By ABR Trustee Donald J. Flemming, MD, and David J. Laszakovits, MBA Delivering our exams at local commercial testing centers has been a topic of conversation for many years. We understand the discontent about added cost for travel and stress of being away from families and training programs. We take this very seriously and are working hard to find more manageable solutions. To that end, we want to share a little about what we’re trying to accomplish, the unique features of the exams, and the obstacles we’ve faced attempting to secure a commercial testing vendor to deliver our diagnostic radiology (DR) initial certification exams. At the most fundamental level, any high-stakes testing organization must achieve several basic exam delivery elements to ensure that our initial certification processes meet best practice standards. Perhaps the most important standard is that the exam be “proctored and secure.” Exams used to evaluate professional performance, such as the SAT, MCAT, and USMLE, usually require the testing environment to be proctored and secured, which ensures the overall fidelity of the exam administration. Prominent commercial testing vendors can’t ensure basic elements we need (e.g., lighting and monitor calibration) to deliver exams. In addition to this basic necessity, delivering an exam to assess the clinical competencies required to practice DR presents a number of other challenges. Because of the nature of practice, the most appropriate way to present DR exam material is through clinical vignettes that have a patient history, a question to be answered, multimedia content, and answer options. The multimedia content usually includes several high-resolution images or a video file. These delivery requirements have proven to be insurmountable obstacles for the testing vendors that we’ve engaged over the years. The majority of these vendors’ clients deliver text-based question exams with little or no multimedia content. For almost a decade, we’ve sought the services of numerous national commercial testing vendors for the delivery of our exams. We’ve been successful in securing a vendor for delivering our radiation oncology and medical physics exams solely because they are text-based with little or no multimedia content. Unfortunately, we’ve not been able to do the same for our DR exams; however, that is not for lack of trying. We have approached two prominent commercial testing vendors to explore our goal of delivering the DR initial certification exams at testing centers. Neither was able to provide a proposal that matched our needs. We are committed to making the initial certification process as effortless as possible. While our past efforts have not been successful, we will continue to pursue everyone’s goal of delivering DR exams in local commercial testing centers. Technology is constantly evolving, and perhaps local exam delivery will become more feasible in the future.