Focus on DR

Focus on DR

New DR Oral Exam Builds on Previous Model with Scoring Rubrics

By Stephen F. Simoneaux, MD, and Desiree E. Morgan, MD, ABR Governors; Mary S. Newell, MD, ABR Associate Executive Director for Diagnostic Radiology; and Brent Wagner, MD, MBA, ABR Executive Director

2024;17(5):6

For the Diagnostic Radiology Certifying Exam, the ABR will be transitioning from a computer-based exam to an oral exam in 2028. The development of the new model benefited from iterative contributions of a wide range of external stakeholders, and the subsequent decision to return to an oral exam format was largely focused on a specific goal: to create an exam that assesses the higher order skills that are part of clinical practice (in contrast to knowledge assessable on a multiple-choice exam).1

In communications related to the change, the ABR compared the 2028 model with the legacy ABR oral exam that existed for decades through 2012. In conveying that the 2028 version will be different from the old DR oral exam, we have unintentionally created the impression for some faculty and candidates that we have not retained some of the attributes and principles of the legacy exam.

The previous and upcoming models both represent composite assessments based on cases presented by and discussed with several examiners during a series of 25-minute one-on-one sessions covering the different subspecialty content areas of radiology. Candidates analyze cases based on their observations of the imaging features and available history and summarize their findings in the form of a reasonable differential diagnosis before suggesting next steps (e.g., additional imaging, urgent referral for consideration of surgery, etc.). The analysis by the candidate resembles a succinct summary that might be part of a multidisciplinary conference, a concise but complete report, or a phone conversation with the treating physician. The examiner might ask clarifying questions or redirect the candidate to the major findings or alternative diagnostic possibilities. Each candidate is assessed by the specific group (panel) of examiners who discussed the cases with them. In the panel discussions, scores for individual sections may be raised if low performance in a particular subject area is considered an outlier.

The most obvious difference in the new exam is that it will be administered remotely using a one-on-one videoconference format. Less apparent to the candidate will be our efforts to mitigate subjectivity and bias in the exam. For example, cases will be given in the same order for each session, and each category will have an identical case set for a given oral exam date. As a result, all candidates examined on a Tuesday will see very similar content (although the number of cases might vary, depending on how quickly the examiner and the candidate can complete a case and move to the next).

Examiners in the old model used a general scoring grid that included three broad categories: observation (identifying the abnormality and pertinent negatives), synthesis (differential diagnosis, including the most likely diagnosis), and management (for example, additional imaging or urgent referral). The new model will build on these by defining specific elements (a rubric) to be used by all examiners as part of the electronic score sheet for each case.

For example, a conventional set of abdominal radiographs in a young adult with vomiting might demonstrate distended loops of gas-filled small bowel. A pertinent negative would be the absence of free air. A second finding would be a subtle lucency overlying the right inguinal region. Additional testing would be a CT scan with intravenous contrast. The major CT finding would be a right inguinal hernia containing thickened ileum with diminished enhancement. The overall management (urgent surgical consultation) would be based on a presumptive diagnosis of ischemic bowel within an incarcerated inguinal hernia. More detailed examples of scoring rubrics are being prepared for the seven content areas by the ABR’s subject matter experts in diagnostic radiology and are scheduled to be posted on the ABR’s website before November 15.

The major goal of the new exam model is to assess the knowledge and skill of diagnostic radiologists. To that end, residents should prepare for the exam in a way that allows them to identify and appropriately communicate the presence and nature of imaging findings, the potential significance of those findings, and reasonable recommendations for next steps. The use of defined rubrics for each case will enhance standardization of objective scoring of the discussions.

  1. Larson DB, Flemming DJ, Barr RM, Canon CL, Morgan DE. Redesign of the American Board of Radiology Diagnostic Radiology Certifying Examination. Am J Roentgenology 2023;221(5). https://www.ajronline.org/doi/10.2214/AJR.23.29585

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