Rigorous Development Processes Ensured Remote Exam Platform Success
By Michael Yunes, MD, ABR Associate Executive Director for Radiation Oncology; Mary S. Newell, MD, ABR Associate Executive Director for Diagnostic Radiology; Geoffrey S. Ibbott, PhD, ABR Associate Executive Director for Medical Physics; James B. Spies, MD, MPH, ABR Associate Executive Director for Interventional Radiology; and Matthew B. Podgorsak, PhD, ABR Board of Trustees Chair
2025;18(3):4
The mission of the ABR is to “certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients.” In the spring of 2020, when the extent of the global pandemic became clear, it was apparent that many of our longstanding mission-critical activities, including administering computer-based exams at testing centers as well as conducting face-to-face oral exams, were no longer acceptable. As did many other organizations, we developed remote processes to keep our candidates, volunteers, and staff safe.
Recent news of a high-profile credentialing organization experiencing problems with the development and implementation of their remote exams underscores the robust nature of the ABR’s processes and contrasts with our successful management of the transition to remote exams.
In studying options for remote exam administration, many potential weaknesses were anticipated and largely prevented through strategic and collaborative efforts by the ABR Board of Governors, Board of Trustees, staff, and volunteers. No implementation can be perfect; however, it was found that limiting the number of modifications at each step and maintaining proven processes minimized the risks associated with reactive and injudicious changes.
The ABR used a roadmap to manage each identified potential problem with a remote exam platform:
- The ABR was transparent with the intent and process of transitioning to remote exams and the development of a software platform.
- Adequate time was planned for the development and testing of the platform prior to implementation.
- The ABR did not rely on external entities for content creation, validation, or software development.
- Feedback from all stakeholder groups was taken into consideration at each step of exam development.
- Exam questions continued to undergo a consistent and robust multistep process of development, editing, validation, and assessment prior to selection for use on an exam. This process has continued to improve and continues to rely on practicing subject matter experts in their disciplines.
- The exam platform was designed to mimic the previous candidate experience of the in-person Pearson VUE proctored exams and the face-to-face oral exams.
- Extensive testing of the software and security was performed prior to going live with an actual exam.
The ABR is dedicated to continued exam development with the following ongoing processes:
- Changes in content or emphasis are publicized well in advance of their inclusion in any exam.
- Exam scoring has remained criterion referenced, not norm referenced. There is no set passing threshold, but rather the passing threshold is set by the item difficulty using a process called the Angoff method. This is performed by a group of volunteers who have a clear understanding of the knowledge base expected at each level of training.
- Best psychometric practices continue to evolve to improve the consistency and validity of each exam.
- Continued software development improves the candidate experience and the quality of the exams.
- Content standards are reviewed and enhanced annually to ensure that the exams remain an appropriate assessment of relevant knowledge.
- Exam security and content confidentiality are essential components to ensure public trust in the validity of ABR certification.
The adaptability of exam candidates significantly contributed to the success of the transition to the remote processes, and their individual feedback contributed to innovations over time. It is expected that infrequent exam day technical issues will randomly arise when connecting to thousands of individual examiner and examinee networks and computers, but managing the systems on the development and delivery side minimized the risk as much as possible.
Responding to an international crisis was difficult to navigate in every facet of life. However, one strong indication of a successful response is the durability of the resultant process once the emergency has eased. The ABR’s achievements benefited from the resiliency, patience, and input of certification candidates and countless volunteers.
International Medical Graduate Alternate Pathway Update
By Cheri L. Canon, MD, ABR President, and John A. Kaufman, MD, MS, ABR President-elect
2025;18(3):3
The ABR’s International Medical Graduate (IMG) Alternate Pathway offers a way for individuals trained in residencies outside the United States and Canada to become board certified. The pathway represents the ABR’s interest in recognizing the knowledge and skill of appropriately trained and highly qualified people from around the world.
We have revised the pathway several times in the past three years, including removing the requirements for nuclear radiology training and for a prospective plan (approved individuals may now receive up to two years of credit for training prior to their application and submission of a Sponsoring Department Agreement). The current program also permits part-time status and discontinuous training, if the pathway is completed within six years from training start date for medical physics, eight years for diagnostic radiology and radiation oncology, or 10 years for interventional radiology.
Extensive ongoing discussions among the Board of Governors, combined with input from external stakeholder groups, led to the announcement in May that the ABR will permit candidates to combine successfully completed training from two institutions (the long-standing policy had required “a single institution”). There are two important conditions: First, representatives of both sponsoring departments must be willing to attest to satisfactory clinical and professional performance during the time of service. Second, at least 24 months must be served in the “final” (second) institution (where the pathway is completed). Additional details can be found on the ABR website. Exam and licensure requirements are unchanged.
ABR leadership believes not only that innovations within the radiologic profession develop from the inclusion of ideas from around the globe, but also that the public is served by a robust set of standards of training and assessment. We agree with those candidates, department chairs, and teaching faculty who think that the IMG Alternate Pathway represents an important opportunity to recognize and certify high quality practitioners in the radiologic sciences.
ABR Budget and Finance Committee Fulfills Duty of Care
By Marina I. Feldman, MD, MBA, ABR Secretary-Treasurer, and Brent Wagner, MD, MBA, ABR Executive Director
2025;18(3):2
The ABR governing board has three legal duties: the “duty of care,” “duty of loyalty,” and “duty of obedience.” The National Council of Nonprofits describes these as:
Duty of Care: Take care of the nonprofit by ensuring prudent use of all assets, including facility, people, and goodwill.
Duty of Loyalty: Ensure that the nonprofit’s activities and transactions are, first and foremost, advancing its mission; Recognize and disclose conflicts of interest; Make decisions that are in the best interest of the nonprofit corporation; not in the best interest of the individual board member (or any other individual or for-profit entity).
Duty of Obedience: Ensure that the nonprofit obeys applicable laws and regulations; follows its own bylaws; and that the nonprofit adheres to its stated corporate purposes/mission.
In reference to the duty of care, the volunteer governors who sit on the ABR Board recognize their obligation to serve as stewards of the fees collected from diplomates and candidates that fund the organization’s activities. These resources allow the ABR to administer the exams and programs that support board certification as a recognized valuable credential.
As defined in the ABR Bylaws, the duties of the Budget and Finance Committee include reviewing and approving the annual budget, overseeing investments, recommending exam and all other fees, reviewing personnel compensation, and related matters as assigned by the Board of Governors. The Committee’s thoughtful deliberations offer oversight of management functions as well as a perspective that focuses ongoing attention on controlling costs.
The committee, along with the Board of Governors, considers the important balance between the stability of financial reserves and the ABR’s potential strategic needs. Over the past five years, resources have been required not only to develop and refine software related to remote exams and Online Longitudinal Assessment, but also to bolster efficiency tools to support volunteer subject matter experts and enhance cybersecurity initiatives. These initiatives strengthen organizational resilience and improve our capacity to respond to the evolving needs of the profession.
