Evolving Conditions Bring Changes to Exam Delivery Platforms
by Brent Wagner, MD, MBA, ABR Executive Director, and Vincent P. Mathews, MD, ABR President
Over the past few months, the ABR Board of Governors has met on multiple occasions to discuss, in depth, revised plans to deal with board certification exams in the setting of the COVID-19 pandemic. Cautious forecasts for a return to a sufficiently stable state before year’s end, which had been widely anticipated in March and early April, were revised on a nearly daily basis in May and June based on adverse trends of the widespread impact of the virus. It became clear that the uncertainty surrounding the safety of travel as well as group testing environments would prevent definitive planning by exam candidates and training programs for the foreseeable future, extending into 2021.
As part of our analysis, we investigated the early experience of other ABMS certification boards regarding options, including remote exams (predominantly in the setting of oral exams). We sought input from program directors and other leaders across all our disciplines and investigated the technical challenges of alternative testing models. What had been viewed as relatively impractical before the pandemic clearly needed to be reevaluated in the setting of evolving circumstances and external constraints. Specifically, the board members challenged each other to look at innovations that would rebalance the requirements for uniformity, fairness, reliability, and security while maintaining the validity of certification and a testing environment that was optimized for the examinees during this time of uncertainty.
Most importantly, we needed to minimize or eliminate travel. This was already a feature of the qualifying exams for radiation oncology and medical physics, which were offered in third-party test centers across the country. Even though local centers could obviate the air travel that would be required for most examinees, there are two major barriers that have prevented us from extending their use to all our exams. First, from a strictly economic standpoint, the ABR has been considered too small for third-party centers to make changes to accommodate even the most fundamental requirements for a viewing interface for diagnostic radiology images (including ambient lighting, image brightness/contrast adjustment, and video loops). Second, the current restrictions imposed on (or by) the test centers are extremely variable and unpredictable across different locations; more importantly, this is out of the ABR’s control and prevents us from confidently providing firm dates for a high-stakes and often stressful exam.
The Board announced in late June that we would design, test, and implement remote platforms to allow administration of all our exams in the first half of 2021. The specifics are still being worked out, and we will be meeting with stakeholder groups (candidates, program directors, volunteer examiners, department chairs, and others) throughout July and beyond. We plan to announce the exam dates before August 1 and will provide more details regarding the interface in the coming months. As we exchanged ideas during recent months with other ABMS Member Boards, who are using a variety of tools to address the same problems that the ABR faces, two themes were consistent across the different specialties: implementation of these changes is much harder than it appears at the outset and communication regarding the complexity of the needed infrastructure and associated processes is extremely difficult.
Despite these challenges, we are excited by what this innovation offers to our examinees and look forward to ongoing stakeholder feedback as we continue to refine the process. The ABR’s ultimate goal is to confer a valid certificate that reflects a significant accomplishment resulting from rigorous training in the radiology sciences.