Increasing Passage Rates for the Anatomic Pathology (AP) and Clinical Pathology (CP) Board Examinations May Lead to Harder Tests In the Future.
Many people believe that American Board of Pathology (ABP) Certification Examination is graded on a curve, that in each testing session examinees are compared to one another and only the top 15% or 25% pass. This is not true. Instead, the ABP has utilizes static criterion-referenced testing (CRT).
"On a CRT, the passing or "cut-off" score is determined in advance by a committee of experts in the field. The candidate’s performance (i.e. mastery of the subject matter) is compared to the cut-off score and not to other test takers.”
What does this mean for future Pathology Board examinees? In any given testing session, everyone could pass! Or everyone could fail! One's ability to pass will be commensurate with their background reading, prior study, experience, slide review, and of course, board-specific study. The Pathology Board Exam is a merit-based test.
Then what is the problem?
As with financial markets, music, fads, and politics, curated examinations like the Pathology Board Exam are subject to trends. Currently, the Pathology Board Examination scores are trending upward. In 2016, total candidate pass rates were 79% for the AP examination and 89% for the CP examination.1 In 2017, total candidate pass rates were 90% for the AP examination and 94% for the CP examination.2 For the first time in years, the pass rates for first time test takers in 2017 were 95% or greater for both parts of the AP/CP exam.
To some, this might indicate that training programs are putting out better Pathologists than in prior years. Yet, it is widely understood that the quality of Pathology training programs is in a state of secular decline.
“...Trainees often lack sufficient experience to practice independently and effectively. Many studies have recognized these challenges suggesting that more effective training for this new century can be implemented.“3
The evidence lies all around us. Although there are some programs that buck this trend, it is clear that Pathology residents are performing fewer autopsies, grossing fewer specimens, looking at fewer slides, performing less hands-on clinical laboratory testing, reading fewer agar plates, and rounding less and less on transfusion patients. This loss of experience alone makes new pathologists less confident and less prepared than their historical counterparts. Meanwhile, we have scarcely touched on how top-down centralized medical education initiatives from bureaucrats in non-pathology specialties are hardly applicable to training competent pathologists.
How can it be that Pathology examinees are scoring better on testing while having less experience (and let's be honest – also reading less)?
We are at a strange inflection point in the world of Pathology training and education. In the midst of a secular downtrend in quality of training, examinees are performing well on a cyclical basis.
Is it likely that the American Board of Pathology is going to permit continued 95+% passage rates when Pathology residents are less well trained and educated than ever before? In 2007, the AP pass rate was 73% and the CP pass rate was 59%.4 While we are not likely to encounter such pass rates in the near future, it is highly likely that the criterion-based testing strategy of the American Board of Pathology will “revert to the mean.” That is, as a matter of logic, examination writers and curators are likely going to create more difficult tests to provide more of a challenge and incentive for study, training, and practice. After all, the motto of the American Board of Medical Specialties, the organization that oversees the ABP, is “Higher Standards. Better Care.”
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