Wet Read: Back to the Future

“Some of the worst mistakes in my life were haircuts.”

— Jim Morrison

How many of you remember the oral boards? Huh? Do you?

Remember the weeks to months of practicing cases, learning the little signs that made a case an “Aunt Minnie”? Remember how many times you were left standing at the viewbox with that brain-dead look on your face, staring at a case that not only didn’t resemble Aunt Minnie, but looked instead more like her ugly niece, Mildred? Ha! Remember how stupid you felt?

Remember practicing your 2-3 minutes of knowledge about an entity so you could hopefully nail that 72 and move to the next exam room with a clear head? Even better, remember the Executive West at breakfast time? Remember the examiners in the hallways and you looking at the floor to avoid eye contact as you slithered towards the gathering room—or as we all thought of it, the slaughterhouse entrance? Do you remember that EVIL hotel? I still think there had to be at the bottom of that heinous pool in the courtyard the bodies of countless candidates who had chosen to plunge in after a particularly bad performance.

Here’s why I bring this up. We’re several years into the new “system,” and I miss the oral boards. And, I think many others do as well. And for good reason – we’re raising the young ‘uns in an unnatural fashion. Here are my thoughts on why I think a computerized ABR exam is unrealistic:

• When I open a study on PACS, multiple choice answers (forced choice, single best) regarding my thoughts about the images do NOT magically appear.
• Clinicians are usually asking me to confirm something is what they hope that the lesion is NOT, the exact opposite of the pick a single correct answer of these exams of late.
• In discussing a case, I am talking to a human being, with potentially odd interpersonal skills, paired against my own potentially odd interpersonal skills, not a keyboard.
• Images rarely have arrows indicating the area of interest (unless one of my colleagues who is crazy on the annotations got to the case first, and THEY MAY BE WRONG.)

So, you get it? I think it was a mistake to ditch the orals. I think the orals provided theater and entertainment, as well as a final hurdle that was both appropriate and suitable for us all. It allowed us to do what we were trained to do—interact both with a film and with humans who are interested in that film. I think we are poorer for having done away with this practice.

I have to thank my wife for this particular column—we have discussed this far too many times for any average couple (we’re both radiologists, naturally). The boards? Just another item of scintillating dinner conversation.

Keep doing that good work. Mahalo.