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.
New Oral Examiner Drawing on Her PhD Experience
By Rodney Campbell, ABR Communications Manager
2024;17(6):10
On her way to earning a PhD in education from Ohio State University, Ashley Cetnar, PhD, MS, concentrated on learning about oral exams. She started putting that experience to use as an ABR oral examiner for medical physics for the first time earlier this year.
Looking back on her experience at OSU, where she earned her degree in December 2020 and is now an associate professor, Dr. Cetnar is thankful for the opportunity to have studied the methodology before starting with the ABR.
“Conducting a literature review on oral examinations was really helpful for knowing the history, background, and the rationale for why you’re doing the assessment,” she said.
Coordinating mock exams was an important part of her learning and remains vital to what she does as an educator. As a first-time examiner, she was able to draw on that experience. She also wants to get a better idea of how her colleagues are performing their duties during future exams.
“I only had the perspective of myself and the examinees that I interacted with,” she said. “It would be interesting to observe other examiners to see if the observations that we saw in the research of oral exams on the mock level are transferable to the real examination.”
Regardless of discipline, every oral examiner has one thing in mind: ensuring that candidates are safe to practice independently. There are no trick questions, and examiners treat the process as a conversation between colleagues, simulating a real-world environment.
“Your goal is to make sure that you understand what they actually know,” Dr. Cetnar said. “This is every candidate’s opportunity to shine and show the things that they have worked toward professionally.”
Being an examiner carries a great deal of responsibility. After becoming a volunteer in 2022 and going through extensive training, Dr. Cetnar was still nervous when she put on the headset to examine candidates.
“It was intimidating because it’s the first time that you have an opportunity to discern whether a candidate knows enough to meet that bar for our profession,” she said. “You prepare as much as you can, but even as an examiner, you’re nervous. Being an examiner is a tremendous responsibility.”
Despite the nerves, her first experience as an examiner went well. Matthew Podgorsak, PhD, chair of the ABR Board of Trustees and a member of the Board of Governors, helped recruit Dr. Cetnar and watched her performance during the spring administration.
“In observing her as she examined her first two candidates in April, I was able to confirm that, as expected, Dr. Cetnar exudes an interaction style that nicely supports the best practice in oral exam administration: providing candidates with an environment that enables them to fully communicate their knowledge and experience during an exam session,” he said. “I certainly look forward to inviting Dr. Cetnar to examine again in the very near future.”
Dr. Cetnar discovered her calling at Grove City College in Pennsylvania, where she earned a degree in applied physics. She went on to earn a master’s in medical physics at Vanderbilt University.
“It was by chance that I decided to major in physics,” she said. “But once I was in that scientific community, it was very supportive. Being welcomed was motivating for me to continue on to earn a physics degree.”
Some students only take STEM classes when required. Dr. Cetnar took that as a challenge to become a better physics instructor, taking part in Vanderbilt’s Center for Teaching. In addition to her PhD in education, she also has a certificate in health professions education from the University of Louisville and a public management certificate from Ohio State, where she’s now pursuing a master’s in public management and leadership. It’s a well-rounded education.
“A lot of people don’t like STEM classes because they think that they’re hard,” she said. “While the subject matter may be challenging, it’s usually correlated to poor instruction. When people think about their least favorite teacher, it might be a science teacher or a physics teacher. That was my primary motivation for learning more about what goes into good teaching.”
Teaching classes keeps her in touch with what aspiring medical physicists know. She’s also encouraged by what she’s seen as an examiner.
“It’s great being able to interact with the next generation of medical physicists who are going to do awesome things for our field,” she said. “It was really rewarding to be part of that process.”
Future Resident Staying Busy in Her Year Away from Studies
By Rodney Campbell, ABR Communications Manager
2024;17(6):8
Annelise M. Silva, MD, EdM, is taking a year off between completing medical school and starting her residency. But this is far from a gap year.
After graduating from the Wright State University School of Medicine this past April 28, Dr. Silva started as national president of the American Medical Student Association (AMSA) on May 1. With more than 30,000 members and 150 chapters, the AMSA is the largest and oldest independent association of physicians-in-training in the United States.
“I wish I would have had a week of vacation,” she jokingly said of the quick turnaround. “I was finishing an away rotation, graduated that weekend, and started (at AMSA) a few days later. The flip from fully clinical to fully business has been a whirlwind.”
Her new duties started quickly. She was on calls to Vice President Harris’ office on her third day and, not long afterward, sitting in on sessions with the National Academy of Medicine and the AAMC.
“I had been in different leadership capacities before, especially in the nonprofit space, but never to this scale and this level,” Dr. Silva said. “It’s still taking me a second to get used to, but it’s an incredible opportunity to bring the voices of future physicians to the table.”
She started medical school in 2020 during the tumult of the COVID pandemic. Already grounded in educational equity work, Dr. Silva was looking for ways to not only build her work in health equity, but also to construct community during quarantine. That inspired her to join the local AMSA chapter at Wright State.
“I have a unique opportunity as a woman of color to use the intersecting lenses of my identity to look at things from a social justice perspective,” she said. “I think often about how we can build more access and communication to help drive patient care in that way.”
In her everyday duties, Dr. Silva oversees the organization’s board of trustees and its 75-member student government. She also works closely with a full-time staff of 20. Dr. Silva spent a year as AMSA’s president-elect before taking the reins this past spring. She will become its immediate past president next spring.
“We’re doing excellent work bringing the medical student voice and the premedical student voice into the spaces where they’re needed because we recognize that it is important for us to help support the healthcare system and society that we will inherit,” she said.
Dr. Silva has been preparing for this role for a while. She started in high school as a peer leadership counselor for Workshops for Youth and Families and then got involved in student organizational leadership in college at Arizona State University (ASU), designing events like multi-state research conferences. After college, Dr. Silva worked with Teach for America (TFA) in Massachusetts as an eighth-grade science teacher during and after earning her master’s in education at Boston University. During her preclinical years in medical school, she worked with fellow ASU and TFA alumnae to found and run the nonprofit Young and Empowered Women, which promotes the professional and personal development of women of color.
She also worked closely as an intern with an executive leadership coaching firm, working with clients like Twitter (X), Airbnb, and the Ford Foundation.
“It gave me the chance to learn what large-scale organizational leadership and change management looks like,” she said.
Her Filipino father and grandfather set the course for Dr. Silva’s career. They’re both diagnostic radiologists and were her first professional role models.
“Radiology has always been the way that medicine has been framed for me,” she said. “I grew up in reading rooms watching my dad interact with colleagues and consultants in the field.”
She’s based in Boston and has submitted her materials to numerous programs across the country with the hope of finding a program that will support her diverse interests in education, research, leadership, and policy. Dr. Silva is keeping her options open and would like to train and eventually work where she can serve people who share her background. She has applied to 80 programs for the Match and hopes to start an internship next July.
“One of the things that makes me most excited about radiology is seeing the push for diversity, equity, and inclusion from a systems perspective that radiologists can provide” she said.
Michele H. Johnson, a professor of radiology and biomedical imaging and of neurosurgery at Yale University, met Dr. Silva through the American College of Radiology’s Pipeline Initiative for the Enrichment of Radiology (PIER) Internship. The program, offered to first-year medical students across the U.S., began through the Commission for Women and Diversity to give underrepresented minorities and women opportunities to explore radiology and engage in research. Scholars are paired with at least one preceptor in the student’s area of interest.
Dr. Silva teamed with Dr. Johnson, who was impressed by her younger colleague’s educational background and eagerness to learn more about radiology.
“She’s interested in teaching and sharing,” Dr. Johnson said. “Having a woman in this spot creates a role model for medical students. Annelise has amassed mentors and sponsors to help her along the way and she will carry that forward.”
Dr. Silva is also part of the task force for the American College of Radiology’s Communities Crushing Cancer initiative through the Radiology Health Equity Coalition. The event, which happens in October every year, matches her goals of raising awareness and providing healthcare opportunities for underserved populations. Working with dedicated people from her intended profession gives her even more inspiration to push forward.
“It all resonates with me, and that’s why I could not imagine being in another field,” she said. “I say this without a match quite yet, but radiology is my heart and my home for where I’d like to be in medicine and my community.”
