Nearly two-thirds of ľֱ readers are very troubled about recent allegations of radiology residents cheating on their boards. But is reviewing old exam questions really cheating?, they asked.
Of the nearly 2,000 people who voted in last week's poll, 62% said they were "very" concerned. The rest of the voters were equally split -- 19% versus 19% -- in being "somewhat" or and "not at all" concerned.
Interestingly, though, many of those who commented believed the so-called infraction did not qualify as cheating.
The original article detailed how the American Board of Radiology (ABR) initiated changes to its certification exams so that test-takers have to rely less on memorization and more on concrete skills. The changes were in response to criticism that residents routinely access a repository of questions from old exams that previous takers had memorized and recalled.
"This is not cheating. All they are doing is reading and memorizing past questions," was a common refrain among the commenters.
It's "standard practice" and not cheating to get help from previous test papers, readers said.
"If reviewing prior questions for exams is wrong, all elementary and high school teachers who give students practice tests for state exams should be arrested," said one doc, adding that "all exam preparation books and courses for everything from SAT, ACT, AP classes to GRE, MCAT on up should also be illegal."
Some might find it hard to argue with that logic, but others did not.
"Cheating is cheating, regardless of how you justify it. It shows poor judgement and a lack of integrity," one reader bluntly put it.
Another echoed the words of Gary Becker, MD, ABR president and CEO, to support his opinion. "When the president and CEO of your board states that studying from the bank of past questions, or relying on the recalls, is inappropriate, unnecessary, intolerable, and illegal, you need to surrender your cherished archive of old exam questions and films and, more importantly, explicitly state disapproval of the established (mal) practice."
Equal access makes a difference
Would it be cheating if everyone had access to the recalled questions? Several readers apparently thought not.
"The key is whether those repositories of memorized questions from past exams are accessible to all the exam candidates. If not, then those who have access will have an unfair advantage over the others who don't." Although this reader did not explicitly state it, it seems his or her opinion is that access to the questions in the first place is not cheating. Other readers stated it more clearly.
"Studying questions and answers of old exams is a good review of the subject and should not be considered as cheating," a doc named Solomon wisely said.
One reader put the blame on the "biased" setup question posed by ľֱ, which supposed that cheating was in fact taking place (see the original article, please).
"I suggest," the reader wrote, "that had the question been stated as, 'How concerned are you about residents having access to and using questions and answers from previous exams as study material in preparation for their boards?' it would have presented a more honest case and would have led to quite different survey results."
There was a gaggle of comments that suggested the boards don't necessarily reflect whether one will make a good bedside physician. In this specific case, however, diagnostic radiologists are rarely bedside physicians.
One nurse described a fellow student with a photographic memory who "was a lousy bedside nurse and after a brief stint on the ward, she wisely sensed her inadequacies and went back to school for a higher degree so that she could teach," lending credence to the cliché "Those who can't do, teach."
This nurse commenter recalled another fellow student who had to take her boards three times before she passed, but was "an excellent bedside nurse."
Another reader added this: "I'm not sure how relevant this is when we have no reproducible data that proves board certification results in more competent, more caring, and more efficient clinicians. What we do know is that it serves to economically enrich the credentialing boards."
But this reader did end his comment on a redeeming note: "That said, cheating raises questions about personal ethics in a profession that promotes ethical decision making" (Shouldn't every profession promote ethical decision making?).
Even if radiologists aren't at the bedside consoling patients, they are part of the hallowed medical profession that often deals with life and death situations, and "if they'll cheat on their boards, they'll cheat on anything," said one doc. "It's not good for the profession, for the patients, or for society."
How do we know, a reader asked, that those who rely on question banks to pass their boards are actually qualified to interpret x-rays, which demands accuracy? "Reviewing material to take tests is prudent but getting the actual test answers to the board questions is totally inappropriate."
Cheating's many sides
One of the nuances in which readers defined cheating is whether the (ill-gotten) material is in your head or in your pocket.
"As long as the test questions and answers are not open in front of them at the time they are testing, it's okay by me," said one.
"It's not cheating unless they bring the 'knowledge' in with them on paper, or other external memory device," said another.
This reader added that the Federal Aviation Administration publishes hundreds of questions for pilot exams, "then it selects a few to be on the current exam." Apparently, the Department of Motor Vehicles does the same.
"If the doctor has memorized all the available questions and has enough information stored in his head to correctly answer them without help of external memory, he is safe enough to 'fly'," this reader concluded.
"Cheating is a matter of integrity. If you cheat, you have no integrity and certainly should not have the privilege of caring for others. The problem is, how do we define and identify cheating," asked one reader.
This commenter defined cheating as having access to "proprietary" materials, adding that today's digital age enables the easy publication of such resources. But other readers reminded us that such recall of questions is as old as, well, phrenology.
Perhaps society is reaping what it has sown, commented some readers.
"This is inevitable within our culture of overachievers," said one.
And another seemed to sum up our culture all too sadly: "All that was done was recollect the written board examination questions soon after the examination was completed. They were never sold for profit!"