Feedback Vital to Development of New DR Oral Certifying Exam
By Robert M. Barr, MD, ABR President
2023;16(3):2
On April 13, the ABR announced that the Diagnostic Radiology Certifying Exam, currently administered in a written multiple-choice format 15 months after graduation from residency, will be replaced with a remote online oral exam. The new format will be required for candidates completing residency during or after 2027 and will be administered using the ABR’s proprietary videoconference exam software.
The announcement represented the culmination of nearly two years of work, beginning with the fundamental question of whether the current exam structure was an optimal way to assess the knowledge and skill of diagnostic radiologists. The question was part of internal discussions and analysis inherent in the ABR’s ongoing efforts to maintain high-quality testing instruments based on sound principles and effective execution. Subsequently, we developed an iterative process of seeking input from external stakeholders, including hundreds of residency faculty, practicing nonacademic radiologists, and recent trainees. We have previously shared some of the recurring themes that surfaced during these discussions. These included the perception that the Certifying Exam should focus more on skills necessary for diagnostic radiology practice (including synthesis of imaging findings and acknowledgement of nuance and judgment when assessing an imaging study in the context of a clinical scenario), should be broader in content (rather than targeted to subspecialty knowledge), and should positively influence study habits that may be too focused on the current multiple-choice exam structure.
In the weeks following the announcement, we had three opportunities for public discussion: sessions at the annual meetings for both the American Roentgen Ray Society and the Association of University Radiologists in April and an open invitation webinar in early May. Most of the feedback was favorable, confirming the perspectives we heard last year during the early phase of the project.
Three recurring questions followed the April announcement. First, we were asked whether we had considered other innovative exam platforms rather than a return to the oral exam model we had set aside more than 10 years ago. In short — yes. Both internal dialogue and external stakeholder discussions stressed that there was no determinative “solution” and that creative alternatives deserved our consideration. However, structured stakeholder exercises targeted to specific goals of the exam consistently demonstrated superiority of oral exam platforms at this time, and the ABR concluded that oral exams would best complement the existing multiple-choice Qualifying (Core) Exam and most effectively assess the knowledge and skills necessary for independent diagnostic radiology practice. Oral exams represent an efficient, cost-effective, and practical solution that is widely used among the ABMS boards in other specialties, and they remain in use by the ABR for interventional radiology, radiation oncology, and medical physics.
Second, we were asked how the oral exam platform would mitigate the subjectivity and bias that could influence pass-fail decisions for the candidates. The new exam platform allows for standardized scoring rubrics and case sets that contribute to the uniformity and fairness of the process. In addition, discussions among examiners in different areas who meet with the same candidate and among examiners within a specific content area also seek to normalize the assessment and scoring of individual candidates.
Third, the range of strong preferences for the most appropriate timing of the exam, which we had encountered during our internal and external discussions, represented an ongoing source of concern. In this regard, the ABR selected what may be considered the “least objectionable” option based on a range of responses. As a result, the first opportunity will be early in the calendar year following graduation from residency. However, we intend to actively consider modification of this timing based on early experience (in 2028 and 2029) to see if there is a more appropriate alternative. It is important to highlight that candidates will have an additional opportunity to take the Certifying Exam later in the calendar year if they prefer and remain eligible for six years following graduation.
For more information, please see our New DR Oral Exam Frequently Asked Questions (FAQs).
