Avoiding Conflicts of Interest Keeps Exams Fair and Relevant
By Cheri L. Canon, MD, ABR President, and Brent Wagner, MD, MBA, ABR Executive Director
2024;17(6):2
The ABR continually monitors potential conflicts of interest among its volunteers. For the Board of Governors, the focus is on the obligations to the corporation (the duty of care, the duty of loyalty, and the duty of obedience). For the Board of Trustees and the volunteers who contribute in varying capacities to the development and execution of exams and Online Longitudinal Assessment (OLA), the emphasis is on the avoidance of conflicts of interest that could compromise the academic integrity and fairness of those instruments. ABR volunteers understand that the learning opportunities that occur in question-writing committees through collegial professional interactions are associated with an implicit responsibility to maintain confidentiality and fairness in the process.
Because most ABR volunteers have teaching commitments as a major part of their practice, individuals must be careful to avoid overlap between their workplace responsibilities and their volunteer service. For example, material created for and contributed to an exam must be exclusive to the ABR and not used for teaching purposes, a research publication, or an educational session at a professional society meeting. Breaking the confidentiality of the exam creation process would potentially compromise the validity of the testing instrument.
The ABR recognizes that diplomates are facing increasing clinical demands in both academic and nonacademic practice settings. Combined with the consolidation of hospitals and systems, there is an opportunity to leverage videoconference functions to allow shared teaching conferences among two or more institutions. This possibility led the ABR in early 2024 to revise its previous position regarding potential conflicts with ABR volunteer service in the context of diplomates conducting case reviews.
First, we eliminated the distinction between what an ABR volunteer might do when teaching or presenting case reviews in their home institution and what they might do when presenting educational material to a different program. Second, we reminded ABR volunteers that, regardless of the teaching setting (internal or external), sharing specific case material or proprietary (“inside”) information about ABR exams is not permitted. This mitigates a potential unfair advantage for programs that have a disproportionately larger number of ABR volunteers on the faculty.
The introduction to the 2025 Conflict of Interest acknowledgement and agreement for ABR volunteers has been updated to define these expectations, recognizing that most activities focused on teaching are not inconsistent with serving as an ABR volunteer:
During your service as a volunteer, you are not permitted to participate in activities which are either promoted as preparation for board exams or offered as a commercial product related to board certification. You are also not permitted to participate in activities in which your status as an ABR Volunteer is used for marketing of a commercial endeavor offering board prep or board review. Limited exceptions to board preparation activities will be allowed. The activity may not be commercial, whether or not overseen by a society or other public organization, or require payment of a fee by the participant. Violations of this policy could be grounds for removal from ABR roles and activities.
Note: ABR volunteers presenting case review conferences at their organization or any other institutions are requested to use this disclosure statement: “The following case material and questions have never been submitted to the ABR (e.g., for use as testing material). I am not here as a representative of the ABR, nor am I providing privileged, non-public information.”
The ABR could not offer valid and relevant assessments across the domains of radiology, radiation oncology, and medical physics without the generous contributions of over 1,300 volunteer diplomates. Creating and administering fair assessments requires acknowledgment and reasonable responses to conflicts of interest when exam content and preparation potentially overlap with teaching and research activities.
