Current Issues in Dermatopathology
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Monday, October 29, 2012
The Boards
In the last few months, there have been quite a few comments and articles about the issue on how the Board examinations are conducted in the United States. The issue came to light, when a radiology resident filed a complaint with the American Board of Radiology, about the use of recalled questions from previous Board examinations. Most residents in Dermatology, Pathology and fellows in Dermatopathology in the last few years, have had open access and used old Board questions as part of their studying materials. How this is happening? Well, most residents, after taking the exam will go to their hotel rooms and try to recall as many questions as they can, first in order to get an idea of how they have performed in the test and second to pass the questions to their junior residents or fellows. There are also Board review courses, which are designed to prepare residents and fellows to pass the boards. Many of these courses use old questions as part of their review material. Physicians who have participated in the Advisory Board committees are often asked to be part of the faculty for these courses. The issue goes even further, many commercial laboratories who want to get new graduates to send specimens to them, often advertise that Doctor so and so, who at some point was part of an Advisory committee, will come to your program and spend a few hours with the residents and prepare them for the Boards. Applicants are asked to sign a statement that attests that they will not participate in copying or sharing Board questions. The Boards of Pathology and Dermatology are trying to enforce this policy, threatening residents and fellows with different types of punishment, if they are caught sharing these information. But, is this practical or it is time to review how these Board examinations are conducted. What is the purpose of the Boards? Well the Board examinations are a suppose to measure competency and assure that anybody who passes the Boards is competent enough to practice on their own. Are the Boards of Pathology, Dermatology and Dermatopathology doing that? I am not so sure. Throughout the years, I have observed, that marginal residents and fellows who are “very good about taking test” will pass the Boards and sometimes residents and fellows who are extremely competent will fail the Boards. The Boards keep recycling questions for many years and in many cases, there are questions that are not pertinent to the practice of Medicine any longer and still appearing in the tests. Many of the questions in the test are about facts that fellows and residents learn for the test and forget after 48 hours. Because of the statistical values, it appears to have the same weight missing a diagnosis of melanoma, that not knowing what are the genetic alterations in many obscure syndromes, which can be readily obtained though a Google search. So what is the solution? Perhaps not recycle questions older than five years, this way the number of questions circulating in different programs will lose their value, almost immediately. Second, although this solution may be utopical, is to have a practical examination with real patients in Dermatology, live specimens in pathology and dermatopathology. That way we will make sure that the “Board Certified” Dermatologists, Pathologists and Dermatopathologists are truly qualified for the practice of their specialty.
About the Author

Omar P. Sangüeza, MD
Omar P. Sangüeza, MD is a Professor and the Director of Dermatopathology at Wake Forest University School of Medicine, and the Editor-in-Chief of The American Journal of Dermatopathology—the Journal of the International Society of Dermatopathology (ISDP). He serves on the Board of Directors of the American Society of Dermatopathology and is a member of the Advisory Text Committee for Dermatopathology. He is Past President of the ISDP, and is certified by the American Board of Dermatology and the American Board of Pathology: Anatomic Pathology & Clinical Pathology.

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