.

As the make-up module was taken on the honor code, we’ll never know if anybody cheated, but it appears at least that no one was caught. On the plus side, we can applaud the ABR for not trying to install any spyware on examinees. Big brother was not invited to the party.

While the module took place several months after the usual pretest studying frenzy, reviewing the content for just one section, particularly mammography, was a stressful but probably not particularly tall order. I imagine nearly everyone took the section honestly.

Now, if you remember, the amusing part of the entire endeavor is that the ABR has admitted in the past that performance on the mammo module (or any individual section for that matter) essentially does not matter in terms of passing the test. No one has ever failed a single section other than physics in the years since the Core exam was first administered.

So, given several years of history to temper expectations, are the results of the module as expected? Did everyone pass?

Yes and yes.

I actually asked the ABR via email what the results were, and I got the impression that they did not want to tell me the specific truth because after a delay of about six weeks they gave me the default phrasing they love to use when discussing exam results:

In regards to specific details such as passes and fails for the breast category, the results for this breast imaging module were inline [sic] with the results from previous ABR exams.

…which means that everyone passed, which they later confirmed in a follow-up email.

I, for one, do not understand the ABR’s resistance to discussing exam results. For example, while the results for the Core exam are more or less released annually, the results of the Certifying exam have never (to my knowledge) been disclosed publicly (e.g. see the official scoring and results page). One presumes that the most likely explanation is that the certifying exam pass rate is 100% and that the ABR is concerned people might question the necessity and utility of an exam with universal passage (but that they also don’t want to make it hard and anger a bunch of already-practicing radiologists who are doing just fine thank you).

But we’re not fooling anyone here. The issues with both initial certification and MOC are neither unique to radiology nor subtle. Transparency and accountability should be the sine qua non for a medical specialty board. And yet.