Focus on DR: Debunking the Myths About ABR Oral Exams
By ABR Associate Executive Director for Diagnostic Radiology Mary S. Newell, MD; ABR Governor Desiree E. Morgan, MD; and ABR Trustee Kate Maturen, MD, MS
June 2026;19(3):5
The reintroduction of the Diagnostic Radiology (DR) Oral Certifying Exam in 2028, after a hiatus of 16 years, has prompted many questions from program faculty, potential examiners, and future candidates. In the face of an unfamiliar exam, some anxiety and uncertainty are unavoidable, but in this article, we hope to alleviate fears by dispelling misunderstandings (or “myths”) we frequently hear from residents. We hope this enhanced transparency regarding the oral exam process will be useful for candidates as they prepare. Although the general principles are similar across all four disciplines certified by the ABR, this article is focused on diagnostic radiology.
A general understanding of the exam process will provide context. In the new DR Oral Exam, a candidate will meet one-on-one with seven examiners in separate 20- to 25-minute video conference sessions. Each of these sessions will test a single content area (such as pediatric radiology or neuroradiology). The candidate will be shown a series of separate cases, intended to assess the candidate’s ability to discuss the major findings and pertinent negatives (“observation”); provide analysis (“synthesis”), which might include a differential diagnosis and a most likely consideration; and suggest a next step (“management”), which might include further imaging, biopsy, urgent referral, etc. For each individual, the overall exam result will depend on separate determinations made by independent examiners without contemporaneous knowledge of a candidate’s performance in other content areas.
A few myths and misconceptions held by some candidates are discussed below.
If an examiner moves quickly to the “next case,” I must have done well.
Sometimes an examiner wants to help the candidate by moving from a set of images with which the candidate is struggling, to a different image set or a different case. Because suboptimal performance on one case is often offset by better performance on a different case, the candidate should not attempt to make assumptions about their performance based on the rate of progression (rapid or slow) to the next case.
If an examiner says little or nothing about my case discussion, I must have done poorly (or well).
Examiners are coached to be patient and respectful to the candidates but are instructed not to give feedback — positive or negative — during the exam. This is difficult for many candidates who expect some performance cues in a learning environment (e.g., during read-out with an attending), but the ABR examiner must attempt to avoid responses that could be misunderstood by candidates as an indicator of how well they’re doing.
The result in a specific content area is highly subjective and depends on my conversational dynamic with the examiner.
Experience with years of oral exams both in person and using a video conference system for all disciplines of the ABR has shown that results are highly consistent and demonstrate a very low level of interobserver variability. This consistency may be counterintuitive because many candidates perceive themselves to be better in some subspecialty domains than in others, but — statistically — candidates who have sufficient knowledge and skill in one content area are also likely to perform well in most (or all) of the other content areas in diagnostic radiology. Looking at it in a different way, the conversation with a particular examiner may feel different, but the assessment element is highly consistent across independent examiners for each candidate.
It’s in my best interest to take a lot of extra time on each case because “fewer cases” mean “fewer opportunities to make a mistake.”
It is usually in the candidate’s best interest to see a wide range of cases. Candidates who may be struggling on a case will benefit from having more opportunities to display their knowledge on subject matter they are better versed in, lessening the scoring impact of the case on which they did not perform well. A competent candidate will benefit from an adequate sample across the domain of each section of the exam.
Exam cases are usually atypical, constructed with a “twist,” or nuanced.
Actually, the opposite is true. Most cases are characteristic of specific clinically relevant diagnoses for several reasons. First, the ABR wants to cover a reasonable segment of the domain in each content area. Second, cases are considered relevant because they are common or reflective of important diagnostic concepts (including urgent findings). Third, highly unusual manifestations of very rare diseases are not useful in establishing whether a candidate has the knowledge required for independent practice. And finally, the new exam is specifically designed on more of a generalist than subspecialist level.
A “conditioned” category is closer to a “fail” than a “pass.”
In fact, a conditioned result is closer to a pass than a fail. A candidate who fails to meet the passing standard in one or two categories (out of seven) will be permitted to return to repeat the specific categories instead of the entire exam. This status is called a “Conditional Pass,” i.e., a pass result that is subject to the condition (requirement) to pass the remaining categories at a later date.
The ABR has a set range for a passing rate for the oral exam.
This is false. The ABR provides careful training and instruction for the examiners to enhance consistency and the candidate experience, but we have no mechanism to determine what the passing rate is (or should be). Independent examiner determinations of performance on the specific content areas are combined in aggregate and there is no administrative attempt to set a range of performance. Historically, for the diagnostic radiology oral exam, the “complete” pass rate is 86% to 92% of first-time candidates. Conditional pass rates range from 5% to 12%, and the fail rate is less than 5%.
Examiners bring their own difficult or esoteric cases to show to the candidates.
Individual examiners do not show their own cases. The case material that comprises an exam session is assembled by a committee of subject matter experts that considers the quality of the images, a range of modalities, and a breadth of diagnoses that are relevant to practice. These decisions are made by a group of volunteer examiners who appropriately challenge each other to create an optimal and standardized set of content that attempts to minimize variability in the exam experience for the candidates.
It is better to take the exam on the last day than the first day.
Years of data have shown no statistically significant difference in the candidate pass rates for exams given on different days or at different times during the day.
