Exam Curiosity Inspired Him to Become Volunteer
By Rodney Campbell, ABR Communications Manager
2024;17(4):10
When he was a fellow at the University of Texas MD Anderson Cancer Center in Houston, there was one thing that Richard Castillo, PhD, wanted to avoid: senior colleagues randomly testing his knowledge in hallways or break rooms.
“I would walk by the wrong person, and they would say, ‘Oh, hey, Richard, what’s this or that?’” he said. “And I would answer, ‘Ah, I don’t know.’ Then I would want to run the other way.”
Dr. Castillo survived the ordeal and earned his initial certification in therapeutic medical physics eight years ago. Now, he finds himself on the question-asking side. Dr. Castillo, who is being promoted to professor at Emory University’s School of Medicine on September 1, will serve as an ABR medical physics oral examiner for the third time this fall.
Curiosity about how initial certification exams are put together led him to apply to become a volunteer.
“The exam process was very much a black box for people,” said Dr. Castillo, who’s also director of the certificate program in medical physics in Emory’s Department of Radiation Oncology. “I wanted to learn more about it and be able to contribute to it in whatever way I could, as an advocate and in service to others who were going through it.”
Dr. Castillo teaches trainees who are preparing for the certification exam. His experiences at MD Anderson and as an ABR volunteer have made him aware of their understandable hesitancy about taking oral exams.
“They have a fear of looking silly and not knowing the answers,” he said. “I’ve tried to leverage that experience and that insight into how I teach and make it about developing a rapport.”
Dr. Castillo believes being empathetic and patient as an oral examiner is key to ensuring a fair process for candidates. After all, he and the other volunteer examiners were once on the other side.
“I try to put myself back there and, more than anything, try to meet that person where they are,” Dr. Castillo said. “They’re nervous. It’s high stress, high pressure. I understand candidates may blank on something that they know just because of the environment and what’s happening.”
Among the myths he wants to dispel is that oral examiners are trying to trick candidates and fail them. Dr. Castillo said that, on the contrary, they want to discover what examinees know and ensure they can be part of a competent patient care team.
“I know how much this means to them,” he said. “I’ve gone through it, and I want to do my part to make the process better. It’s an interesting thing being an oral examiner because you want the people to pass so badly, but you can’t speak for them.”
Dr. Castillo also volunteers for the American Association of Physicists in Medicine (AAPM), where he serves as vice chair of the Equity, Diversity, and Inclusion Committee, chair of the Diversity and Inclusion Subcommittee, and founding chair of the Hispanic and Latin-X Medical Physics Subcommittee. (The ABR has a DEI committee that includes members of the boards of governors and trustees.)
He brings that experience into his ABR volunteer duties by seeking ways to ensure that exams remain fair and relevant for all candidates.
“I’m highly motivated to pursue that type of inquiry,” said Dr. Castillo, who was named a fellow of the AAPM in July. “In the meantime, I want to keep doing what I’m doing, which is serve the ABR, our trainees, and examinees in the best way that I can.”
ABR Associate Executive Director for Medical Physics Geoffrey Ibbott, PhD, was a professor and chair of the department of radiation physics at MD Anderson when Dr. Castillo was there. He was impressed by his young colleague, who had 20 publications and several grants, including a prestigious K01 award from the National Cancer Institute that goes to early career-stage researchers in cancer control and prevention.
Dr. Ibbott suspects that Dr. Castillo wasn’t caught off-guard very often when facing a pop quiz.
“Richard needn’t have been concerned,” Dr. Ibbott said. “He was an outstanding student, postdoc, and faculty member at MD Anderson, and I remember him as always being very well prepared for meetings, presentations, and even his annual reviews. He took on his responsibilities with enthusiasm.”
ABR To Gather Stakeholder Input on IR/DR Certification Exam Structure
By John A. Kaufman, MD, MS, ABR Secretary-Treasurer; Cheri L. Canon, MD, ABR President-elect; and Brent Wagner, MD, MBA, ABR Executive Director
2024;17(4):3
The ABR continually considers the appropriateness of the certification process, including the validity and focus of its exams. Earlier this year, the ABR asked interventional radiologists to comment on (a) whether its exams in support of initial certification in interventional radiology/diagnostic radiology are effective in assessing competence in diagnostic radiology and (b) if not, what modifications might be considered? Initial responses from a few dozen interventional radiologists varied widely and have prompted consideration of a systematic and focused inquiry by the ABR.
Background
ABR certification in interventional radiology was developed to represent competency in two broad components: interventional radiology (IR) and diagnostic radiology (DR), together referred to as IR/DR. ABR certification, as recognized by the American Board of Medical Specialties (ABMS), describes interventional radiology as a specialty that “combines competence in imaging, image-guided minimally invasive procedures, and periprocedural patient care to diagnose and treat” a variety of benign and malignant conditions.1 Although the Accreditation Council for Graduate Medical Education (ACGME) refers to the residency pathway as “interventional radiology,” it is inextricably linked to DR and includes three years of training in the latter. The resulting certificate “signifies competence in both DR and IR” and the individual is “certified in both DR and IR.”2
Near the end of the third year of residency, candidates seeking IR/DR certification take the same Qualifying (Core) Exam in diagnostic radiology as the candidates for DR certification. After the completion of training, both groups are assessed via a computer-based exam that is part of the Certification Exam – 118 questions that cover broad topics in diagnostic radiology (the “essentials” of the specialty).
Beyond this, the initial certification exams differ. For DR, the current model includes an additional 180 questions, divided into three individual modules, that are selected by the candidate based on preference for a single practice profile (e.g., musculoskeletal, breast, thoracic, etc.) or some combination of specific subspecialty areas. For IR/DR, beyond the essentials content, 60 written questions are administered in interventional radiology, and there is a separate four-part oral exam covering the imaging features, procedural techniques, and clinical management related to a broad range of interventional radiology procedures.
Beginning in 2028, the candidates for DR certification will no longer take the computer-based certification exam (see table). Instead, a seven-section oral exam will assess higher-level skills such as observation, synthesis, and management.3 Candidates will be evaluated on communication and their ability to incorporate clinical information into recommendations for management and additional imaging when appropriate.
|
Diagnostic Radiology (2028 model) |
Interventional Radiology / Diagnostic Radiology (current model) |
|
Qualifying (Core) Computer-based Exam |
Qualifying (Core) Computer-based Exam |
|
Certifying DR Oral Exam |
Certifying IR/DR Oral Exam |
|
|
Certifying Computer-based Exam:
|
Next Steps
This month, the ABR will begin a multifaceted process of stakeholder engagement to gather input regarding what, if any, changes to the IR/DR certification exam structure need to be considered. The ABR has retained a third-party healthcare communication and marketing firm to facilitate discussions with stakeholder groups including professional societies and program director organizations. This is very similar to the process we used when evaluating similar questions for DR certification,4 and we look forward to learning from diverse perspectives among our colleagues in professional societies and variable practice environments. We have also created a conduit for public comment that will be open until September 30.
References
- Interventional Radiology/Diagnostic Radiology. ABR website. https://www.theabr.org/interventional-radiology.
- Kaufman JA. The interventional radiology/diagnostic radiology certificate and interventional radiology residency. Radiology. 2014; 273:318-21. doi: 10.1148/radiol.14141263. PMID: 25340266.
- New Diagnostic Radiology Oral Exam. ABR Website. June 10, 2024. https://www.theabr.org/news/new-diagnostic-radiology-oral-exam
- Larson DB, Flemming DJ, Barr RM, Canon CL, Morgan DE. Redesign of the American Board of Radiology Diagnostic Radiology Certifying Examination. AJR Am J Roentgenol. 2023; 221:687-693. doi: 10.2214/AJR.23.29585. Epub 2023 Jun 7. PMID: 37315014.
Addressing the Independent IR Residency Trainee Gap
By James B. Spies, MD, MPH, ABR Associate Executive Director for Interventional Radiology
2024;17(4):6
In recent years, the number of trainees applying for a five-year integrated interventional radiology (IR) residency has been increasing but with a corresponding decrease in the applicants for the independent IR residency. It appears that medical students committed to IR are showing a preference to match directly from school into integrated residencies, and a diminishing proportion of diagnostic radiology (DR) residents are applying for an IR independent residency.
Regardless of the reasons, the trend accelerated with this year’s independent IR residency match, with a dramatic decrease in the proportion of available positions filled. Of the 159 available positions, only 93 (58.5%) filled via the match. Of the 73 programs participating, only 28 (38.4%) filled via the match. Many training programs depend on independent residents during PGY-5 and PGY-6 and are now facing gaps in their trainee staffing.
As a result, the ABR has received inquiries from program directors about whether international medical graduates (IMGs) can be recruited to fill these open positions. While technically this may be allowable under ACGME rules, there are some potential pitfalls for IMGs who have no other U.S. or Canadian training. Perhaps the most important is that completing an independent IR residency alone does not result in eligibility for ABR interventional radiology/diagnostic radiology (IR/DR) board certification. For current trainees, the only pathways to ABR board eligibility in IR/DR are: (1) completion of an integrated IR residency, (2) completion of a DR residency followed by an independent IR residency, (3) completion of the five-year IMG IR alternate pathway, or (4) completion of a four-year IMG DR alternate pathway followed by an independent IR residency.*
Completion of an IR independent residency alone is not an option for either an American or international graduate. There must be appropriate DR training or experience as well, as the certificate qualifies the diplomate to practice in both disciplines. An independent IR residency does not provide diagnostic training.
It is also important to realize that the ACGME requires that DR training (either a DR residency or IMG DR alternate pathway) be completed before the independent IR residency. Therefore, if a program director offered an international graduate a two-year IR independent residency position without the requisite qualifying DR training, the IR training would not count toward eventual board eligibility. The DR training would need to be completed and the IR training then repeated to meet the requirement. Offering a two-year independent residency position without preceding DR training might be fine if the international graduate plans to return to their home country to practice. However, the program director would be doing a disservice to the trainee if the trainee’s eventual goal was ABR certification.
A better alternative would be to include the two-year independent residency in a five-year IR IMG pathway, with a three-year plan beyond that for additional training or faculty service. Candidates on this pathway are sponsored by the department, and the individual trainee’s plan must be approved by the ABR, but successful completion would result in the candidate’s board eligibility. An important prerequisite is that the candidate must be fully trained in their home country in radiology, including one year of IR training, and qualified to practice IR independently in that country. If that stipulation is met, the department can develop a training plan for the candidate that fits the mutual needs of the department and the candidate, with an eye toward ensuring that the individual will be capable of successfully passing the Qualifying (Core) and Certifying exams and practicing IR independently. The details of the requirements of the IMG pathway can be found here.
While at first glance the choices might seem confusing, all are directed toward a single goal: to ensure that those seeking ABR certification in IR/DR have sufficient training and experience to practice independently, competently, and safely. The ABR recognizes that there may be different paths to reaching that goal and has created options to allow candidates from a range of backgrounds to reach IR/DR certification.
* The ABR recently approved a limited two-year IMG pathway for IR that it is only open to those who successfully completed a four-year ABR IMG DR pathway. This is most applicable for IMG candidates who want IR/DR certification but are in a department without an accredited IR residency. An IR IMG alternate pathway can only be completed in a department with an ACGME-accredited IR residency. Inquiries regarding this limited pathway or the other alternative pathways should be directed to the ABR at 520-790-2900.
