“That’s a Good Question!”: Recent Inquiries About the New DR Oral Exam
By Mary S. Newell, MD, Associate Executive Director for Diagnostic Radiology; Kate Maturen, MD, MS, ABR Trustee; Desiree E. Morgan, MD, ABR Governor; and Stephen F. Simoneaux, MD, ABR Governor
2025;18(3):5
Time passes quickly! The new DR Oral Exam will launch in 2028, and ABR volunteers and staff are in planning and implementation mode. Candidates, educators, and diplomates are also thinking deeply about the exam and asking on-point clarifying questions at society meetings and elsewhere. Here is a sample of what has been on people’s radars.
How will ultrasound be represented on the exam? Ultrasound will be examined in a way that feels “organic,” in that it will appear during exam sessions where it generally would in routine practice. For example, an ultrasound might be the primary study presented as part of a case to a candidate in the MSK, pediatrics, or abdomen sections, or the “next study” a candidate might request after seeing a mass on mammogram, but it will be shown only rarely in neuroradiology. Specialized ultrasound studies including thyroid, fetal, and vascular will be examined in the abdomen section.
What about procedures and noninterpretive skills? Will they be tested? Both areas will be incorporated into exam content. Basic diagnostic procedures might be examined as part of a broader case discussion. For example, during a case demonstrating suspicious breast calcifications, an examiner might ask about possible biopsy methods, indications for core biopsy, procedural steps, and possible complications. Similarly, a candidate might be asked to describe the risks associated with paracentesis or lumbar puncture and how to perform each. Noninterpretive skills content will concentrate on areas of safety and professionalism, often as part of another case. For example, a candidate might be asked to consider how to report an interpretive error by themselves or a colleague. Another candidate might be asked how to diagnose and manage a contrast reaction or extravasation as part of a discussion surrounding a renal mass seen on CT. Basic radiation safety and dose reduction principles might also be a subject of discussion. The examined content in both areas will be material that practicing radiologists might encounter on any given day.
Will my exam fees go up because of this new oral exam initiative? The ABR makes significant efforts to control costs, with fiscal stewardship being a prime priority of the ABR Board of Governors. Exam fees are not expected to increase as a result of the return to the DR Oral Exam.
Will I be expected to figure out what sequence is being shown on MRI cases; is that part of what is being tested? No. MRI studies will be labeled for sequence type (e.g., T1 with contrast, T2, DWI). The ABR Image Quality Committee and the Board of Trustees think that having candidates spend exam time identifying sequences would not add value to the exam experience. The rare exception might be a case where recognizing the specific sequence is the concept being tested (e.g., in-phase vs out-of-phase imaging in the abdomen, or “silicone-only” image on a breast implant study).
What is the ABR doing to make sure my exam is similar in scope and depth to other candidates’ exams? To facilitate every candidate’s opportunity to showcase their knowledge and skill, we are taking the following steps to optimize the standardization and fairness of the oral exam experience:
- We will provide standardized examiner training. Such training is already operationalized for the interventional radiology, medical physics, and radiation oncology oral exams and is continuously evaluated and improved.
- New examiners will be coached, mentored, and monitored.
- Case sets are determined in advance by a committee of subject matter experts (practicing radiologists) and will not vary from one candidate to the next on a specific exam day.
- Category meetings after each exam session will evaluate daily case performance. Cases that did not perform as expected can be discussed by each category group to help level-set the scoring for those cases.
- Finally, panel meetings at the end of each exam session will allow examiners to discuss the performance of candidates holistically. A candidate who performed at a borderline level in a few areas but showed clear capability in the other sections can be discussed and identified as competent overall and scored accordingly.
As additional questions arise about the new DR Oral Exam, we will provide answers in future Beam articles and on our website. More information can be found here:
DR Oral Certifying Exam Sample Cases and Discussion
