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Physician Exam Scandal Inquiry Raises More Questions

Joe Cantlupe, for HealthLeaders Media, August 12, 2010

As I've been told, there are several levels of appeals that can drag on for months until a final determination is made. The appeals reviewers include representatives of ABIM staff, which may be seen as a conflict of interest. An independent panel appointed by the ABIM will consider the final appeal.

In its inquiry, the ABIM has recovered 36 boxes of paper evidence, six computer hard drives and audio and video recordings from Arora that were used in the investigation of the physicians, according to the Wall Street Journal.

Indeed, although Arora Board Review was the primary target of the investigation, that certainly doesn't excuse doctors who may have inappropriately given answers or taken answers from others. I wrote about this on June 17, quoting Christine K. Cassel, MD, ABIM's President and CEO. She said each question crafted for the ABIM certification exam is "like a precious jewel."

"A couple of thousand people attended (the exam sessions) and not everyone stole questions, but no one alerted us," Cassel said. "If people see unethical behavior they should let us know."

Robert M. Wachter, MD, a member of the executive committee of the ABIM and professor and associate chairman of the Department of Medicine at the University of California, San Francisco, writes in a blog "Dr. Arora ran an ABIM board review course with a difference."

"Attendees of the Arora Board Review were allegedly shown actual questions form past exams, fed to Dr. A from prior test takers—who shared dozens, and in some cases, hundreds of questions," Wachter wrote.  He noted that the board is suing Arora and a "handful of the most egregious offenders for significant damages."

"When you took your boards, you signed an attestation or clicked a little box pledging that you wouldn't share the questions with anyone else," he writes. "It's a pledge worth honoring." Wachter could not be reached for comment, his secretary said.

Wachter is correct in what he is saying, to a degree. But it may be worthwhile for the ABIM to examine how it conducts its own investigations.

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