Oral Exam Format Highly Valuable for Assessing Candidates
By Matthew B. Podgorsak, PhD, ABR Board of Trustees Chair, and Brent Wagner, MD, MBA, ABR Executive Director
2025;18(1):5
The ABR mission includes assessment of knowledge in the four radiologic disciplines (diagnostic radiology, interventional radiology, medical physics, and radiation oncology). Various exam models are used by medical certifying boards; the ABR employs a multiple-choice format for the qualifying exams (typically taken during training) and an oral exam for the certifying exam (offered after completion of training). Radiation oncology, medical physics, and interventional radiology have used certifying oral exams for decades. Following a hiatus of approximately 15 years, diagnostic radiology will return to an oral exam in 2028.
Since 2021, the ABR oral exam platform has used a videoconference format that includes screen-sharing for relevant images. The session allows a one-on-one discussion between the examiner and the candidate. Each candidate interacts with four to eight examiners (depending on the specific discipline) who individually commit to a score on their portion of the exam. The group of examiners who interacted with an individual candidate during an exam session subsequently arrive at a decision (pass, fail, or conditional pass) together. The process allows for minor shortcomings in one area to be offset by exceptional performance in other sessions when the final decision is made.
Multiple-choice exams are efficient and predictable in assessing fundamentals of knowledge and comprehension, whereas oral exams are important in assessing application of knowledge, analysis, and evaluation. Oral exams focus on elements of the knowledge and skill domain that are closely related to clinical practice, including problem solving and communication. They also allow certification candidates to demonstrate the breadth of their knowledge beyond rote memorization.
Committees of subject matter experts create standard case sets and pre-established expectations of performance elements that represent competence in the field. On exam day, group discussions among these experts after the exam sessions are completed help to normalize the criteria and minimize outlier scoring determinations by individual examiners. However, similar to the way a patient or a clinical colleague might judge the competence of a radiologist, radiation oncologist, or medical physicist, the examiners employ a level of subjectivity in their assessment. Medical care is often complicated; unlike multiple-choice exams, oral exams allow candidates to express judgment when offering thoughtful conclusions in the setting of nuanced circumstances. The result is a highly reproducible exam that allows candidates for certification to demonstrate the knowledge and skill they have acquired through rigorous training and study and reassures the public of the high standards associated with board certification.
