Initial Certification for Radiation Oncology


Last verified on January 24, 2023



Are ABR exams scored on a curve?

No. The radiation oncology initial certification exam and all other exams administered by the ABR are criterion-referenced exams.



What is a criterion-referenced exam?

A criterion-referenced exam is one that measures examinee performance against a predetermined criterion or standard, not against the performance of others taking the exam. The criterion-referenced standard is established by a team of practicing physicians, most of whom are directly involved with resident training, based on their evaluation of each exam question. To learn more about this method and how it differs from norm-referenced scoring, please visit our Exam Scoring Model page.



Why do some exam questions not include age and sex in the clinical history?

Age and sex are excluded from exam questions for which the information is not needed to understand the clinical scenario and answer the question. Removing this nonrelevant data benefits the examinee not only by increasing focus on the concept being tested but also by improving exam platform navigation efficiency.



How is the pass/fail rate determined?

The exam’s pass/fail rate is determined by applying a criterion-referenced exam standard, which is set ahead of time by a volunteer panel of clinicians, physicists, and biologists. Anyone meeting or exceeding the criterion-referenced exam standard passes, and anyone falling below the criterion-referenced passing standard fails. The ABR never sets a pre-determined pass/fail rate. The specific standard setting method used for determining the pass/fail rate is the Angoff procedure (Standard Setting Bodies). This method is widely used and accepted by the majority of the American Board of Medical Specialty certification boards.



Why were pass rates for physics and radiation and cancer biology exams lower in 2018 than in the past?

Scores in physics and radiation and cancer biology are generally lower than in clinical radiation oncology. The reasons behind these lower scores may be multi-factorial. One factor may be a lack of clarity regarding up-to-date reference study sources, and heterogeneity of teaching standards across programs. We are working with our committee chairs to develop a more useful study and reference guide for trainees and are encouraging stakeholders in the academic radiation oncology community to create greater consensus regarding curriculum content and teaching methodologies.



How are the exams developed?

Individual exam questions for the clinical exams are created by members of eight clinical category committees. All of these volunteers are clinically active and include individuals in academic and private practice, department chairs and program directors, all of whom work directly with residents. The physics exam is developed by radiation physicists who are all active in the clinic. The radiation and cancer biology exam committee consists of scientists who are all members of clinical departments and physician/scientists who maintain active clinical practices in addition to their research activities. Before any question is added to the inventory for subsequent use, it is reviewed for clarity by staff editors. Questions are also “tested” without scoring on exams before they are later used as actual scored questions. This testing process is used to assure reliability of the questions.



Who determines if individual questions are relevant and/or timely?

All questions anticipated for inclusion in the exams to be administered in a given year are reviewed by a panel of clinicians, physicists, and biologists as a final review of accuracy, clarity of language, and relevance. Final determination is made entirely by active clinicians (from both academia and private practice). Questions not felt to meet those criteria are either discarded or set aside for revision and subsequent reconsideration.



My subject performance was reported in quartiles: how should I interpret that reporting?

Quartiles are provided in feedback to give examinees an idea of where they stand in relationship to the other examinees. They do not indicate where one stands in relationship to the criterion-referenced passing standard. Performance in the first quartile would indicate scoring in the lowest 25 percent of exam takers and conversely, performance in the fourth quartile would indicate scoring in the top 25 percent.



If I failed one or both of the basic science exams, is there any way that I can regain exam synchrony with my peers who passed the exams? Will administration of my clinical qualifying exam be delayed?

Yes, as long as all parts of the written qualifying exams are passed at the time your peers are eligible to take the oral certifying exam, you will remain in synchrony with them. Failing one or both of the basic science exams does not delay the administration of the clinical qualifying exam. To stay on track, you may retake one or both of your basic science exams along with your eligible clinical exam the following year.



If I failed one or both of the basic science exams, will that change my period of board eligibility for initial certification?

No. A candidate’s board eligibility is based on completion of residency training, not exam performance. The ABR grants board‐eligible status to a candidate for certification from the completion of training to December 31 of the sixth full calendar year after completion of training.



Can the ABR review and revise exam scores?

No. We do not review or revise scores after they are posted to myABR. After the exam is administered, each candidate’s exam response data is reviewed to ensure that his or her data is complete. The number of responses is confirmed as the correct number for the exam that the candidate took. An initial scoring is completed, and all scores are reviewed. Then, each question on each exam is reviewed statistically. Any question that does not perform as expected is sent to the appropriate committee for review. The committee determines whether the keyed answer is truly correct and that there are not other question answer options that could be confusing. If the committee decides that the keyed answer is incorrect, they may remove the question. Scores are then recalculated and checked again for accuracy before posting to myABR.



How can I obtain more information about the 2018 exam scores or prior scores?

Your program director has been provided with additional information about the 2018 exam scores as well as a summary of the passing standard for the past five years. Please contact your program director for additional information.