In his January “Ethics in Orthodontics” column, Dr Peter Greco noted that students using old board questions give themselves an advantage; if they don’t, they receive a disadvantage (Greco P. Academic impropriety. Am J Orthod Dentofacial Orthop 2011;139:5-6). How so? Virtually all students take the written examination. There are no grades; you either pass or you fail. There is no posting or ranking of programs based on board scores. You don’t need to be boarded to practice. What is the advantage or disadvantage? The purpose of the written exam is to ensure that an examinee possesses the minimum level of knowledge. People learn differently: by reading, doing, visual stimulation, auditory input, and so on. If some want to study from old board questions, fine, as long as in the end they know what we want them to know.

Dr Greco also noted that other certifying boards have similar issues and have taken legal steps to protect the use of their questions. Of the multitude of current orthodontists who passed the written exam using old questions as a preparatory tool, are we to rescind board certification from all who learned in this manner? How knowledge comes to be assimilated is irrelevant as long as the one possessing that knowledge uses it for the benefit of the public we treat. Since other learned professions, such as law, allow the use of old board questions, let’s look at this issue differently. Programs have been collecting board questions for decades. Why do students use old questions? To study from! When students study together using old questions, they compare answers, go over concepts, definitions, landmarks, mechanics, whatever. They are learning. Students should learn as much as they can and in any way they can. Learning more makes them better orthodontists. In reality, many old answers to board question are wrong; they get challenged and looked up, and the correct answer is then dispersed to the group. Now they’ve learned something new.

The board believes that its questions are proprietary and should only be used for their intended purposes. This flies in the face of reality. Maybe we need to ask different questions. Is a multiple-choice exam the best way to test a candidate’s knowledge base? It might be the most expedient way to examine large numbers of people on how well they take tests, but it might not show whether they understand orthodontics. Many students score well on standardized tests, yet are poor diagnosticians or clinicians. Others score poorly, but they have a wonderful grasp of theory, knowledge, and mechanotherapy.

Dr Greco stated that using old questions after signing the pledge not to is a violation of the principle of fidelity, the cornerstone of confidentiality, which is paramount in the delivery of health care, and that this might lead to future similar behavior such as breaching a patient’s confidences once one gets into practice. This has nothing to do with fidelity, confidentiality, or the delivery of health care. To imply that because one did not keep test questions confidential he or she will subsequently breach a patient’s confidentiality once in practice is a stretch at best.