Review courses and board exams

Four years ago, I wrote a post called "Hints for new residents." Among my 15 tips was this: "Read, read, read. This isnt like school. You cant cram for your boards. You can’t learn 4 or 5 years’ worth of material in a one-week review course. You have to learn it as you go along."

Just published online in the journal Surgery is a paper entitled "Review courses for the American Board of Surgery certifying examination do not provide an advantage" by four officials from the board.

They surveyed new surgeons who took the certifying (oral) exam, 1067 for the first time and 329 who had previously failed the test, during the time period from October 2012 through June 2013. The overall response rate was 90%.

The pass rate for first-time takers was significantly better than that of repeaters, 82.1% and 72.6% respectively, p < 0.001; 77.9% of all examinees took a review course—76.1% were first-time takers compared to 84.6% of those repeating the exam, p = 0.002.

From the paper: "The overall CE [certifying exam] pass rate did not differ between those who did and those who did not participate in a review course (82.7% vs. 78.9%; p = 0.22)."

The results were controlled for sex, US or international med school graduate, written board exam scale scores, average written board scores over the last five years for the candidates program, and size and type of program.

The review courses were also analyzed, and the authors found that attending any one of the specific courses failed to predict passing the certifying examination. The only significant predictor of passing the certifying exam was the scale score of the candidate on the written examination.

The authors concluded: "On the basis of this survey, there was no evidence that participating in a board review course provided a benefit to passing the CE of the ABS."

The work was presented at a meeting, and the transcribed discussion was also published. The assigned discussant, Dr. Michael Nussbaum, said, "As a long-term program director, I really strongly believe that preparation for the CE is a 5-year process, not something that can be taught in a short course or crammed for."

I am pleased that the board and the discussant agree with what I said four years ago.

However, it is not clear from this paper that review courses are of no value when preparing for the written board examination. The paper said the score on the written examination correlates with passage of the oral examination. If a review course a helps candidates pass the written exam, then indirectly, a course might have a positive effect on the outcome of the oral exam.

Another problem with the paper is its failure to separate prep courses for the written and oral exams. One would not expect a course directed at the written exam, which is more of a multiple choice test about remembering facts, to help with the oral exam, which focuses on a candidate’s judgment and maturity in managing hypothetical patients.

The authors noted that only 29% of candidates for the boards in took review courses in 1990, and the courses are expensive.

Should the nearly 80% of candidates who took courses 2 years ago not have done so? Unfortunately, this paper does not conclusively answer the question.

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A medical student in Cuba is looking for advice

Someone writes: I am trying to help a friends brother who is not a US citizen and currently a medical student in Cuba, and I came across your very informative web site. The brother most likely is going to be able to come to the United States in the fall.

My friend is wondering if he should complete the last year of medical school there in Cuba or come here and continue on. It seems like there is no benefit from completing med school in Cuba, given the difficulty to be licensed in the U.S. And the difficulty in getting a residency position.

Does any of the course work from his studies in Cuba transfer over to U.S? Is it likely that hed have to get a bachelors degree here before ever going to a U.S. Med school? My friend says that he has an outstanding record in the Cuban medical school, speaks excellent English, does well on tests, etc. Any advice you could give?

As far as I know, no medical students from Cuba have transferred to a med school in the United States recently or possibly ever. Regarding your questions, I can only give you my best guesses.

I doubt very much that a course from the Cuban medical school would be accepted here in the US. US med schools that accept a few transfers from Caribbean schools like Ross or St. Georges usually take those students at the beginning of the third year of medical school.

A few schools are doing combined BS/MD degrees in five or six years, but I dont know of a single US school that would take a student directly out of high school into a 4-year program.

A possibly more reliable way to become a physician in the United States would be to graduate from an American university, take the Medical College Admission Test, and apply to med school.

Last month, the ECFMG posted this on its website: "The ECFMG is pleased to announce that it will resume processing of service requests in relation to applicants from and institutions in Cuba. As previously announced, ECFMG was not processing such requests, pending approval of its license application for Cuba by the Office of Foreign Assets Control (OFAC) of the U.S. Department of the Treasury. Today, ECFMG was advised that OFAC has approved the license application."

There are 14 medical schools in Cuba. I do not know if any or all of them will be acceptable to the ECFMG or what position residency program directors will take on applications received from students in those schools. Many current offshore graduates are having problems obtaining residencies in US programs. What will happen with the addition of 14 more schools with an unknown number of graduates is anyone’s guess.The fact that he is a non-US citizen is not helpful.

One of the 14 is the ELAM medical school which has 19,550 students. Wikipedia says it is accredited by the ECFMG and the Medical Board of California.

It is not clear how that many students can be clinically trained in a country with only about 11 million citizens and 13 other med schools. For comparison, the US, which has 30 times the population of Cuba, has 140 allopathic medical schools with about 80,000 total students.

I dont know if Ive clarified things for you or made them more confusing. Your friends brother is going to have to decide for himself what he wants to do, but if he is a truly outstanding student, maybe he should stay in Cuba and finish his education. However, he must understand that there is no guarantee he will be able to obtain a residency in the US, and no residency means no ability to be licensed and no way to practice medicine here.

If any of my readers have other thoughts, I hope they will comment.

Addendum on 8/20/15 at 11:25 a.m. The medical student is not a US citizen.

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