Multiple-choice board exams may not be the best assessment modality for doctors in training:
Educators may not actually teach to the test, but students think to the test, in linear multiple choice.
We spend the first few years of medical training imbuing our bright medical students with test-taking expertise focused on obscure and rare but well-characterized diseases. We then expend the remaining years breaking them of these habits to get them thinking of horses instead of zebras.
[See this related post about what med students use to study.]