No ‘Evil Scientist,’ He Works to Make Exams Fair and Relevant
By Rodney Campbell, ABR Communications Manager
2024;17(4):9
Physicians and physicists who work with trainees often benefit from serving as ABR volunteers. It’s definitely been a worthwhile experience for Ken Buckwalter, MD, MBA.
Dr. Buckwalter has volunteered with the ABR for 15 years as an oral examiner and question writer for the Diagnostic Radiology Certifying Exam. In his day jobs, he has instructed residents and fellows, inspiring him to learn how ABR exams are constructed, so he can help the organization continually improve those assessments.
“I was curious about the process,” he said. “If you’re training residents and fellows, you want to understand what the exam looks like.”
A clinical professor of radiology and associate chair and associate chief medical information officer in the division of musculoskeletal radiology at the University of Michigan Medical School, Dr. Buckwalter was initially surprised by the work and assessment involved with writing exam questions.
“A question goes through so much review,” he said. “It goes to an (ABR staff) editor and then you have peers looking at it. And then typically the committee chair reviews it and sometimes it goes up another level for review. The exam has so many eyeballs on it. The effort that goes into making it is remarkable.”
ABR volunteers are subject matter experts in their fields who represent a broad range of professional experience. When committees gather to write questions, their goal is to develop content that a competent candidate in their field can correctly answer. There’s never an intention to trick exam takers.
“There’s no evil scientist behind any of this work,” Dr. Buckwalter said. “It should be a group of well-intended people who work to ensure that questions are legitimate and relevant. The amount of oversight is significant, and the goal is to identify people who probably ought not to practice radiology.”
He recently saw an exam from a candidate’s perspective when he was tested at a facility in Ann Arbor, Michigan, to gain certification in clinical informatics. It was an interesting experience for a physician who has become more accustomed to writing questions than answering them.
“I was clearly the oldest person in the testing facility,” he said. “These people were taking their GMATs and LSATs and wondering, ‘Who is this old guy?’ It was pretty funny.”
Dr. Buckwalter brings a wealth of clinical and academic experience to his volunteer duties. He worked at the Indiana University School of Medicine Department of Radiology and Imaging Sciences with Val Jackson, MD. While Dr. Jackson was the chair of the department, Dr. Buckwalter served as vice chair of clinical operations and clinical director for radiology in the healthcare system.
Dr. Jackson, who served as the ABR’s Executive Director from 2014 to 2020, was happy to see her colleague start volunteering for the organization.
“Throughout his time at IU, he had a heavy clinical load, but was very productive in research and education,” Dr. Jackson said. “He rose through the academic and leadership ranks quickly. He also was always extremely generous with his volunteer activities to multiple organizations, including the ABR.”
Dr. Buckwalter added an MBA to his list of accomplishments in 2014 when he was at Indiana University. He earned his medical degree at Sidney Kimmel Medical College at Thomas Jefferson University and performed a residency at the University of Chicago Hospitals and a fellowship in MRI/body imaging at the University of Michigan Health System.
He saw the business-focused degree as a necessity for the administrative side of his career.
“It gives you tools like a Swiss Army knife,” he said. “You’re exposed to management techniques that can be used in many aspects of administration. I’m glad I did it and it’s been helpful.”
Dr. Buckwalter is proud to have served the ABR since 2009 and sees committee work as a vital contribution to his field. He is among approximately 1,300 volunteers who make the initial and continuing certification processes fair and relevant for physicians and physicists. The result is worth the time investment.
“Doing volunteer work is essential to our specialty having a good exam process,” he said. “It takes work, but it’s worthwhile.”
It’s a Success! Update on the ABR 16-Month Pathway in Nuclear Radiology
By M. Elizabeth Oates, MD, ABR Trustee, and David Laszakovits, ABR Communications Director
2024;17(4):5
Graduates of the redesigned ABR 16-month pathway in nuclear radiology (NR) are eligible for primary certification in diagnostic radiology (DR) or interventional radiology/diagnostic radiology (IR/DR) and subspecialty certification in NR (ABR-NR) (or, alternatively, may qualify for the American Board of Nuclear Medicine, ABNM). The pathway was developed to meet the increasing demand for subspecialty trained expertise in NR in academic and community practices, triggered by the explosion of new diagnostic and therapeutic radiopharmaceuticals (“radiotheranostics”) and the burgeoning use of hybrid molecular imaging technologies in clinical care and research.
Traditional Pathway vs. 16-Month Pathway
The traditional approach for becoming eligible for ABR-NR subspecialty certification involves completing a one-year fellowship in an NR or nuclear medicine (NM) program accredited by the Accreditation Council for Graduate Medical Education (ACGME) after graduating from residency training in DR or IR. The ABR 16-month pathway in NR leverages flexibility within DR and Integrated IR residency programs for the resident to spend up to 16 months in a discipline. Thus, pathway participants can gain eligibility for both primary and subspecialty certification during the standard four (DR) or five (IR) years of residency training.
The original 16-month pathway was introduced in 2010; the redesigned pathway formally went into effect July 1, 2017. Its key components are in keeping with the ACGME NR fellowship program and are summarized in Table 1.
Table 1. Key Components of ABR 16-Month Pathway in Nuclear Radiology
Enrollment Process
Enrollment is on a rolling basis; there is no annual timeline. However, applications must be received and approved at least six months prior to graduation. To enroll, each resident must complete a short application form. The application must be accompanied by a Sponsoring Department Agreement (SDA) that is signed by the residency program director and the NR/NM preceptor, who both attest to their commitment to the resident’s training in accordance with the pathway requirements. The NR/NM preceptor must be ABR-NR and/or ABNM certified and is typically an appropriately recognized Authorized User. These forms are available here.
As referenced in Table 1, the NR/NM/MI/RPT-related clinical experiences are flexible and specific to each resident/program. In the application, the program describes their detailed plan for providing the participating resident with the requisite training. Popular NR-related rotation choices include but are not limited to abdominal/body, breast, cardiovascular, interventional, musculoskeletal, neuro/head & neck, pediatric, and thoracic. Notably, some residents have instead opted for more months of dedicated NR/NM/MI/RPT.
Status Report
Between July 1, 2017, and June 30, 2024, 76 participating programs enrolled a total of 247 residents who have either completed the pathway or are in progress. Five programs have had 10 or more enrollees, with the University of Pennsylvania well in the lead with 20; 11 programs have enrolled five to nine residents (see Table 2).
Table 2. Participating Programs with Five or More Enrollees (as of June 30, 2024)
| Program | Number of Enrollees |
| University of Pennsylvania | 20 |
| Medical College of Wisconsin | 13 |
| SUNY Upstate Medical University (Syracuse) | 13 |
| Massachusetts General Hospital/Harvard Medical School | 12 |
| University of California (San Francisco) | 11 |
| Baylor University Medical Center (Dallas) | 9 |
| Mayo School of Graduate Medical Education (Rochester) | 9 |
| Cleveland Clinic Foundation | 8 |
| Indiana University | 7 |
| Rutgers-Robert Wood Johnson Medical School | 6 |
| Yale University | 6 |
| Duke University | 5 |
| Hartford Hospital | 5 |
| Staten Island University Hospital | 5 |
| University of California (San Diego) | 5 |
| University of Kentucky | 5 |
Between 2018 and 2024, 206 residents completed the pathway. As of June 30, 2024, 41 were in progress: 30 will graduate in 2025 and 11, in future years (see Figure 1). It is anticipated that residents will continue to be enrolled on a rolling basis, and these numbers will change over time.
Figure 1. Numbers Enrolled (by completed/anticipated graduation year, as of June 30, 2024)
The first opportunity for a graduate of the 16-month pathway to sit for the NR subspecialty exam was in 2021. The number of NR diplomates increased remarkably during 2021-2024 (see Figure 2). Of the 61 diplomates earning ABR-NR during these four years, 37 (61%) qualified by way of the 16-month pathway, while the other 39% were NR/NM fellowship graduates or eligible via the alternate practice pathway.
Figure 2. Number of DR or IR/DR Diplomates Certified in Nuclear Radiology (2013-2024)*
*Note: No subspecialty certification exam was offered in 2020 due to the COVID-19 pandemic.
Current Impact
In March to May 2024, the ABR surveyed the 125 graduates of the 16-month pathway who hold DR or IR/DR certificates. As of June 30, 2024, 75 (60%) have attained advanced certification: 30 (24%) with ABR-NR only, 35 (28%) with ABNM only, and 10 (8%) with both ABR-NR and ABNM.
Of those surveyed, 74 (59%) responded. Of the respondents, approximately 86% completed at least one fellowship after their DR or IR residency (abdominal/body radiology was the most popular fellowship). The vast majority of those who pursued ACGME-accredited neuroradiology or pediatric radiology fellowships either already have, or plan to sit for, those respective ABR subspecialty certificates.
At the time of the survey, approximately 58% of the respondents were in academic practice (with nearly three-quarters university based). Approximately 80% were practicing nuclear radiology at least some of the time or as part of their typical workload; 40% reported that it comprised more than 50% of their time or workload.
Future Horizons
We anticipate that graduates of the 16-month pathway in nuclear radiology will continue to support clinical practices in this rapidly expanding domain to the benefit of radiology, medicine, patients, and society.
ABR Volunteer Roles Change With the Seasons
By Desiree E. Morgan, MD, ABR Governor
2024;17(4):1
As summer spirals toward fall, I hope you are refreshed by the more laid-back pace of life that warmer weather tends to bring. The dependable change in seasons is mirrored in the activities of the ABR, where in August we prepare for upcoming transitions in item-writing cycles, committee rosters, and leadership, as well as new projects for improvement of our certification processes. I pause to reflect with gratitude on the work of our volunteers who will rotate from their roles with us, and I am thankful for their enthusiastic support of our shared mission.
In this issue …
Outgoing ABR President Robert M. Barr, MD, looks back on his seven years on the ABR Board of Governors, and discusses, among other topics, the organization’s biggest challenges and accomplishments during his tenure.
ABR Secretary-Treasurer John A. Kaufman, MD, MS; ABR President-elect Cheri L. Canon, MD; and ABR Executive Director Brent Wagner, MD, MBA, announce plans for a multifaceted process of stakeholder engagement to gather input about the IR/DR certification exam structure.
ABR Governor Donald J. Flemming, MD; ABR Board of Trustees Chair Matthew B. Podgorsak, PhD; and ABR Executive Director Brent Wagner, MD, MBA, explain how residency programs’ structured training and the ABR’s development and administration of standardized exams work together to create a fair and meaningful certification process that benefits patients.
ABR Trustee M. Elizabeth Oates, MD, and ABR Communications Director David Laszakovits, MBA, describe growing interest in the ABR’s 16-month pathway in nuclear radiology (NR) for attaining primary certification in diagnostic radiology or interventional radiology/diagnostic radiology and subspecialty certification in NR.
ABR Associate Executive Director for Interventional Radiology James B. Spies, MD, reports that an increase in applicants for integrated IR residencies has led to a decrease in residents applying for independent IR residencies and discusses how modifications in the international medical graduate (IMG) pathway could allow IMGs to fill open positions while also making progress toward certification.
ABR Board of Trustees Chair Matthew B. Podgorsak, MD, et al. discuss the ABR’s process and timeline for evaluating if diplomates are meeting their Continuing Certification requirements.
ABR Communications Manager Rodney Campbell interviews residents Michael LeCompte, MD, and Joy Ogunmuyiwa, MD, members of the ABR’s Radiation Oncology Initial Certification Advisory Committee, about the benefits of volunteering to expand their experiences and help other early-career physicians.
Diagnostic radiologist Ken Buckwalter, MD, MBA, talks with ABR Communications Manager Rodney Campbell about his 15 years as an ABR oral examiner and question writer and the effort volunteer committees invest into writing relevant exam items.
ABR Communications Manager Rodney Campbell shares how curiosity about the exam development process and a desire to make it better led medical physicist Richard Castillo, PhD, to become an ABR volunteer and oral examiner.
Congratulations to ABR President-elect Cheri L. Canon, MD, on being named professor emerita at the University of Alabama at Birmingham and to the nine ABR medical physics volunteers who became Fellows of the American Association of Physicists in Medicine (AAPM).
