No Longer ‘All Over the Map,’ Her Exam Questions Are Now on Point
By Rodney Campbell, ABR Communications Manager
2024;17(2):10
An educator herself, ABR volunteer Elizabeth (Beth) Bossart, PhD, has learned several lessons as an Online Longitudinal Assessment (OLA) question writer and Initial Certification oral examiner.
As is the case with most question writers, developing the right formula was a struggle at first. Dr. Bossart’s early attempts required assistance from her more experienced fellow committee members. After a few tries, she found the key.
“The original group of questions that I wrote were all over the map,” she said. “Now, when I write questions, it’s a much simpler process. I start from what it is I’m trying to figure out and work backward rather than write a question and see where it goes.”
Dr. Bossart is an associate professor of clinical radiation oncology at the University of Miami’s Miller School of Medicine. She says that developing therapeutic medical physics questions for OLA participants also helps her in the classroom.
“I teach graduate classes, so it’s been very useful to my regular life to learn how to write and edit,” she said. “Editing was easier than writing.”
All ABR question-writing committees work as teams to produce fair and relevant questions for the audience. For OLA, the goal is writing questions that don’t require studying. That requires a mix of volunteers who represent academic and clinical practices.
“Sometimes, my level of walking-around knowledge is a little different,” Dr. Bossart said. “It’s nice to have volunteers who are more clinical because they help me learn. If there’s something that you really don’t do, somebody on the committee always has a little more specialized knowledge of the subject. I learn something every time we have a committee meeting.”
She served as an oral examiner in 2021. In addition to the ABR-provided training, Dr. Bossart had experience giving mock oral exams to residents, which allowed her to come into the exam feeling confident. In this case, both the examiners and examinees enter better prepared.
“I think having that experience of doing it on a regular basis with residents helps when I give an exam because I feel like I already know the process,” she said.
Her work as an examiner is to discern how much the examinee knows about the subject matter. Dr. Bossart remembers being on the other side of the process as an examinee; she earned her initial certification in 2003 after her residency at the University of Florida.
She believes that it’s important to keep examinees from straying too far from the subject or overexplaining their answers. Simply put, an oral exam is just two people talking.
“When you examine somebody, you want to get them calm because most of them are nervous,” she said. “You try to reassure people that this is a conversation and that they should just focus on the moment and not worry so much about passing or not passing.”
Dr. Bossart took her oral exam in Louisville, a rite of passage for many physicians and physicists who have earned initial certification over the years. She was living in Miami at the time and her parents, who were headed to Ohio from Houston when she was taking the exam, thought it would be a good opportunity to stop in and see her.
“I told them that I wasn’t going to be able to do anything with them until after the exam was over,” she said. “When I walked into the hotel lobby after my exam, my parents were there waiting for me.”
It was a happy result all the way around. Dr. Bossart saw her parents and, a couple of weeks later, learned that she was board certified. She’s never taken that accomplishment for granted and is always willing to give back as an Initial and Continuing Certification volunteer.
“It’s important to help out and be part of the process,” she said.
Urology Resident Finds It’s Never Too Late to Switch to Radiology
By Rodney Campbell, ABR Communications Manager
2024;17(2):7
All it took was a little exposure to radiology and Parris Diaz, MD, was beaming. Dr. Diaz, who’s in the intern year of his urology residency, was ready to switch fields. Even at age 30 with an uncertain future ahead, he’s confident that he’s making the right decision.
“You need to be happy in what you’re doing,” said Dr. Diaz, who’s in the urology program at the University of California, San Francisco (UCSF). “I love the field of urology. It has impacted me in more ways than I can count. It has taught me so much, and I’m so appreciative, but I’m excited to go into radiology and discover this new field that I never knew was going to be the one for me.”
Dr. Diaz is the first from his family to attend college. His mother is a caregiver and his father works in construction. When he entered UCLA’s David Geffen School of Medicine, he hadn’t settled on a career direction.
“I went into medical school kind of wide-eyed,” he said. “I went to every specialty thinking, ‘This could be it. This could be the one.’ I went in with no expectations and urology was the one that stuck out to me just because of the people. There are amazing individuals in urology and great personalities.”
His first chance to perform a radiology rotation came during his urology residency. His two opportunities to investigate radiology in his third year as a medical student were canceled.
Dr. Diaz’s urology program set up a two-week mini-rotation last December after he told his director that he wanted to change his plans. It gave him the chance to gain experience with abdominal and chest imaging.
“I always thought radiology was interesting, but I just never knew anything about the field,” he said. “It’s one of those fields where if you don’t rotate on it or do it, how do you really know what the life is like?”
Once he got in the reading room, he knew he was in the right place. It wasn’t a dimly lit spot filled with physicians hunched over their computers. It was instead a place that inspired him to pursue an exciting new direction.
“There’s a lot of collegiality there,” he said. “There’s a lot of learning happening. There’s a lot of people calling, asking for help. The interaction that you’re having, physician to physician, is very gratifying. I know it’s something that can make me happy.”
Seeing physicians working across disciplines to determine patient care matched his experience as a urology resident. He often finds himself consulting with diagnostic radiologists.
“I think radiologists have so much knowledge about every other specialty and they have the tools to help consultants inside the hospital, outside the hospital, in every setting,” Dr. Diaz said. “When I don’t know what’s going on, I find myself calling a radiologist and saying, ‘What should we do next? What should we be looking for?’”
Dr. Diaz has secured a spot as a medical resident at UCSF that starts after his urology time ends in June. He’ll re-enter the Match in September.
“I’m excited for more growth as a doctor that I know will only help me as a radiology resident,” he said.
He’ll likely use some of his time to counsel other residents who are thinking about changing their fields, just as he sought and received advice when he plotted his move.
“There aren’t many of us out there, but I am happy to be able to let others know that it’s OK to switch,” Dr. Diaz said. “It’s OK to change your mind. You’re not a quitter. You have to choose what type of life you want … what type of career you want. It’s never too late to reinvent yourself.”
Even with at least a year off his residency track, Dr. Diaz is willing to sacrifice time for career satisfaction. His professional life could easily last between 30 and 40 years, so he wants to be happy and fulfilled.
“I know that it isn’t going to be an easy road, but it’s a career that I know that I will really enjoy,” he said.
Assessment of Knowledge and Skills: Advantages of OLA
By Robert M. Barr, MD, ABR President; Brent Wagner, MD, MBA, ABR Executive Director; and Brooke Houck, PhD, ABR Psychometrician
2024;17(2):2
As part of our commitment to the public, and consistent with the standards determined by the American Board of Medical Specialties (ABMS), the ABR Continuing Certification program includes methods to allow diplomates to demonstrate that they “have the knowledge, clinical judgment, and skills to practice safely and effectively in the specialty.”1 The ABR refers to this as “Part 3” of the Continuing Certification program.
Online Longitudinal Assessment
More than 95% of ABR diplomates use Online Longitudinal Assessment (OLA) to satisfy the Part 3 requirement. OLA fulfills another requirement of the ABMS which mandates that we “offer assessment options that have a formative emphasis and that assist diplomates in learning key clinical advances in the specialty.”1 The details of the OLA program were addressed in a previous issue of The Beam. Compared with a point-in-time exam, OLA has been preferred by ABR diplomates because it offers immediate feedback on specific question topics, a dashboard to show progress and performance relative to the standard, and an opportunity to learn (the formative component) while being assessed.
The weekly administration of OLA questions is focused on “walking-around knowledge”: knowledge that a typical radiologic professional would need in order to provide general clinical services without having to access reference texts or consult with a colleague. Because it corresponds to expertise applied in day-to-day professional work, the knowledge tested in OLA is not expected to be something for which a diplomate would need to research or commit to extensive study.
The longitudinal element of OLA is manifest in its continuous question distribution over the five-year cycle of Continuing Certification participation, and the platform retains the most recent 200 questions for individual users to review as desired.
A small number of elective question declines are available each year to allow for better alignment with the scope of one’s practice. OLA provides a tailored assessment for diplomates, whereas a point-in-time exam is more generalized and cannot accommodate the specificity of the various daily work activities of a wide range of radiologic professionals. When a diplomate elects to decline a question, she or he is customizing the assessment to cover what they do in practice, rather than what they, theoretically, might need to do in practice.
Continuing Certification Exam
The alternative to OLA is the Continuing Certification Exam (CCE). The CCE is offered to diplomates who choose not to participate in OLA or who have not met their standard via OLA. CCE content differs from OLA and requires some review or targeted study to refresh one’s knowledge of topics relevant to the practice of the discipline.
For medical physics and radiation oncology, the content is similar to that of the second qualifying exam, although adjustments are made to focus on the established practice of diplomates instead of preparation for certification for recently trained candidates. For diagnostic radiology and interventional radiology, the CCE is similar to the computer-based initial certification exam, with approximately 40% of the questions focusing on general topics (essentials of diagnostic radiology) and 60% on specialized content.
Passing the CCE results in a reset of the five-year cycle for the Part 3 requirement. The exam takes approximately four hours, is offered twice each year, and can be taken during year four or year five of the cycle.
Conclusions
ABR board members, as your professional peers, strongly encourage diplomates to participate in OLA rather than relying on the CCE option. OLA is more flexible, is built around adult learning theory, and includes the opportunity to identify and address knowledge gaps. OLA also allows for directed feedback to the ABR that supports continued improvement of not only the assessment process but also the scientific content. Lastly, OLA provides a customized experience aligned with one’s scope of practice, while the CCE measures a broader set of knowledge and skills less tailored to the individual radiologic professional.
- American Board of Medical Specialties. Standards for Continuing Certification. https://www.abms.org/board-certification/board-certification-standards/standards-for-continuing-certification/
