Current Structure and Purpose of the American Board of Radiology Examination Process

Abstract

Dr Richard Gunderman deserves credit for his thoughtful analysis and critique regarding the American Board of Radiology (ABR) examination process (1). As a past president of the ABR, I would like to make a few comments regarding Dr Gunderman’s key questions. First, the oral examinations of 2001 are markedly different from those of 1934. Each of the 10 sections has more than 1,000 cases in its electronic database, from which are selected 10–15 cases for each of the eight sessions during the 4 days of the examination. The databases are continually updated, as well. Each examination is standardized for a given session, and the use of computercompatible answer sheets allows for specific analysis of each case and calculation of its merit as a discriminating item. In other words, each case is now validated by experience. All clinical material is presented in digital format on high-resolution monitors, and the images are stored on the hard drives of those individual computers. This format allows more cases to be shown in the allotted time and increases the validity of each section. Second, are the residents studying the right things? Dr Gunderman is correct in his assumption that a scale does not define a desirable weight. It does, however, measure the weight, and someone then determines if that weight is appropriate for a specific purpose. How do we know what the “right things” to study are? Surely, the ability to interpret images and to communicate an impression of the findings to referring physicians is the heart of our specialty, and the ABR oral examinations test that ability well. Third, the written and oral examinations do not cover every area of radiologic practice. All candidates for certification have completed 5 years of training in programs certified by the Accreditation Council of Graduate Medical Education. Each of these programs has a curriculum made up of “essentials.” The program directors must certify that the residents have successfully completed the program and passed a series of monthly evaluations before residents are eligible to sit for the ABR examinations. The entire content of the 5-year program cannot be covered in the written and oral examinations. It is the successful completion of the residency itself that is the sine qua non of ABR certification. Fourth, the ABR examination is not intended to be a quantitative measure of how good a radiologist an individual candidate will become. As Dr Gunderman states, “One of the great virtues of the board examinations is that they are ultimately scored on a pass/fail basis.” The ABR is not charged with ranking radiologists in a manner such as the Associated Press poll ranks college football teams. Rather, “the Mission of the American Board of Radiology is to serve the public and the medical profession by certifying that its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill and understanding essential to the practice of radiology, radiation oncology and medical physics” (2). The three examinations and the new Maintenance of Certification program fulfill that mission well. The key words in the statement are “requisite” and “essential.” Fifth, the ABR examinations are high-stakes testing. After 25 years of experience in examining in the oral examination, it is clear to me that a wide spectrum of knowledge and ability exists among our candidates. All our psychometric data show that the testing does validly discriminate the “fail group” from the “pass group.” The collective wisdom of experienced oral examiners is a reliAcad Radiol 2001; 8:1260–1261