ABR Presentation at Association of University Radiologists Meeting Highlights New DR Oral Exam
By Cheri L. Canon, MD, ABR President-elect, and Desiree E. Morgan, MD, ABR Governor
2024;17(3):4
The ABR had an opportunity to present an update at the Association of University Radiologists (now the Association of Academic Radiology [AAR]) meeting in Boston in April.
Steve Simoneaux, MD, diagnostic radiology vice chair for the ABR Board of Trustees, presented an overview of the new DR Oral Certifying Exam to be introduced in early 2028. Information was shared online soon after last year’s announcement regarding the new exam and it has been supplemented over time, but Dr. Simoneaux provided a summary of important elements.
Most notably, the exam will be given remotely using case sets from seven categories1 to assess the clinical, observation, communication, and professionalism skills required of an independently practicing diagnostic radiologist. Dr. Simoneaux’s presentation also noted the differences between the previous oral exam and the 2028 model: the new exam will include not only enhanced standardization of the scoring rubrics but also uniform case sets that will vary little from one examiner to the next within a specific exam category for each testing session.
Informal conversations in the days that followed Dr. Simoneaux’s presentation revealed unexpected confusion among trainees and faculty attending the AAR meeting regarding the fundamental exam format. Like its predecessor of more than a decade ago, the new DR Oral Exam will include imaging cases that the examinees will analyze and discuss at a level that would be appropriate when consulting with a referring physician or issuing a written report. This discussion would include pertinent findings, a reasonable differential diagnosis, the most likely diagnosis, and the next steps to be considered (including additional imaging when appropriate). If relevant, an explanation of artifacts or a description of precautions or expected potential complications involving diagnostic radiology procedures (those relevant to and performed by general radiology practitioners) might be part of the discussion.
In her portion of the session, ABR President-elect Dr. Canon noted the increased interest in the ABR’s International Medical Graduate (IMG) Alternate Pathway for individuals who complete residency outside the U.S. and Canada. Over the past two years, the ABR has modified the requirements and reduced the application fee for this program, which currently has 275 candidates enrolled (most in diagnostic radiology). She also noted the ongoing engagement of tens of thousands of diplomates in Online Longitudinal Assessment (OLA) to satisfy Part 3 of their Continuing Certification requirements and described the quality improvement efforts in OLA content based on feedback provided by program participants. In the context of competency-based medical education (CBME), the ABR will continue to explore and engage in conversations with all stakeholders including the American Board of Medical Specialties (ABMS), the Accreditation Council for Graduate Medical Education (ACGME), and program directors in our specialties to determine the best path forward to address complicated questions of resources and the inherently variable learning rates among trainees to be capable of independent practice. Dr. Canon also reviewed the ABR’s priorities, including efforts to control costs, improve clarity of communications, and maintain reasonable standards in support of candidates, diplomates, and the mission. She concluded by recognizing the vital importance of volunteers, who provide their subject matter expertise in the creation of high quality ABR exams.
Elizabeth Oates, MD, presented on the growing interest in the 16-month pathway as a route to subspecialty certification in nuclear radiology. Since 2017, 74 programs have had residents enrolled in the pathway. As of April, 239 residents had either completed or were enrolled in the pathway, and 2024 represented the highest total number of graduates (44). An ABR survey of those who had completed the pathway, conducted earlier this year, included the question “Why did you choose to pursue the ABR 16-month pathway?” The most frequent response was “Enjoy field/advances in field/future potential.”
While at the AAR meeting, the ABR met with several stakeholder groups, including the Society of Chairs of Academic Radiology Departments (SCARD), the American Alliance of Academic Chief Residents in Radiology (A3CR2), the Association of Program Directors in Radiology (APDR), the Association of Program Directors in Interventional Radiology (APDIR), AAR, and the American College of Radiology (ACR). Some of the discussions revealed ongoing concerns regarding the timing of the new DR Oral Exam, and the potential implications for fellowship training or disruptions in clinical practice. Extensive input from stakeholder groups in advance of the ABR’s decision revealed a lack of consensus on the “best” time for the exam to be administered. The timing is set for 2028: a resident’s first opportunity to take the certifying exam will be during the first five months of the calendar year following completion of training. The ABR has consistently expressed willingness to consider other options after 2028, based on ongoing input from program directors, faculty, department chairs, and the candidates themselves. In addition to hosting stakeholder meetings, the ABR held an appreciation reception for our ABR volunteers in attendance at the AAR meeting.
- Diagnostic Radiology Oral Certifying Exam categories: abdominal, breast, cardiothoracic, musculoskeletal, neuro, nuclear, and pediatric
Change in the Timing of the IR/DR Oral Certifying Exam
By James B. Spies, MD, MPH, ABR Associate Executive Director for Interventional Radiology
2024;17(3):7
Board certification is a central goal of graduating residents in interventional radiology. Many employers and health systems require certification within a specified interval after board eligibility is established and therefore the timing of the exams is important. For IR residents, the computer-based Qualifying (Core) Exam is the same as for diagnostic radiology residents and occurs after 36 months of training. Upon graduation, there are two components of the certifying exam to consider – computer-based and oral. Both need to be passed to become IR/DR certified.
The computer-based component is given once a year, usually in the early fall, coordinated with administration of the Diagnostic Radiology Certifying Exam. Graduating IR residents qualify to take this exam upon successful completion of their training, and they may register for the exam the same year as their graduation.
When interventional radiology was a subspecialty of diagnostic radiology, IR fellowship graduates were required to have a full year in practice prior to taking the oral component of the certifying exam, and thus certification was delayed until the following calendar year. Mindful of the burden this might have on candidates trying to meet certification requirements in their practice, this requirement was changed with the new IR residencies in 2020, and those graduates qualified for the oral exam immediately after completion of training. The last group of fellowship graduates completed training in June 2020, and all subsequent graduates have been qualified to sit for the exam at the fall administration that same year.
While this may have aided a small number of graduates in their desire to become certified as soon as possible, somewhat surprisingly, we have found that a majority of candidates have not chosen to register for the oral exam in the fall after graduation. This might be due to the many transitions newly graduated interventional radiologists face in the first few months after completing training. Most will have a new job, often in a different city or state, and settling themselves and their families into a community is time consuming. They are beginning a new practice, with unfamiliar rules, administrative burdens and the stress of adapting to practice as an IR attending. With all these burdens, setting aside the time to prepare for both the computer-based and oral components of the certifying exam might be a challenge. Perhaps for this reason, many take the computer-based component in the fall of their graduation year but choose to defer the oral component until the following spring or even later.
Regardless of the reasons why new grads choose to defer the oral component of the exam, it has made it challenging for ABR staff to predict the number of registrants for the fall and spring oral exams. This, in turn, makes it difficult to plan the number of exam days needed and the number of examiners necessary for each exam. This has a significant impact on the examiners, who need to plan the time they must set aside for each exam well ahead of exam days.
Two of the other ABR disciplines (radiation oncology and medical physics) have a longstanding requirement that the oral certifying exam may not be taken until the calendar year after graduation, and their primary exams are in the spring. The new Diagnostic Radiology Oral Exam, scheduled to begin for those graduating in 2027, will also require that the exam be taken no sooner than the calendar year after graduation.
With both these factors in mind, the ABR Board of Governors decided in February 2023 that for IR trainees graduating in 2024 or later, the first opportunity to sit for the oral exam will be spring of the following calendar year. This will result in the spring IR oral exam becoming the primary oral exam for the year, anticipating that a majority of eligible candidates will choose that administration. IR (and the other disciplines) will continue to offer a fall oral exam, but with a much smaller group of candidates.
The goal of this change is to meet the anticipated needs of the candidates for a more stepwise approach to certification and for the ABR to plan more accurately for its exam events. We hope that with graduates taking the computer-based component in the fall of their graduating year and the oral component the following spring, certification will be a less of a burden on the candidates and provide a more stress-free exam experience.
Visiting Scholars Finding Program ‘Enriching,’ ‘Engaging’
By Rodney Campbell, ABR Communications Manager
2024;17(3):10
When the ABR Board of Governors approved funding to sponsor the American Board of Medical Specialties (ABMS) Visiting Scholars Program starting in 2022, it provided another avenue for residents and ABR-certified early career physicians and physicists to pursue their research goals.
Four physicians have benefitted from being selected for the program so far. The current class includes Leslie Chang, MD (radiation oncology); Francis Deng, MD (diagnostic radiology); and Ria Mulherkar, MD (radiation oncology). Sara Hunter, MD (diagnostic radiology) was the sole member of last year’s class.
Applications for the next cohort will be accepted until June 17.
We asked our three current Visiting Scholars for updates on their projects and what they think of the experience.
What is the subject of your research?
Dr. Chang: My research involves the development of a patient safety and quality improvement (PSQI) curriculum within radiation oncology residencies. We developed a pilot workshop for residents to work through the different steps in the development of a departmental QI initiative in improving multidisciplinary patient handoff when adaptive radiation therapy is planned. The curriculum covers topics such as stakeholder engagement, process mapping, causal analysis, intervention implementation, and sustainability. The impact on physician education and interest in future QI initiatives will be assessed through pre-post curriculum surveys and PSQI-based exam questions.
Dr. Deng: The aim is to develop a platform that enables deliberate practice for cross-sectional image interpretation. The basic idea is a simulated diagnostic image viewing environment that allows learners to drill a microskill over and over again, such as systematically searching through a volume of CT images for a specific set of abnormalities. The platform would assess the performance of learners and whether they have met a threshold of competence for the activity. At the same time, the platform provides feedback on the correct answer and enables more efficient development of visual expertise.
Dr. Mulherkar: The subject revolves around the idea of self-efficacy, or, in other words, the confidence that individuals have in their own ability to do something. We know that women are underrepresented in many highly technical medical specialties, and this is a multifactorial issue. One potential contributor to this is lower perceived self-efficacy in women compared to men. My project uses both survey and interview techniques to determine whether there are gender-based differences in self-efficacy of medical students and residents when it comes to radiation oncology. Do women feel less confident in performing highly technical tasks associated with the specialty, and could this make them less likely to pursue the field?
How did you choose your research subject?
Dr. Chang: The decision stemmed from a personal interest in quality improvement projects in radiation oncology during my clinical training. Engaging in departmental patient safety initiatives and participating in leadership development programs equipped me with the necessary skills within a systems thinking framework to tackle this project. It had also taught me skills that have not been formalized in medical education, although it is a formative aspect of physician engagement in quality and safety initiatives in practice.
Dr. Deng: I had this idea since reading a body of literature on learning radiograph interpretation led by Dr. Martin Pusic, who is now the director of the ABMS Research and Education Foundation. The whole idea made so much sense to me, but it struck me that it has yet to take hold in radiology education at large and it has not been well implemented for cross-sectional imaging, which is what I deal with as a neuroradiologist. The Visiting Scholars program became an opportunity to create collaboration and push the idea further.
Dr. Mulherkar: I am very interested in educational research as well as gender disparities. When I learned of the opportunity of the ABMS Visiting Scholars Program through the ABR, I discussed my interests with one of my mentors, Dr. Ellsworth. She pointed me to some literature in this space, and after discussing our ideas, we were able to design a project investigating this issue.
How has your Visiting Scholar experience been?
Dr. Chang: The Visiting Scholar experience has been incredibly enriching, providing a broader understanding of various programs and research in continuing medical education. It has facilitated connections with the specialty societies within ABMS and Council of Medical Specialty Societies as well as broader medical organization such as American Medical Association, Accreditation Council for Graduate Medical Education and Educational Commission for Foreign Medical Graduates. It has also helped foster collaborations between scholars and provided insight into ongoing questions in medical education to refine examination methods and improve patient outcomes.
Dr. Deng: The program is more than just a grant mechanism for one’s project. It has been a way to network with, get inspired by, and share ideas with other educators at various career stages who are involved in medical education research and organizational leadership. Many innovative ideas in the medical education space are brewing outside of radiology and it’s helpful to get exposure through a program like this and related conferences to know what’s going on and think about bringing it into radiology.
Dr. Mulherkar: The experience has been amazing. It’s such a privilege to be part of the monthly sessions with the other Visiting Scholars. It’s an opportunity not just to hear about their incredibly important work, but also to learn from their research methods and the challenges they have faced. Recently, we had an opportunity to all meet in person at the annual Visiting Scholars meeting in Chicago, and it was wonderful to be able to connect with physicians across different specialties who have similar interests in research and education.
