ABIM responds to doctors sharing board certification questions

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

by Christine Cassel, MD

The American Board of Internal Medicine (ABIM) is sending a clear message to doctors this week: Compromise the integrity of the certification process and face swift and serious penalties.

ABIM responds to doctors sharing board certification questionsABIM is sanctioning 139 physicians for sharing, buying, or soliciting confidential, copyrighted questions that were part of the exam used to certify doctors in internal medicine and its subspecialties. We also initiated legal action against five physicians who were among the most egregious offenders.

I think all of us can agree that physicians are – and should be – held to an exceptionally high standard of clinical skill and ethical behavior – this higher standard is vital if we want to continue to have the privilege of voluntary self-regulation. Board certification, a process developed by physicians nearly 75 years ago, provides patients with assurance that the doctors they choose are competent and knowledgeable in their chosen field of practice. Through the actions we are taking, we are reassuring patients that they can continue to trust this process and, and physicians can continue to trust that it is a fair and rigorous assessment of their medical knowledge and judgment.

As reported in the Wall Street Journal – the physicians receiving sanctions participated in a New Jersey-based course that purported to help physicians get ready for board certification. Participants were encouraged to relay questions from memory to the company immediately after they took an ABIM examination. They were also provided with questions obtained by other physicians who had completed ABIM examinations.

Through an extensive investigation, we established that the physicians being sanctioned shared or solicited actual ABIM examination questions. [read some of the emails here]. This is a significant breach in the professional standards we require of all of our board-certified physicians and any candidate taking the exam. Hundreds of questions were compromised and immediately removed from our question pool.

As most physicians know, before sitting for an ABIM exam, every test taker agrees in writing to not discuss the contents with anyone. Certification candidates are clearly warned that ABIM will impose severe penalties on any physician involved in efforts to provide examination question content to others.

So this week we have announced the following actions:

· Physicians who disclosed, purchased, or solicited ABIM exam questions were notified that their board certification is being suspended for up to five years, based on the extent and egregiousness of their offense.

· Physicians who have not achieved certification and who disclosed ABIM exam questions or solicited them were notified that they will not be admitted to sit for a certification exam for a term of one year or more based on the extent and egregiousness of their offense.

· Certification is being revoked for any physician who systematically sought to undermine certification through the organization, collection, and distribution of ABIM exam questions.

Our investigation revealed that the course operator repeatedly told participants that they were receiving actual ABIM questions and requested participants to send questions to the course operators after their exam. Although we do not have evidence that most physicians complied with this request, none notified us that this was happening – and all should certainly have known it was “against the rules.” As a result, any physician who took the course will receive a letter expressing our very serious concern about their failure to notify us about the questionable activities in the course.

We are also increasing our sizeable security and investigations procedures, and adding staff to monitor activity and conversations on websites and in chat rooms.

Sharing test questions from memory is a serious problem that threatens the integrity of all standardized testing. It is grossly unethical, and ethics are critical to the practice of medicine and are the foundation of a successful doctor-patient relationship. The Board and leadership of the American Board of Internal Medicine took swift and decisive action in underscoring that unethical behavior from physicians seeking board certification will not be tolerated.

Christine Cassel is President and CEO of the American Board of Internal Medicine.

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  • anonymous

    Kevin is so diplomatic with his headline: “sharing” certification questions. Cheating is more like it, LOL.

  • http://supremacyclaus.blogspot.com Supremacy Claus

    If 90% of candidates pass, why bother cheating? It may be easier to just study a bit more, than to hussle to get the questions.

  • The Happy Hospitalist

    Dinosaur actions by a rapidly changing practice environment. Imagine the fear concierge medicine must envoke in the ABIM. Patients paying for direct care. No ABIM exam necessary. Patients won’t care

    Spying on chat boards. Seriously? That’s what the thousands of dollars go to

    Perhaps once bundled care with hospitals goes through recertificatipn will become irrelevant and the ABIM will cease to exist as giant security force of fear this post represents itself as.

  • Bobby

    “Although we do not have evidence that most physicians complied with this request, none notified us that this was happening – and all should certainly have known it was “against the rules.”

    So they are acusing people without evidence???

  • anonymous

    is the certification to establish competence or excellence? because it is being used to establish competence by the insurance companies. the exams are way beyond basic competence.

    is there any grounds for antitrust issues to be raised with regards to board certification? i would love to see the abim require any one working with them to actively maintain certifications, and not just geriatric certification but also the internal medicine certifcation, even if grandfathered in. after all, they should be the ones demonstrating commitment to the process of maintaining certification. i would hazard that a lot of the academic subspecialists who comprise their committee members would not be inclined to take the time to study so that they could pass–the same time pressures that challenge the rest of practitioners.

    i guess the board has broad discretionary powers.
    the physician community should think about whether they want to allow this board to have so much oversight on these certifications which are increasingly being required for hospital and insurance credentialing. if as a community they just all stopped their certification renewals, they could save tens of thousands of dollars (each). this money could be spent on cme or other educational activitiies more relevant to the individual physicians day to day practice.

  • Lars Michaels

    Everyone who attendended, or even registered, got a letter from the ABIM yesterday. In it, everyone was preemtively acused of not informing the ABIM that Arora was sharing board questions, whether they were aware of it or not.

    ABIM also states that it will place this letter in their files. This is completely insane. How can you get a letter like this just for attending a board review course and acused of something you did not do?

    Even in the article written above, they said that they did not have evidence that most physicians complied with sharing information, but how could they just acuse everyone like this and place letters in their files and get away with it?

    • madhusree singh

      @ Lars- I absolutely agree with you- I got this letter as well. the nerve of ABIM, guilt by association here. I attended the Arora Board Review course because every body in my east coast residency program did so. I left me young infant in the uncertain, so I thought, care of my husband for a week, to study. I did not promise to do anything unethical and did not do anything wrong and ABIM has the nerve to send me this letter. WOW! its like being in kindergarten and the whole class is being punished for something one child did. Where is the logic?

  • anonymous

    I am fairly appalled by the whining here. The Journal says that physicians attending the couse were TOLD that the questions being used in the course were actual exam questions and they should also share questions after they took the test. That is cheating. The article says the ones being sanctioned are the ones they have evidence against. Everyone else who took the course is just guilty of not speaking up and is not being sanctioned (but getting a hand-slap letter in their file). I agree they should have spoken up. I am also not sure I would have spoken up, either. But I think ABIM’s actions are correct. If I cheat on certification, do I deserve my patients’ trust?

  • Reflex

    I wonder if the ABIM feels that after a test everyone taking it should have their memories erased so they don’t remember any questions? After all, that would be cheating if they need to re-take the test.

  • Curious

    I agree with what everyone else is saying on this as well as other blogs.. the use of phrases such as “board type” questions and “i have seen questions like this on my old board exam” are very frequently used when helping residents and students learn “high yield” facts while preparing for their board exam. This is mixed into board review and didactic teaching sessions as well as during bedside teaching rounds with patients. In addition almost ALL board review courses offer similar questions and/or concepts that have appeared on old exams… Some of these very board reviews are attended by entire residency programs at the recommendation by their leadership (program directors, department chair, attending physicians).
    Arora’s specific board review was attended by thousands yet only 139 residents received sanctions (suspensions/revoked certificates). ABIM states that Arora advertised that his course material provided “actual questions from old exams” and that course participants were well aware of this fact. ABIM states that this constitutes “cheating.” and “unfair advantage” for the board certification exam. If that is the case than shouldn’t all these thousands of physicians have their board certifications brought into question and be subject to the same judgement that they imposed upon these select 139 physicians? (Not that I agree with this). Or maybe ABIM really does understand that the concept of “board review” is just exactly that, reviewing internal medicine in general with a focus on high yield “board relevant material” that in all likelihood has appeared on old examinations…. Obviously some other agenda is going on here……Is it about $$ as others have stated, I’m not sure. You have tarnished the reputations of these 139 physicians and in the process disheartened and lost support from us… your community of physicians. You have reached settlement with Dr. Arora. Please reconsider the harsh and unnecessary actions you have taken against our 139 colleagues and the possible thousands of others whom you have sent letters of reprimand to….

  • http://www.talktoyourunconscious.wordpress.com BobBapaso

    Pilots have a better safety record than doctors. All possible questions on pilot certification exams are published ahead of time so the candidate can study them and learn what he is supposed to know. Passing a test on paper does not insure a good or safe pilot or doctor. Pilots then fly with a pilot examiner. If they don’t offend or terrify the examiner seriously they are allowed to carry passengers.

  • Sp1nDoc

    This is indeed appalling. Almost every board review I have ever considered attending or actually attended purports to prepare the attendees by using “board-like” questions. While it is clear by the emails that certain examinees when beyond the pale by their actions, it is far from clear that every attendee should be castigated.

    But, this whole charade is really a joke. Like Happy points out, the cheese has moved. This proves that the ABIM uses proprietary questions of a rare and uncommon nature while the review boards play a cat-and-mouse game to identify the proper trivia so that attendees may pass. The Board now certifies that they can pass a trivia test, nothing more or less

    And what does this have to do w/ real life? Absolutely nothing. Unless you are a surgeon or ER doc, most issues in medicine are not solved by simple recall. You talk to your peers (cheaters!) open books (shocking) and even surf the Internet (no way!). A proper exam would allow ALL of the above to replicate real practice. And let me tell you, with all those resources, there are ~still~ a few bad apples who cannot practice medicine.

    While excellence is important, re-certification ought not to ensure that certain candidates can pass a trivia test w/ transient knowledge that is just as quickly purged. It ought to aim to identify individuals who cannot practice despite abundant resources … and rather than “Pass / Fail” them, it ought to use the vast millions they have (check out GUIDESTAR.ORG) and take responsibility for remediating those individuals so they can continue to practice good medicine …