From the Board of Governors: New DR Oral Exam Will Improve Assessment of Candidate Knowledge and Skills
By ABR Governor Desiree E. Morgan, MD; ABR Executive Director Brent Wagner, MD, MBA; and ABR Director of Psychometrics Ben Babcock, PhD
October 2026;19(5):4
In 2023, the ABR announced that we would be phasing out the diagnostic radiology (DR) multiple-choice certification exam and transitioning back to an enhanced version of the oral exam model that we had used for decades prior to 2014. A small pilot exam is planned for September 2027, but most 2027 DR residency graduates will take the new DR Oral Exam in February 2028.
The decision to return to the oral exam for diagnostic radiology was based on a decade of informal feedback from practicing radiologists that the multiple-choice exam did not effectively assess the application of knowledge and the related nuance of creating a reasonable differential diagnosis that are part of the clinical practice of the discipline. The fundamental arguments supporting the change were based on two major themes. First, the practice involves synthesizing diagnostic possibilities rather than merely selecting an option from among four provided choices. Second, communicating the potential diagnoses — and the rationale for arriving at the most likely considerations — is a critical skill that a multiple-choice exam does not assess. After an iterative process that involved collecting input over many months from more than 100 external stakeholders, the ABR developed a model that is similar to the oral exams administered in the other three disciplines (interventional radiology, medical physics, and radiation oncology).
The new oral exam platform and process include significant enhancements from the previous DR oral exam. First, the exam will be administered as an interactive virtual videoconference in a location of the candidate’s choice (subject to technical and privacy requirements). This eliminates the stress and cost of travel and the potential anxiety of meeting with the examiner in an unfamiliar environment. Second, the case sets will be assembled with additional requirements compared with the past exam, which means the general topic coverage will be more balanced from candidate to candidate. Third, the IT platform will allow standardized scoring based on specific predefined performance elements, as assessed by the examiners. Finally, examiners in each category (e.g., neuroradiology) will meet before the exam to develop a common understanding of the performance needed to demonstrate competence on each case. This calibration step is designed to establish consistency among examiners before the exam is administered.
The input from our external stakeholders and the work of our volunteers was critical in developing these process enhancements. We appreciate their collaboration as we strive to accurately and fairly assess the judgment and expertise that are essential to the standing and advancement of the profession and, in doing so, serve our mission: “to certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients.”
