A Shameful Silence Over Physician Exams

Joe Cantlupe, for HealthLeaders Media , June 17, 2010

The Arora Board Review's principal, Rajender K. Arora, MD, has surrendered his certification to perform the tests, according to the ABIM. In a court filing, ABIM alleged that Arora and other associates improperly disseminated copyrighted test questions. Physicians paid between $1,000 and $1,495 for the Arora Board Review courses.

The questioning in the ABIM's board certification process evaluates what it terms the "knowledge, skills and clinical judgment" of participating physicians and "assures that those who are certified have demonstrated the requisitive expertise to deliver excellent patient care in internal medicine."

"Every single one of these questions is like a precious jewel," Cassel says. "We get a group of experts from all over the country who come together to write these questions and then edit, and have them have them pre-tested and tested to make sure everything is valid," she says. "It takes two years to make one question that works. It's a huge amount of staff time. Every one of those questions is very valuable, and hundreds of questions were exposed."

A sample question used by ABIM, and provided to HealthLeaders Media, begins:

A 14-year-old boy noted swelling of the right arm and had 15 minutes after shop class . . . "

The Arora question starts:

A photograph of a white 14-year-old boy is shown with swelling of his right forearm that developed after attending a class on wood chopping . . .

Generally, investigators for ABIM found in this question and others that the Arora question "is almost identical to the ABIM question and contains the same unique fact pattern."

Physicians who solicited or shared questions from Arora Board Review could be suspended for at least one year or more, based on the seriousness of the offense.

"Thousands of physicians go through the test every year and almost do it honestly by studying and learning what they need to know," Cassel adds. "It made me feel dismayed and sort of sickened, because it's my profession that I care deeply about and we set a standard for ourselves, what we are doing for patients and the public."

The heartache may not be over, though.

Because of what happened, the ABIM is conducting an investigation of other testing services, Cassel says.

"We have ongoing surveillance," Cassel says. "We have increased this. We do scan all the review courses as well as the blogosphere. We do have ongoing investigations of a couple of additional programs, but nothing to suggest anything like this."

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Joe Cantlupe is a senior editor with HealthLeaders Media Online.

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