Now That It’s Over, Thoughts on the ABR Certifying Exam

On Monday last week, the American Board of Radiology published scores for the first group of radiologists to take the ABR Certifying Examination, held Oct 2^nd and 3^rd.

As such, this week provides a nice opportunity to reflect on the examination, including the weeks that led up to it, the examination itself, and the future.

Before:

• I noted quite a bit of heterogeneity among my colleagues with respect to how much (if at all) they studied.

• Most of us have recently started new jobs (first jobs, in fact). Many people seemed to take the week of the examination off to study. A few people held off their new jobs until the examination. Only one person I am aware of was given extra paid vacation because certification is very important to his group.

• Failure does not seem to be as big a concern as it was in the old system, where you would take the exam while in residency at Louisville. With the former exam, there was concern about embarrassment among co-residents and difficulty obtaining a job. In this case, most people seemed to have the attitude “if I fail, nobody needs to know and I can re-take it Q6 months for 5 years.”[[{"type":"media","view_mode":"media_crop","fid":"43274","attributes":{"alt":"Arjun Sharma, MD ","class":"media-image media-image-right","id":"media_crop_9836811787908","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4712","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 160px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Arjun Sharma, MD ","typeof":"foaf:Image"}}]]

• Nobody really knew how to study. For my part, I assumed the test would be similar to the MOC exam so I went off the advice of other attendings who had recently taken the MOC exam.

The exam:

• Around 270 questions, of which 70ish were noninterpretive. As Neil U. Lall, MD, pointed out,

I think there were technically 300 questions for everyone – the reason it may have looked like different numbers (270 for you, I think around 240 for me) is that a lot of the questions were multipart ones.

• After the noninterpretive batch, the other sections are mixed together.

• The PDF provided on the ABR website for the noninterpretive section is a very good guide for that section. The Stanford lecture series hosted by David Larson is a great adjunct.

• The exam still has some kinks to work out. A couple questions in the noninterpretive section were technically incorrect with two correct answers provided. There was a question later in the exam that should have had part two lock out part one but failed to do so (ie, part two gave the answer to part one). There was a question in the format “all of these are true EXCEPT” which is a not-allowed question format for the examination.

• The video/cine clips are suboptimal in presentation. You can’t look at just one frame, you can only put the cine bar on a given second and watch that second over and over.

After:

• The scores came far more quickly (four weeks) than they did for the first run of the CORE.

• Overall, I think the questions were quite fair and probably similar to the CORE, but a bit easier. There were far fewer obscure questions, less involvement of the corners of radiology (second trimester OB ultrasound, cardiac, arterial Dopplers, etc), and far less nucs/physics.

• I am pretty sure I would take this exam again rather than go to Louisville. It seems like practicing general radiology for three months is good preparation for the examination. If the goal was to have radiologists practicing rather than studying for three to six months (a disputable claim), then the examination works. My sense is that a lot less time was spent studying and that is a good thing.

So perhaps this is a better setup, even though  the combination of: first job, new institution, move after fellowship, board certifying exam, and – for me – getting married made for a pretty stressful few months post-fellowship.

I have not heard from anyone who failed. Obviously, plenty of people must have failed. But I heard far more groans after the first CORE than I heard this week.

The best way to study? I more or less agree with the advice I got regarding the MOC exam: practicing radiology day-to-day is the best study method. In the weeks before the exam, review case files or question banks in whatever specialty you choose. Review the noninterpretive Guide.

The best strategy for splitting up the three subspecialty sections? I did an MSK fellowship and so chose to do two sections MSK and one section general. I believe this was a mistake. The exam works such that, if you do:

• One section of, say MSK, you get Level 1 MSK questions
• Two sections of MSK, you get one section worth of Level 1 and one section worth of Level 2
• If you do all three sections as MSK, you get one section of Level 1 and two sections worth of Level 2

Therefore, it makes sense to me that if you’re going to studying any subspecialty hard enough to do Level 2 questions, you might as well do all three subspecialty sections in that subspecialty. Otherwise, stick to three different Level 1 sections (eg, MSK, GI, and GU).

Acknowlegement: thanks to Neil U. Lall, MD for his commentary and help with this post.

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