ABR To Gather Stakeholder Input on IR/DR Certification Exam Structure

By John A. Kaufman, MD, MS, ABR Secretary-Treasurer; Cheri L. Canon, MD, ABR President-elect; and Brent Wagner, MD, MBA, ABR Executive Director

2024;17(4):3

The ABR continually considers the appropriateness of the certification process, including the validity and focus of its exams. Earlier this year, the ABR asked interventional radiologists to comment on (a) whether its exams in support of initial certification in interventional radiology/diagnostic radiology are effective in assessing competence in diagnostic radiology and (b) if not, what modifications might be considered? Initial responses from a few dozen interventional radiologists varied widely and have prompted consideration of a systematic and focused inquiry by the ABR.

Background

ABR certification in interventional radiology was developed to represent competency in two broad components: interventional radiology (IR) and diagnostic radiology (DR), together referred to as IR/DR. ABR certification, as recognized by the American Board of Medical Specialties (ABMS), describes interventional radiology as a specialty that “combines competence in imaging, image-guided minimally invasive procedures, and periprocedural patient care to diagnose and treat” a variety of benign and malignant conditions.¹ Although the Accreditation Council for Graduate Medical Education (ACGME) refers to the residency pathway as “interventional radiology,” it is inextricably linked to DR and includes three years of training in the latter. The resulting certificate “signifies competence in both DR and IR” and the individual is “certified in both DR and IR.”²

Near the end of the third year of residency, candidates seeking IR/DR certification take the same Qualifying (Core) Exam in diagnostic radiology as the candidates for DR certification. After the completion of training, both groups are assessed via a computer-based exam that is part of the Certification Exam – 118 questions that cover broad topics in diagnostic radiology (the “essentials” of the specialty).

Beyond this, the initial certification exams differ. For DR, the current model includes an additional 180 questions, divided into three individual modules, that are selected by the candidate based on preference for a single practice profile (e.g., musculoskeletal, breast, thoracic, etc.) or some combination of specific subspecialty areas. For IR/DR, beyond the essentials content, 60 written questions are administered in interventional radiology, and there is a separate four-part oral exam covering the imaging features, procedural techniques, and clinical management related to a broad range of interventional radiology procedures.

Beginning in 2028, the candidates for DR certification will no longer take the computer-based certification exam (see table). Instead, a seven-section oral exam will assess higher-level skills such as observation, synthesis, and management.³ Candidates will be evaluated on communication and their ability to incorporate clinical information into recommendations for management and additional imaging when appropriate.

Next Steps

This month, the ABR will begin a multifaceted process of stakeholder engagement to gather input regarding what, if any, changes to the IR/DR certification exam structure need to be considered. The ABR has retained a third-party healthcare communication and marketing firm to facilitate discussions with stakeholder groups including professional societies and program director organizations. This is very similar to the process we used when evaluating similar questions for DR certification,⁴ and we look forward to learning from diverse perspectives among our colleagues in professional societies and variable practice environments. We have also created a conduit for public comment that will be open until September 30.

References

1. Interventional Radiology/Diagnostic Radiology. ABR website. https://www.theabr.org/interventional-radiology.
2. Kaufman JA. The interventional radiology/diagnostic radiology certificate and interventional radiology residency. Radiology. 2014; 273:318-21. doi: 10.1148/radiol.14141263. PMID: 25340266.
3. New Diagnostic Radiology Oral Exam. ABR Website. June 10, 2024. https://www.theabr.org/news/new-diagnostic-radiology-oral-exam
4. Larson DB, Flemming DJ, Barr RM, Canon CL, Morgan DE. Redesign of the American Board of Radiology Diagnostic Radiology Certifying Examination. AJR Am J Roentgenol. 2023; 221:687-693. doi: 10.2214/AJR.23.29585. Epub 2023 Jun 7. PMID: 37315014.

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