Radiology Certification: Does it Ever End?

Just recently, I received my certificate from the American Board of Radiology designating me a Diplomat of the ABR for having fulfilled the requirements of maintenance of certification (MOC). This certificate was given to me for successfully passing the 10-year recertification exam, given in Chicago, this past March. As I stared at the document, and read all the official language on this quite sophisticated looking diploma, which ironically looks no different than the one I received 10 years ago, after having passed the “original” 10 part oral board exam, I began to reflect back on that dreadful event…the oral boards!

I can vividly recall being a fourth-year radiology resident, and each day, starting around the beginning of April, of our fourth and final year of residency, we would cut out early from our assigned rotations, and head to the library to study for the oral boards. Since our program was a small size residency program, there were only three fourth-year residents. I can only assume that this was the reason we were allowed to leave early each day, as the workload could be handled by the other residents and attending radiologists (such a thing would be considered blasphemy today). In any event, the three of us would sit down and go over “hand-me-down” questions that were given to us by previous fourth-year residents, who had already graduated and sat for the boards. We would simulate what it might be like to be in Louisville, being asked to produce differential diagnoses based upon one or two images. Back then; many of us still used textbooks, review books, and many other written sources of radiology manuals, instead of the Internet. We even went as far, as to see who could accumulate the greatest number of books by the time they graduated. As if the greatest number of books translated into being the smartest radiologist or something. Now, it almost seems archaic for one to refer to a textbook, as opposed to just pulling it up on the Internet, when you have to look something up. How strange.[[{"type":"media","view_mode":"media_crop","fid":"28587","attributes":{"alt":"Laurence Spitzer","class":"media-image media-image-right","id":"media_crop_1472815082930","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2914","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: 221px; width: 166px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Ultimately, the end of the year came, and it was time for us to head down to beautiful Louisville, KY, as so many generations of radiology residents had done before us, to sit for the dreaded oral board exam. I can recall the musty, dark, old hotel room with the faux wood furniture, and the stained bed linens. I can recall seeing other residents in the hallways and hotel lobby, biting their nails, pacing back and forth, huddled in study groups for some last minute cramming. It’s amazing with all the tension and nerves that I didn’t just call it quits and leave, right there on the spot.

Finally, it came time for me to be examined. Although, I don’t remember exactly what I was asked in each section, I do remember certain things: like the examiner who crinkled a cellophane candy wrapper while I was testing, and then proceeded to get up and walk back and forth as I was answering his questions. Or the examiner that showed me a very strange looking bone tumor in an MRI of the femur, and then cut me off mid-sentence when I was describing the tumor, by saying, “forget this question, you’ll never see a single case of this in your entire career! You passed!” As everyone before me had warned, the day was extremely stressful, tiring, and nerve wracking. All I could think of during the flight home was, “there has to be a better method to evaluate ones fund of knowledge and level of competence after finishing a radiology residency.” I was genuinely amazed to open the letter from the ABR a couple weeks later to find that I had passed the exam.

Jump ahead 10 years later, and all those horrible memories came flooding back to me when I received the notice that as part of the ABR’ s MOC program, I would be required to sit for a recertification exam in three subjects of my choice. Wow, it really does never end. No matter how old you get, and how long you’ve been in practice, there’s always a test (and a fee!) at the end!

Although, the format would be different, I kept thinking to myself, how in the world am I going to find the time to study for a board exam when I am working 9-10 hours a day, taking call once a week, staying in the hospital until 10 pm at night, coming home to a family with children with homework, after-school activities, bills to pay, chores to do around the house, etc. Impossible! How would I succeed without having people to ask who took the exam before me? How would I succeed without the resources that I had as a resident? How would I find the time to study?

Ultimately, I found one colleague who had taken the exam (as I was only the second year of the test being administered), and ironically he tested in two of the same sections that I had elected to be tested in. Despite being exhausted from work each day, I tried to review sample cases each night for about 15-20 minutes, utilizing the Web to find as many radiology cases as I could. Funny how this time around, I did almost all of my studying on the Internet, rather than with books.

Finally, the day came. I flew to Chicago the day before, and stayed overnight at a local hotel (no, not the Executive West like in Louisville). On the morning of the exam, we were all taken by bus to the ABR testing site. After checking our IDs, we were led into this enormous, dark testing room, filled with about 500 mini workstations in a single-file line. We were assigned a small workstation, within a little cubicle, and the test began. Some four hours later, it was done. I had finished. Again, I had this strong sense that I would be coming back to Chicago, as I felt for sure that I had failed. Surely, I thought, there must be a better way to do this. There were many questions I had no clue as to what the answer was, and it felt like there were many cases that I had not only never seen during my preparation, nor had I ever come across in my practice. On top of this, there was a healthy selection of non-clinical questions pertaining to health care, statistics, probability, and other really “relevant” information.

Several weeks later, as was the case 10 years before, I almost had a heart attack when I received the letter from the ABR stating that I had passed the exam! Are you kidding me? Me? Passed on the first try? Today, as I stare at the diploma, I can only think to myself, it’s more than likely I will have to do this again, 10 years from now. As before, you have to ask yourself one question: does it ever end?