Louisville or Bust

“…The Derby City venue—The Executive West Hotel, a shopworn hostelry hard by the Louisville Airport, designed by someone with a deep appreciation for the 1970's.” —Running the Table: The Legend of Kid Delicious, The Last Great American Pool Hustler by L. Jon Wertheim

I just finished this book. I had no problem visualizing the scene for the Derby City Classic. You may have already surmised that you won't find Sartre or Tolstoy on any of my bookshelves. I love billiards and just about any other bar game. I have a pool table in my basement to go along with three other tables (foosball, poker, and coffee), and a dart board, which intermingle among the woodshop, guitars, weight room, putting green, beer fridge, Murphy bed, and HDTV. It is my version of the “He Man Woman Haters Club” of the Little Rascals. Unfortunately, I don't get to spend enough time in my man cave and usually wander down there to find my 5-year-old daughter and fellow pool sharks and con men in a high stakes game of 8 ball with their “pooling sticks.” Not great for the felt on the pool table. At some point when my wife bans me from the rest of the house, I figure I can live down there, no problem.

Louisville is an odd place. Merely mentioning its name can raise the pulse of any senior radiology resident in the United States. I remember my first trip to Louisville to the American Board of Radiology's annual retreat. I had been regaled with war stories of the oral board exams by more senior residents. And I'd heard several urban myths, like the candidate who ran to the bathroom and was passed films under the door or the exotic dancer who was sent into one of the rooms as a prank on one of the examiners. When I arrived, I discovered the hotel was exactly as billed—a cross between a horror movie and a surreal nightmare. It was filled with 20-something-year-olds in the prime of their lives who looked like refugees from an asylum, all oral boards takers like myself. Hotel dwellers were walking around in circles in the parking lot, mumbling to themselves, and staring blankly at the walls. In the coffee shop, everyone sat alone, disheveled, forlorn and preoccupied, on the brink of desperation. These were my people, I thought to myself.

The oral board exam is an odd dynamic. As you undoubtedly know, during testing, examinees receive grades based on their observations, synthesis, and management of unknown cases. These criteria can be used globally. For example, I observed that all the hallways had a piece of red construction paper taped to the ceiling between the light and room door to decrease glare. Aside from fact that this couldn't possibly be effective, I synthesized that dimmer switches hadn't yet been stocked on the shelves of the Home Depots in Louisville. I was unsure on how to manage this. I guess that translates into a 69 for this case. I observed that none of my examiners could pass any section of the test except the one they were giving, even with the answers. I synthesized that this was truly unfair. Not sure how to manage this one either, another 69. I observed candidates receive scores ranging from 69 to 72. I synthesized that this could possibly be the most dim-witted scoring system ever invented: another 69 for management. I observed that some of my examiners seemed cantankerous. I tried not to take their attitudes personally but it left me a bit perplexed, even more so than some of the cases I was shown. I remember thinking to myself, “Compared to what I'm going through, really, how bad can it be for them?”: hmm, a 68 for this one. Miraculously, I somehow managed to come through the experience with all extremities intact. When I received my letter telling me I had passed, like many of my people, I felt more a sense of relief than happiness—like a cancer had been removed from my body.

Now I am an examiner for the ABR. I have officially crossed over to the dark side of the Force. The older I get, the better I used to be. I have new insight on examiner petulance. For those of you who have never examined, here is the drill. You fly to Louisville the day before the boards, take the 30-second van ride from the airport to the hotel, and receive your room key in a paper envelope marked “VIP.” This also contains compensation for your services, a $5 coupon from the ABR for Willies gift shop in the lobby (I'm not kidding). Your room and testing center is unremarkable except for the desktop computer set up in the back with a bar code reader. At 5 pm, you report for orientation. You are told a variety of useful facts about the exam and examinees (in case you have repressed your own painful memories) such as “candidates may be nervous” and “be cheerful.” You receive a book with unknown cases, go to dinner, come back and prepare your cases for the next day, and then to bed. At 6:15 am the next morning (3:15 am for people from California), environmental services begin pounding on your door imploring you to leave so that they can tidy up the room and prepare it for the exam. Why this takes an hour is unclear to me. I guess they need to clean up the beer cans, pizza boxes, and overturned mattresses in all the examiner's rooms. You stumble downstairs, usually get lost in the maze of hallways like some scene in Spinal Tap, have breakfast, and get back to your room ~7:15 am. As you walk by the greeting room and see all the morning candidates, you realize things could always be worse—you could be in that room. The exam starts at 7:30 am and goes all day until 5:00 pm or so. Then you meet to discuss candidates, go to dinner, come back and prepare your cases, and go to bed. Then, the whole thing starts over again: Groundhog Day.

I prefer examining for the certificate of added qualification (CAQ). Overwhelmingly, candidates are knowledgeable, facile, and very pleasant to examine. Also, when you examine for CAQs, you only have to spend 3 days in Louisville instead of 4 or 5, which is a plus. On the other hand, for someone like me who wants to pass everyone, I have more of a dilemma when faced with a borderline CAQ candidate. For the resident oral board exams, I can rationalize passing a marginal candidate by telling myself that this person will likely never venture near an interventional suite for the next 40 years of his or her career. So as long as they have a general understanding of intervention and equate VIR with “no trespassing” or “don't ever try this,” it is probably OK. It would be better if they had to wear a skull and crossbones medallion around their neck but OK. On the CAQs, this line of reasoning is more problematic.

Taking the oral exam is an acquired skill and a test of patience; however, administering the exam is an art. I've learned quite a few things since I began examining. One of the first things I learned is that you can't fail someone for being irritating. If you think examiners are a bit odd, believe me, they don't hold a candle to the examinees. Whether it is the intense pressure that makes people behave in strange ways or maybe the strange people who behave even more strangely under pressure, I'm not sure. For example, it seems abundantly clear to me that in any oral test, examiners have the correct answers, are typically chosen to examine because they are experts in the field, and ask questions to measure a candidate's knowledge. Yet, at least one candidate in every group responds to questions like a kindergarten teacher speaking to one of her pupils. It usually starts with the phrase, “My technique is…” I usually wonder if they honestly believe that they were the first ones to ever cut Gelfoam^® into small pieces and swish it between two syringes using a 3-way stopcock.

The ABR has recently announced a new format for certification that doesn't include a visit to Louisville. At this point, I'm not sure how I feel about that. But I do know that personally, after it's all over, if I'm ever at the Executive West again, it will be for the Derby City Classic.