Meeting Continuing Certification Requirements: Assessment Timeline
By Matthew B. Podgorsak, PhD, ABR Board of Trustees Chair; Jennifer Stickel, PhD, Future ABR Trustee; Kalpana M. Kanal, PhD, and Robert A. Pooley, PhD, ABR Trustees; and Geoffrey S. Ibbott, PhD, ABR Associate Executive Director for Medical Physics
2024;17(4):7
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.” The ABR assesses whether diplomates who gained initial certification in 2002 or later maintain their knowledge and skills throughout their careers with the administration of the Continuing Certification (CC) program. Diplomates certified before 2002 hold lifetime certificates that do not need to be maintained, although some lifetime certificate holders have voluntarily entered the CC program. In this article, we will explain the process and timeline followed by the ABR to evaluate if a diplomate has met their CC requirements.
Participation guidelines for the CC program can be found here. A diplomate must meet four parts to maintain their certificate: (1) professionalism and professional standing; (2) lifelong learning; (3) assessment of knowledge, judgment, and skill; and (4) improvement in medical practice.
Diplomates no longer must attest to meeting the requirements for Parts 1, 2, and 4 annually. However, the ABR conducts random audits during which documentation is requested from the diplomate to provide evidence that the requirements have been met. It is a good idea to periodically review one’s professional activities and associated documentation to ensure compliance with these requirements.
Several years ago, the ABR implemented Online Longitudinal Assessment (OLA) for Part 3 of the CC program. This meets the recent American Board of Medical Specialties (ABMS) mandate that Member Boards such as the ABR assess a diplomate’s knowledge, judgment, and skill at least every five years. The ABR offers diplomates two options to fulfill the Part 3 requirement. The first is comparing their OLA cumulative score to their passing standard during the last year of a five-year cycle. The end of a diplomate’s five-year cycle is indicated on their OLA dashboard as the Part 3 deadline, and a diplomate can pass the Part 3 component by being above their passing standard at any time during that final year. The second option is for a diplomate to take and pass a Continuing Certification Exam (CCE) during the fourth or fifth year of their Part 3 cycle.
To efficiently administer the Part 3 assessment for the thousands of diplomates across all disciplines who are maintaining their certificates, the ABR Board of Governors decided to split the initial cohort into groups of diplomates with assigned deadlines between December 31, 2024, and December 31, 2028. This way, a smaller and more consistent number of diplomates will be assessed annually. It is therefore possible for diplomates who are in the same department to have different Part 3 deadlines spread across the 2024-2028 timeframe.
If a diplomate does not meet the Part 3 requirement at the end of their five-year cycle or does not meet the requirements for Parts 1, 2, and 4 at the conclusion of an audit, their certification status within the public reporting database will be changed to ”inactive.” Further details can be found in the Continuing Certification FAQs.
Q&A with ABR Leadership: Reflections on Seven Years on Board of Governors
Outgoing ABR Board President Robert M. Barr, MD, shares thoughts on his ABR Board of Governors term.
2024;17(4):2
What were the ABR’s biggest challenges during your time on the Board?
COVID presented the biggest challenge during my term on the Board of Governors. Exams across all disciplines were repeatedly postponed and then ultimately canceled when it became clear that the ABR would need to pivot to a completely remote testing paradigm for oral and computer-based exams to resume.
Other challenges were more predictable, including the continuing need to ensure that ABR certification is valid, credible, reasonable, and cost-effective. Lastly, making sure that the ABR continues to evolve appropriately in the face of the changing scientific and societal landscape is challenging. ABR content must remain up to date as innovations in practice are introduced, and our policies (for example, residency leave) need to be flexible enough to be inclusive and nondiscriminatory.
What were the organization’s biggest accomplishments in those seven years?
The shift to a completely remote testing platform was the organization’s most impactful accomplishment. It was helped greatly by our successful implementation of Online Longitudinal Assessment (OLA), which was in planning when I joined the BOG in 2017 and had just begun when the pandemic hit. Transitioning to remote exams for board certification may seem now like “no big deal,” and we heard frustration from many at the time that it should happen more quickly. In a high-stakes testing environment, however, we simply couldn’t afford to roll out a version that would have had a significant likelihood of failure. One of the other ABMS Member Boards experienced a significant failure impacting large numbers of candidates, and none of the other Member Boards had yet rolled out a successful model at the time we developed ours.
The transition was successful because of the efforts of volunteers and staff throughout the organization. It has led the ABR’s evolution into an organization with a heavy IT focus, enabling numerous other beneficial changes, including office automation and increased organizational efficiency.
The other major accomplishment during my time on the BOG was a shift in communication strategy, with a heavy emphasis on stakeholder input. This occurs largely through the stakeholder advisory committees that have been established for initial and continuing certification in each discipline. The ABR has also been active in seeking regular input from related organizations in the radiologic disciplines. Some projects have required more individually tailored approaches to stakeholder engagement. Perhaps the best recent example is the comprehensive stakeholder sessions used to inform the ABR’s shift to oral exams for initial certification in diagnostic radiology, scheduled to begin in 2028.
It is important to remember that the ABR is not a member organization and that our primary stakeholder is the public. However, the radiologic community is a critical stakeholder and we do listen to feedback. We believe that it serves the radiologic community to ensure both rigor and reasonableness in our certification processes. The ABR, like other ABMS Member Boards, has been criticized as “tone deaf” in the past. We hope to continue moving in the right direction to correct that impression.
What did you learn about the organization as board president?
The organization is fortunate to have terrific staff. Staff members are talented and dedicated. Many are experts in their respective areas. Equally impressive is the group of accomplished volunteers who bring extensive experience, care deeply about the mission, and take their roles seriously. The sheer number of volunteers is hard to fathom — currently over 1,300 participate regularly on numerous committees to develop and validate our assessment instruments. The ABR is a strong organization because of its volunteers and staff.
What did you bring to the role as a private practice diagnostic radiologist?
Nonacademic practitioners make up the majority of ABR diplomates, and our practices are impacted by many of the decisions affecting both initial and continuing certification. I think that all volunteers are mindful of the realities of our diplomates, but it is helpful to have a range of perspectives when developing policy. My background as a relative “outsider” and long-time advocate for radiology practice has helped inform my view of the ABR’s role among numerous other educational, scientific, administrative, and advocacy organizations within radiology, and how the parallel efforts of these various organizations best serve our patients, thereby strengthening our practices and our specialty. I am also aware of the difficulty those in private practice face in finding the time to participate as ABR volunteers. Private practice volunteers are critical on our committees. Hopefully, the ABR will continue to improve the efficiency and flexibility that volunteers need to support those in a wide range of practice environments.
Being an ABR volunteer is an unpaid position. What do you get personally and professionally from being one?
True that it is unpaid, and it also comes with real work. Most of the volunteer positions are fairly time intensive. On item-writing committees, submitted work is reviewed in detail among your peers. Among leadership (Board of Trustees and Board of Governors), there are frequent, lengthy meetings dealing with complex and often high-stakes issues.
Despite this, our colleagues know what the ABR does, and what it means to contribute to that process. It is one of the most rewarding things I have done in my career, partly because of the importance of the task, and largely because of the wonderful group of volunteers similarly drawn to the mission.
It is challenging to make time during the day as workloads for all of us have increased. I am indebted to my colleagues at Mecklenburg Radiology Associates for providing me the flexibility and support to have served these past seven years.
How has your volunteer experience impacted the way you view the importance of board certification?
I have always believed in the importance of board certification. We are fortunate in each of the radiologic disciplines to have jobs that are in high demand, are intellectually stimulating and at the cutting edge of innovation, are valued by our payors and employers, and are critically important for the lives and health of our patients. My own gratitude for being able to practice in a field that I love helped stimulate my desire to support organized radiology. A robust board certification program serves our patients and helps ensure the continued validity and value of our field.
Dr. Cheri Canon will become board president in September. What qualities does she bring to the role that make her the right choice as your successor?
They are too numerous to count. She is a skillful leader who is effective and efficient. Everyone — myself included — loves working with her. She has great judgment, listens well, and makes everyone on the team better. She will benefit from a talented and thoughtful group of governors, a terrific president-elect, Dr. John Kaufman, and an exceptional executive director, Dr. Brent Wagner. The ABR is in great hands.
Overlapping Roles of the ABR and Residency Programs Support High-Quality Patient Care
By Donald J. Flemming, MD, ABR Governor; Matthew B. Podgorsak, PhD, ABR Board of Trustees Chair; and Brent Wagner, MD, MBA, ABR Executive Director
2024;17(4):4
The ABR and residency training programs pursue overlapping goals but use separate and distinct methods. Achieving certification requires rigorous training and passing a series of standardized exams. These two components support high-quality practice by radiologic science professionals (in radiology, radiation oncology, and medical physics), which ultimately serves the interests of patients and the public.
The mission of the residency programs is to graduate the best trained residents possible within the limits of available resources, and the program faculty aspire to develop medical professionals who exemplify excellence. Accreditation by the Accreditation Council for Graduate Medical Education (ACGME) (for physicians) or the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) (for medical physics programs) requires compliance with standards that cover – among other elements – curricula, goals and objectives, faculty qualifications, assessment and feedback processes, and training environment. Overall, the program requirements define parameters within which programs must perform to support a setting that is conducive to effective learning. In recent years, a program’s efforts have been increasingly assessed by evaluating outcomes based on defined objectives that include the success rates of their residents with the certification process.
Assessment of individuals during the residency is primarily formative (“assessment through learning”), which often includes informal questioning and intentional observation of a resident’s knowledge and skill when applied to, for example, a diagnosis, a treatment plan, a procedure, or safe and effective use of clinical technology. Secondarily, summative assessment (“assessment of learning”) can be used to measure progress through graduated levels of responsibility, with the goal of competence for independent practice. For ACGME-accredited residencies, evaluation by the Clinical Competency Committee is in part directed toward progress relative to well-defined milestones. For CAMPEP-accredited residencies, the program director, like their ACGME counterpart, is required to meet periodically with each resident to evaluate the resident’s progress.
Multiple years of residency training, combining longitudinal experiential learning with frequent in-depth faculty observations and feedback, are invaluable not only for a resident’s acquisition of skills and knowledge that form the basis for excellence in practice but also for the objective determination of their competence and suitability for independent practice.
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.” Complementing the extended training period of the residency, the ABR’s point-in-time exams offer two distinct features that contribute to the validity and value of board certification. First, ABR exams represent a standard that normalizes the inherent variability of opportunities, education and assessment across residency programs. Second, they offer a goal for trainees (and faculty) to encourage the pursuit of excellence via self-study across a broad range of specialty skills and knowledge.
Development of a valid and comprehensive exam as a high-stakes assessment instrument requires the collective wisdom of subject matter experts combined with the generous efforts of practitioners who volunteer from diverse academic, research, and clinical practice backgrounds. Most important, defining the relevance, reasonableness, and boundaries of the breadth and depth of the practice domain is most effectively accomplished by committees whose members respectfully challenge each other and are motivated to produce a high-quality exam.
The ABR’s team of psychometricians helps guide exam construction to contribute to fairness and reliability. Acknowledging that no testing instrument is perfect, rigorous statistical analysis after each exam administration seeks to confirm reliability of the assessment for individuals and the cohort of candidates. For example, although uncommon, problematic questions that might have been ambiguous or confusing are identified by systematic post-test analysis and, after review by subject matter experts, may be omitted from scoring to enhance fairness.
The complementary functions of structured residency training and systematic development and administration of valid standardized exams contribute to achieving the goal of creating a fair and meaningful certification process that can be trusted and valued by the health care system and patients alike.
