Gratitude and Guidance: A Successful Candidate’s Road to IR Certification

Gratitude and Guidance: A Successful Candidate’s Road to IR Certification

Last month, Rayna Howse, MD, MBA, reached a career milestone: She passed the Interventional Radiology Oral Certifying Exam and became board certified by the ABR.

She recently provided feedback to help future candidates succeed on the exam.

How did you feel going into the exam and how did you prepare?

Rayna Howse, MD, MBA
Rayna Howse, MD, MBA

I was nervous, but I knew that thorough preparation and understanding the exam format would help calm my nerves. The ABR provided valuable assistance leading up to the exam by hosting two informative sessions led by Dr. James Spies and Dr. Anne Covey. These sessions were instrumental in familiarizing candidates with the format of the IR/DR Oral Exam. One session included a Q&A segment where candidates could seek advice from successful past examinees regarding resources and gain clarification on the exam structure. For future candidates, I highly recommend participating in these sessions as they offer crucial insights.

In preparation for the exam, I reviewed the materials recommended during the Q&A session and sought advice from recent test-takers. The ABR also offers a noninterpretive skills guide.

I also reviewed cases I was less familiar with by consulting other IR physicians, reading Journal of Vascular and Interventional Radiology articles, or referring to the Kandarpa Handbook of Interventional Radiologic Procedures.

What was the most beneficial aspect of your preparation for the exam?

Engaging with a colleague who was also taking the exam in a case-based study approach. We simulated the exam closely by providing each other with cases from the SIR Case-based Review Monograph (ebook found on the Society of Interventional Radiology website) and other relevant materials. This entailed one of us presenting a patient’s history, with the other asking additional questions, determining the appropriate imaging, evaluating images, making a diagnosis, discussing pre-procedure considerations (e.g., labs and medications), formulating a procedure plan, and outlining responses to common complications (e.g., medication overdoses, bleeds, dissections, emboli, drainage catheter issues, etc.), then going over post-procedure management for the case. This collaborative approach proved to be highly effective in preparing for the exam and improved my confidence in interacting with examiners.

Does the ABR have resources to help prepare for the exam?

Absolutely! There’s an exam guide available on the ABR website.

Additionally, the ABR has released a mock exam video that allows candidates to become more acquainted with the style and format. I highly recommend watching!

Could you give a quick-crash course on how the exam works?

The exam consists of four sections:

  1. Arterial
  2. Venous/Lymphatic
  3. Hepatobiliary/GU/Oncology
  4. Core IR (which includes common procedures and troubleshooting)

Of note: neurointerventional radiology is not included in the exam.

Each section contains multiple cases; the number may vary from one candidate to another. To pass the exam, candidates must achieve an average score of 70 in each section. Examiners assign scores to each case as follows:

  • 68: Clear Fail (Examinee approached case in an unsafe way and/or had very limited knowledge)
  • 69: Marginal Fail (Examinee had some knowledge of the case, but missed key points)
  • 70: Marginal Pass (Examinee was comfortable with the case, basic competency achieved)
  • 71: Strong Pass (Examinee was very comfortable with the case)
  • 72: Very Strong Pass (Examinee had comprehensive knowledge of the case)

The ABR mock exam video provides a good representation of the exam’s style, difficulty, and scoring. It even shows examples of a 68 Clear Fail, 69 Marginal Fail, and 72 Very Strong Pass.

Each examiner gives a numerical score for their section. The performance on the overall exam is discussed later in the panel by the candidate’s four examiners if the candidate has a failing score in one or more sections. In the event that a candidate passes three sections and has a 69 in the fourth, the examiner in that section has the option of raising that score to passing if the candidate did well on that section. A score in that single section can only be raised and never lowered.

What was the remote experience like?

My remote experience was positive! The software was user friendly. When I faced a momentary interruption in my internet connection, my examiner was helpful and understanding, allowing me to seamlessly resume where I left off.

Furthermore, in the event of a more extended internet interruption, the ABR tries to offer a same-day makeup option for a section that could not be completed as initially planned.

What did you think of your examiners?

My overall impression was positive! All the examiners I interacted with were courteous, helpful, and professional. They redirected me as needed and I never felt like they were trying to mislead me.

Fair warning: Examiners may interrupt to move to the next case once they have enough information to make an assessment. This does not necessarily mean you are doing badly!

Another quick note: If your examiners don’t talk much, just keep doing the best you can and don’t assume the worst!

Is there anything else you wish you knew going into the exam?

For some exam scenarios, I noticed that my practice’s approach differed from the textbook answer. Most of the examiners were receptive to me explaining both options, which not only made me more at ease, but also allowed me to demonstrate my understanding of the material. When in doubt, don’t be afraid to talk through your thought process!

How did ABR staff perform?

The ABR staff provided an excellent level of support and assistance throughout the entire process. I reached out to them multiple times leading up to the exam to confirm logistical details, such as the start time, camera specifications, and how to handle technical issues.

How do you feel now that you are certified?

I am relieved and grateful. It is an honor to be welcomed as an ABR certified interventional and diagnostic radiologist!





















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