The Return of Oral Board Exams For Radiologists

AUTHOR: Maya Shah, OMS-II at Michigan State University College of Osteopathic Medicine

In April of 2023, the American Board of Radiology (ABR) announced the reinstatement of the diagnostic radiology (DR) oral exam starting in 2028. Individuals at Wayne State University School of Medicine and Detroit Medical Center published an article titled, “The New Diagnostic Radiology Oral Exam: Challenges, Opportunities, and Future Directions”, which discusses the new era of radiology board-certification. The original oral exam was administered to residents up until 2012, when the ABR shifted to exclusively computerized assessments. Currently, radiology residents must pass two multiple-choice exams in order to obtain board-certification: the DR Qualifying Exam, which is typically taken in the third year of residency, and the DR Certifying Exam, which is taken as early as one year after residency. The ABR has confirmed that as of 2028, the DR Certifying Exam will be replaced with a DR Oral Exam for all residents hoping to be certified after 2027 (1).

The shift in DR examination presents a new landscape that programs must navigate. “The American Board of Radiology's decision to transition to an oral certifying exam, which seeks to incorporate the best elements of previous iterations, comes with a variety of challenges and opportunities. The class of 2027 will be the first to sit for the new certifying exam," said Dr. Arif Musa, diagnostic radiology resident at Detroit Medical Center.

The ABR justifies the transition to an oral exam with the intention of evaluating skills that cannot be easily assessed on a computer-based exam. These skills include differential diagnosis ranking, case discussion, clinical judgement and awareness, professionalism, and communication (1, 2). Additionally, the ABR has acknowledged weaknesses of the past oral board exam that they hope to improve in the upcoming years. For instance, the previous oral exam required that examinees travel to Louisville, Kentucky for the assessment. In 2028, the ABR will administer the oral exam in a virtual format in an attempt to provide more flexibility and conducive test-taking environments to examinees (1, 2). They also aim to reduce examiner bias and subjectivity by introducing standardized testing and scoring format (2).

While the ABR is optimistic about the change, there are some concerns among radiology educators and examinees. Since the first class of residents who will take the oral exam have already initiated their radiology training, residency programs have not yet had the opportunity to redirect funds toward oral board preparation. Due to time and funding constraints, current residents may be at a disadvantage (1). Additionally, the oral examination format is not necessarily preferable among test-takers. Radiology residents were polled regarding their test-taking preferences, and the results demonstrated that the majority experienced less anxiety during computerized exams (3). Finally, bias and subjectivity may hinder the validity of the oral exam. Although the ABR is making strides towards standardization, the examiners may have preconceived notions regarding race or ethnicity that could potentially skew the results (1).

"The transition to an oral certifying exam by the American Board of Radiology could enhance the assessment of practical communication skills, decision-making, and the ability to explain complex concepts clearly. However, it also raises concerns about added pressure, subjectivity, and the logistical challenges of evaluating candidates in this format,” said Dr. Evien Albazi, PGY-1 transitional year resident at Trinity Health, Grand Rapids, and future diagnostic radiology resident.

Despite the challenges associated with the establishment of a new examination, the ABR remains committed to comprehensive evaluation of radiology candidates. The board has acknowledged critiques of the previous exam model and is dedicating extensive efforts towards improving the prospective assessment. With adequate time and resources, both radiology residents and program directors can successfully adapt to these new standards. The ultimate goal remains unchanged: produce highly qualified, competent diagnostic radiologists.

ABOUT THE AUTHOR

Maya Shah is a second-year medical student at Michigan State University College of Osteopathic Medicine. She is from Bloomfield Hills, MI and graduated from Michigan State University in 2023 with a B.S in biology. Her career goals include diagnostic or interventional radiology. In her free time, she enjoys reading, traveling, photography, and volunteering.

 

 

 

 

 

References

1. Pfiffner S, Albazi E, Musa A, et al. The New Diagnostic Radiology Oral Exam: Challenges, Opportunities, and Future Directions. Acad Radiol 2023, Volume 31, Issue 5, 2190 - 2191. https://doi.org/10.1016/j.acra.2023.12.026.

2. American Board of Radiology. (2023 Nov 30). New DR Oral Exam Update (November 2023) [Video]. YouTube. https://www.youtube.com/watch?v=U-BXkkHCpyM&t=213s&ab_channel=AmericanBoardofRadiology.

3. Becker GJ, Dunnick NR. Intended consequences of computer-based core and certifying examinations in diagnostic radiology. AJR 2008; 191:1302–1305. https://doi.org/10.2214/AJR.08.1232.