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  • ABR “Exam of the Future” Sharpens Focus on Images

    April 01, 2013

    This year’s American Board of Radiology (ABR) Core Examination promises an even greater challenge to radiology residents: navigating the inaugural “Exam of the Future.”

    Years in the making, the new ABR Core Examination in Diagnostic Radiology is a comprehensive review of diagnostic radiology and physics concepts as they relate to imaging. It is highly standardized and tests clinical reasoning and management at a much greater level of analysis than in the past.

    “Some felt that parts of the previous exam were esoteric and that the questions lacked clinical relevance,” said ABR Trustee Duane G. Mezwa, M.D., professor and chair of diagnostic radiology and molecular imaging at Oakland University-William Beaumont School of Medicine in Rochester, Mich., and a faculty advisor to the RSNA Resident and Fellow Committee. “We developed a new structure that is much more relevant to daily clinical practice.”

    Set to debut this fall, the ABR Core Examination will be administered as a qualifying exam to third-year diagnostic radiology residents in lieu of the traditional written examinations in both physics and diagnostic radiology. Residents on the new schedule will take the ABR Certifying Exam 15 months after completing a four-year radiology residency, replacing the oral examination traditionally given during the fourth year of training. The first certifying exam will be offered in 2015.

    For third-year residents preparing for the first ABR Core Examination, the new test represents uncharted territory. They are the pioneers; there is no one to give them feedback and advice based on previous tests. “As we get closer to the date, it’s becoming a little more stressful,” said Joshua Kuban, M.D., a third-year radiology resident at Baylor College of Medicine in Houston. “There’s no existing formula for success on this exam.”

    “Residents don’t know what to expect,” said Aparna Annam, D.O., a fellow in pediatric interventional radiology at Texas Children’s Hospital in Houston and chair of the RSNA Resident and Fellow Committee. “Because there is no precedent, they’re not all sure what they’re supposed to study.”

    ABR Resources Prepare First Class of Residents

    To that end, ABR is providing a variety of resources for residents including a study guide and a 100-item practice exam on its website. (See Sidebar.) The organization is also inviting the inaugural class to participate in one of two Core Pilot Examinations administrations to be conducted at both the Chicago Test Center and the Tucson Test Center on June 20-21 (first administration) and June 24-25, 2013 (second administration).

    “This class will be the best prepared in ABR history,” Dr. Mezwa said.

    For third-year residents, however, the practice test could mean added travel and expense during a year in which they are slated to participate in the four-week American Institute of Radiologic Pathology (AIRP) course in Maryland. “I wish the ABR Core Pilot Exam was available locally,” Dr. Kuban said. “Between AIRP and two trips to Chicago for testing, the third year is going to be very expensive.”

    ABR moved the Core Examination to the third year partly to enable residents to subspecialize during the fourth year without the pressure associated with studying for the ABR certifying oral examination, a period often dubbed “board frenzy.”

    Historically, some programs in diagnostic radiology allowed residents time off from clinical duties to study for the oral exam. However, the new ABR exam structure provides an opportunity to reevaluate this practice. A position statement issued by the Association of Program Directors in Radiology (APDR), published in the November 2012 issue of the Journal of the American College of Radiology, describes the rationale behind a recommendation of no time off from clinical service before the ABR Core Examination.

    “At Baylor, we’re trying to set up a curriculum to take advantage of the fourth year,” Dr. Kuban said. “We’ll have six months that are service-oriented and six months of mini-fellowships and electives.”

    “The fourth year will allow residents to gain an area of focus before taking the Certifying Exam,” Dr. Mezwa added.

    The new timeline also will mean that most residents will graduate as U.S.-board eligible rather than board certified, Dr. Annam said. “Time will tell whether this will become an issue when applying for jobs,” she said. “The people who are hiring will have to know that certification is expected to come later.”

    Exam Emphasizes Images, Practical Clinical Issues

    To gain firsthand experience of the breadth of material and familiarity with the exam centers, Dr. Annam recommends that eligible residents take the Core Pilot Exam if possible. She completed a pilot version of the test and believes the exam meets its intended goals. “The questions did not deal with esoteric minutiae, but with relevant, practical matters like how to reduce radiation dose or fix an artifact on an exam,” she said.

    The exam covers 18 categories: breast, cardiac, gastrointestinal, interventional, musculoskeletal, neuroradiology, nuclear medicine, pediatric, reproductive/endocrinology, thoracic, genitourinary, vascular, CT, MR, radiography/fluoroscopy, ultrasound, physics and safety.

    As ABR representatives to the RSNA Resident and Fellow Committee, John Krol, M.D., and Monique Meyer, M.D., relay new information about the exam to committee members. “Prior tests included few images, so it’s nice to know this exam will have lots of images, which is the core of radiology,” said Dr. Krol, a third-year resident at the University of Kentucky College of Medicine in Lexington and a member of the RSNA Resident and Fellow Committee.

    “I would say 75 to 80 percent of the test will have an image associated with the question,” Dr. Mezwa said. “Around 40 percent of the questions relate to factual knowledge and 60 percent involves higher levels of analysis, like ABR’s standard oral exams.”

    Unlike previous incarnations, the new Core Examination will not feature a separate physics component; instead, physics questions will be integrated into each category. Performance on the entire set of physics items will be evaluated separately in scoring the examination.

    Residents can expect to see curriculum adjustments to keep up to date on physics instruction. Dr. Annam suggested that physics be taught along with each core subject. Many residents, like Dr. Kuban have been studying RSNA Physics Modules online to prepare. (See Sidebar.) “The physics component is the big unknown,” Dr. Kuban said. “I’ve been using modules on the RSNA website as a primary means for review and our program at Baylor is providing us with a two-week review course.”

    Despite uncertainty over the new exam, there is optimism that the inaugural session will be a success. “Understanding the basics of the test development has led me to believe that those individuals developing the test of the future have my best interests in mind,” Dr. Krol said. “I feel comfortable that I will be tested thoroughly, and my results will be a product of whether or not I understand the fundamentals of what I need to know to do this job.”

    Core Examinations Set for Fall 2013

    The first ABR Core Examination will be offered at ABR exam centers in Chicago and Tucson, Ariz., on September 30 and October 1, 2013, and on October 2 and October 3, 2013. These dates were chosen to avoid close proximity with the last large June 2013 oral exam administration. Core Examinations will be administered each June thereafter.

    The first ABR Certifying Examination—to be administered 15 months after completion of diagnostic residency training—will be offered in Fall 2015. For more information, go to www.theabr.org. 

    Prepare for ABR Exams with iPad-compatible apps

    Sabeen Dhand, M.D.

    GoodReader for the iPad
    GoodReader for the iPad. A directory of electronic resources subdivided into systems/sections, each which is further organized based on the electronic resource (i.e. articles, conferences, etc.)

    Image courtesy of Sabeen Dhand, M.D.  

    Tablet computers such as iPad and compatible apps are ideal preparation tools for the ABR’s new computer-based, image-rich certification exams, according to Sabeen Dhand, M.D., a third-year resident at Northwestern Memorial Hospital in Chicago.

    Dr. Dhand saw the potential of the iPad as a radiology education tool from the time he got his first tablet in 2010. He exchanged e-mails with Steve Jobs, the late founder of Apple, setting a chain of events in motion culminating in Northwestern offering iPad availability to all radiology residents in September 2011. “At Northwestern, we’ve loaded more than 1,000 articles on the iPad and any new content is automatically updated for residents,” he said.

    At an RSNA 2012 session, Dr. Dhand and colleagues reviewed iPad-compatible apps that could help residents prepare for the ABR Core Examination. Many such apps are available on the iTunes store for free or less than $10. “There’s no single dedicated app for the new Core Exam,” Dr. Dhand said. “It’s more a matter of finding what’s available and applying it to your preparation.”

    Dr. Dhand recommends Elsevier Case Reviews Online as a comprehensive source. Each of the five different apps cost $19.99 on iTunes. Radiology Assistant ($5.99) is another useful app, Dr. Dhand said. Developed by the Radiological Society of the Netherlands, the app includes a good selection of articles on all the major anatomical regions. And for reading all those radiology articles, Dr. Dhand suggests downloading GoodReader for the iPad for $4.99.

    Access iTunes at itunes.apple.com.

    Web Extras

    ABR offers a multitude of resources at www.theabr.org:

    • The ABR Exam Experience: an overview of what happens on the days leading up to and including the exam day for various ABR examinations. Download a PDF of the document.
    • The ABR Core Practice Examination: Content selected for this practice exam is a sample of what could be found on a Core Exam. The software interface is the same as that used in the ABR exam centers.
    • Information on the Exam of the Future: Access a fact sheet, a PowerPoint presentation and a timeline for transition to the Core and Certifying Exams.

    RSNA/AAPM Online Physics Modules 

    Access the self-guided modules that include self-testing features to create a comprehensive experience for the viewer at www.rsna.org/RSNA/AAPM_Online_Physics_Modules_.aspx 

    ABR Exam April cover image
    Images will be a central component of the new ABR Core Examination scheduled to debut this fall.
    Duane G. Mezwa, M.D.
    Aparna Annam, D.O.
    ABR webexam screenshot
    The American Board of Radiology (ABR) is inviting the inaugural class to participate in one of two Core Pilot Examinations scheduled for June 2013. Above: a screenshot from the ABR Practice Exam. Image courtesy of the American Board of Radiology
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