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Behind the Story: Doctors caught cheating on the way to the top

 

Memorizing test questions and passing them on to future test takers is considered cheating by most people. However, for many radiologists, attempting to become board certified, it is simply a technique used to study. CNN's "Exclusive: Doctors cheated on exams" takes a close look:

"From my understanding, I would say nationwide from my friends across the country who are all in the same stages of training throughout the years, everyone gets a group. People decided beforehand what sections I will focus on, in terms of trying to recall those questions and answers," said Dr. John Yoo, a practicing radiologist. "And then immediately after the examination, the residents get together and try to put these down onto paper or word processor to be able to share it with the classes coming behind you."

While Yoo and many others see “recalls” as study guides, Dr. Matthew Webb, the doctor who tipped off CNN, and Dr. Gary Becker, executive director of the American Board of Radiology, do not.

"We would call it cheating, and our exam security policy would call it cheating," Becker told CNN.

Scott Zamost, senior investigative producer for CNN, discusses how one whistleblower led to CNN's report, a nationwide call for the practice to stop and a follow-up story on cheating dermatologists in an IRE Behind the Story Q&A:


Photo credit: reegone, Flickr

How did you first come across this story?

We were contacted by Dr. Matthew Webb about the use of “recalls” at a military radiology program in San Antonio. My first reaction was that this was something that I had never heard before, so I was immediately intrigued by the potential story. Initially, it was a story about possible cheating at a well-known military program, because we didn’t know whether the practice was going on anywhere else.
 

Did I understand correctly that Dr. Matthew Webb was terminated from his job before he went to CNN and spoke up about the recalls? Was Webb's credibility ever an issue for you?

As with all whistleblowers, one of my first questions is, “Why are you speaking out now - what’s your motivation? Dr. Webb was candid – he had been fired from the radiology program and he was trying to get reinstated. He thought the recalls were cheating, but obviously also was not happy about what had happened to him.

As we began investigating, we asked him for all the paperwork about his case, since the military would not be permitted to release it for privacy reasons. He didn’t hold back, even if the documents did not paint him in a favorable light.

At the same time, we began the process of verifying his allegations about the “recalls,” and every one of them checked out. He did not exaggerate or mislead us – his information was simply correct. It’s just that he strongly considered the practice cheating, while the vast majority of radiology residents did not.

When we interviewed Dr. Gary Becker, executive director of the American Board of Dermatology, he said he believed this was cheating and agreed with Webb that it would be “despicable” if radiologists gained their board certification that way without the proper knowledge. To us, this further verified Webb’s claims and bolstered his credibility.

Who was the hardest person to get on camera or on the record? Did you use some of the techniques that you mentioned using in an FBI story at a previous IRE conference

It took several weeks for Dr. Becker to agree to speak to us. As I do with all potential interview subjects, I told his staff what we were interested in discussing and that it was important to get their message out to the public. The radiology board had already taken a position in the radiology community that the use of the recalls was unprofessional and illegal, but Becker had not specifically used the word “cheating” to directly describe the practice.

I think being upfront from the beginning goes a long way in securing a difficult interview. For the FBI misconduct investigation, it was a process that took several months before the agency would agree to provide a top FBI official to go on camera. In this case, I pressed the military in a lengthy phone conversation to talk to us on camera. I had been making a lot of phone calls to radiology residents, and those conversations had gotten back to the program’s leaders as well as the public affairs office. By the time I called for comment, they had already prepared a statement and set up a phone interview with the program director, who was forthcoming about the use of recalls. But, despite efforts to go beyond that conversation and several follow-up statements, the military would not go on camera for this story.

At the Radiological Society of North America's annual conference, how many people did you have to go through before one of the doctors would go on the record? 

This was the most challenging part of the story. First, I felt it was critical to have the interviews with Dr. Webb and Dr. Becker completed before the conference. We wanted to establish on camera the radiology board’s position on the recall so we could get reaction at the conference.

I arrived with another CNN staffer who was working with me on the story the day before investigative correspondent Drew Griffin would be there. We had done a considerable amount of research about these recalls prior to the convention, but did not have specific information other than our initial tip about where the so-called cheating was going on and for how long. Becker had told us the use of the recalls had gone back “a long time,” but he could not be more specific.

We also had spoken to a number of practicing radiologists who confirmed this was fairly common and widespread, so we knew we were onto something. One of those radiologists connected us with a doctor who was going to the convention. She was nervous about talking about the recalls (an indication that this would not be easy), but agreed to introduce us to other radiologists. We made it clear that we wanted to understand and hear why the recalls were used and whether residents considered them cheating as Becker had told us.

Prior to the convention, we were told by the media office that we’d essentially have an “escort” while there because we couldn’t shoot on the exhibit hall without one. We were concerned about someone following us around and listening in on interviews. That didn’t turn out to be an issue because the “escort” was only really needed on the exhibit hall, where we would shoot b-roll and a stand-up.

On the first day, we found out there was a resident lounge area, so with the help of the doctor we had met earlier, we went from table to table during lunch speaking with residents off camera. Most freely admitted using or knowing someone who had used the recalls.  At one table, three radiologists were most candid and began describing how it all worked. I immediately knew we had to get them on camera, and two agreed. I conducted the interview, and we ended up using them in our story.

The next day, the atmosphere had changed. We continued speaking to many radiologists off camera, but got the sense that the word was out that CNN was there asking about “cheating” and the use of recalls. No one else would go on camera, but we didn’t need it at that point since we had gotten the two key interviews the day before.
 

What documents cemented the story for you, and how did you get those documents?

The actual recalls from the military program were a gold mine. They included at least 15 years of questions and answers as well as what appeared to be an elaborate Power Point of recent recalls. We reviewed the radiology board’s exam security policy as well as how it was changing its test.

We also examined radiology blog entries, which provided a fascinating look into the recall issue. In several postings, we found residents openly asking for help in obtaining recalls; some even offered to trade theirs for another program’s (as we discovered, the value of the recalls depended how well the residents in a particular program remembered the test questions).

The military’s own responses to our inquiries over several months were also critical to the story. When the military confirmed Webb’s allegations that faculty were aware of and even encouraged the use of recalls in some cases, we knew this was significant.
 

What was the most challenging aspect of this story?

We needed to understand how doctors are board certified, the nuances of that process and why this was actually cheating. In terms of interviews, the most challenging was getting doctors to go on camera. This was not something they were eager to talk about, let alone in front of a national audience.

How long did it take to complete the print and broadcast package?

I started working on this in late June 2011. A majority of the interviews were conducted in the three months prior to airing the story in January. The article for cnn.com, which was close to 3,000 words, took several weeks to complete and get approved.

After completing this story do you have any recommendations for other journalists who might try to replicate this kind of story? 

We would not have known about this story without a specific tip unless you monitored radiology blogs or the American Board of Radiology’s testing procedures.
 

Thus far, what feedback have you received?

As expected, the radiologists don’t consider this cheating, even though their own board is clear that it’s not only cheating, but illegal. The story prompted a large response on cnn.com and various medical blogs. One comment led to a tip about dermatology, which in turn led to our follow-up story about a similar issue in that specialty. The dermatology story also prompted a significant response from the medical community.

Do you have plans for a follow up story on this topic?

We immediately began researching a follow-up based on the response. For example, the American Board of Medical Specialties, in the wake of our story, condemned the use of recalls. We started seeing other statements pop up on this issue from the medical community. Combined with what we found out about the use of “airplane notes” to prepare for the board exam in dermatology, we produced a follow-up piece for AC 360, which aired three weeks after the original investigation.  (The program originally aired a shorter version of the story, which was a two-part, 12-minute piece for CNN Presents, our weekend show).

Johanna Somers is a graduate student at the University of Missouri School of Journalism

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