EOF Core exam - Purpose - The American Board of Radiology

ABR Update
Kay H. Vydareny, M.D.
Associate Executive Director of the
ABR for Diagnostic Radiology
American Alliance of Academic Chief Residents in Radiology
(A 3 CR 2 ), Association of University Radiologists (AUR)
Annual Meeting
April 2013

Topics
• Exam of the “now”
• Exam of the “future” (ie October 2013)
• IR-DR residency

June 2013 exam
• Last major exam
• Biggest yet given – complete exam + condition
• No “pilot” exams as in past few years

What will happen to the oral exam
• Nov 2013, May 2014, Nov 2014 – oral exams
(full and conditions)
– If fail Nov 2014 – move to core
– If condition Nov 2014 – move to certifying (2
categories/conditioned category +essentials and
NIS)
• If fail, take entire certifying
• IR exam (SS and IR/DR) will be reborn in 2015
in Dallas at ABOG test center

How long is your certificate valid
• Continuous certification = no end date began
2012
• Must participate in MOC – yearly rolling
lookbacks with first three year lookback in
2017
• Remember – could lose certificate in 2018 if
do nothing except maintain a license

Public reporting
• Status is available on ABR, ABMS website
• Status reported as:
– Certified, meeting requirements of MOC
– Certified, not meeting requirements of MOC
– Not required to participate in MOC
• Status can be updated within 1 day

How long are you “Board eligible”
• 6 years after finish training
• If not certified, must have additional year of
training
• Will have opportunity to take Core and
Certifying exam twice/year

Subspecialty certificates
• When earn, will have no end date; contingent
on meeting MOC requirements
• DR and SS certificates will be synchronized
with ConCert
• Can earn NM SS certificate with 16 months of
NM during residency.

Topics
• Oral examination 2013
• Exam of the “future” (ie October 2013)
• IR-DR residency

EOF Core exam - Goals
• Overarching goal: to protect the public by
determining that a diagnostic radiology
candidate has acquired basic knowledge, skill,
and understanding of the entire field of
diagnostic radiology, including physics
• Specific goal: to administer an examination
that is relevant to current radiologic practice

• Scoring goal: to make reliable pass/fail
decision about the candidate

Core exam - Timing
• Residents expected to take at “36” months
– Exception – research residents with >9 months
research in first 3 years can delay
– Few other exceptions will be granted
• First exam September 30-October 4, 2013
• Subsequent exams – June/ July + October
• Oral exams to fade away…last one Nov 2014

Core exam, structure
• Image-rich, practice related
• Will assess knowledge and comprehension
(40%) and application, analysis, synthesis, and
evaluation (60%)
– Combination of current written and oral
• Level of expertise expected for the exam is basic
to intermediate
• Mostly MCQ’s, few new item types (hot spot,
labeling, extended matching)

• 18 categories, each must be passed
• Organ system: MSK, Cardiac, Thoracic, Gastrointestinal,
Urinary, Repro/Endo, Neuro, Pediatric, Breast, Vascular
• Modality: Ultrasound, Interventional, Nuclear
Radiology/Molecular Imaging, CT, MRI, Rad/Fluoro
• Fundamental concepts: Patient safety, physics
• Items presented in random order

Breast Cardiac GI MSK Neuro Peds Thorax
Repro /
Endo Urinary Vascular Q#
CT 60
IR 60
MR 60
NM/Molecular 60
Rad/Fluoro 60
US 60
Physics 110
Safety 60
Q# 60 60 60 60 60 60 60 60 60 60
minimum 60 questions per row/column

RISE (RadioIsotope Safety Exam)
• Plan - to embed in Core and Certifying exams
• Rationale: radioisotope safety is important for
all DR not just for AU’s
• 50-60 scorable units
– 25-30 already in NM, Safety, Physics
– 25-30 additional radioisotope safety items
• Scored after certifying exam

Core exam, general
• Exam will take two half days
• Given in central locations – Chicago, Tucson –
2x year (October/June)
– ABR committed to distributed exams timeframe

Who writes the questions
• Item writer committees in each category
– Composed of diverse group of ABR certified
volunteers, all of whom must be in MOC
– Academic, private practice, geographical
distribution
– Include physicist
• Question vetted, edited by entire committee
• Test Assembly meeting – each question vetted
by all attendees. Many discarded.

Core exam, Physics
• Practical, image based
• More questions than other categories
• Physicist included on each of the
item-writing committees

Scoring
• Criterion (not norm) referenced
– Measures what a candidate can do vs. how he/she
does compared to others
– Determined by “Angoff committees” who vote
“Would marginal candidate answer this question
correctly”
• Average for all questions=passing score for exam,
modules
– 100% could theoretically pass exam
• Pass/fail/condition outcome

ABR study materials
• Study guides
– Posted on website: www.theabr.org
– Topics covered listed after each exam
• Blueprints
– Posted on website
– % of questions/major topic/category
• The ABR Exam experience

• Practice exam
– On website
– Subset of exam (110 cases) with answers
– No results
– Can the practice online exam be made available to
attendings and PDs as a guide for teaching
• Available to anyone with a PDB (my ABR).

What can I study for Quality and
Safety
• Study guide a partial syllabus
• Blueprint will be published

Core pilot 2013
• Will be administered June 20-21, 24-5
• Available only to those who will take exam in
Oct 2013
– Space limitations will limit others (PD’s, other
residents)
• Feedback will be given by category (reference
to peers – not pass/fail)

Pilot exam
• Interest high in pilot: within 45 minutes of
opening registration 3/11/13 >300 candidates
registered
• 3/22/13: 1074 out of 1110 candidates
registered
– 84% in Chicago; 16% in Tucson
– First session most popular
– Still seats available in both sites

Questions about pilot
• Will the practice exam be used to set the
passing standard for the actual exam
– NO, Angoff committees do that
• How will the ABR use the candidates’ data
from the pilot exam
– NOT AT ALL

Impact on training
• Residents must be exposed to all basic
diagnostic radiology by end of third year
• APDR consensus statement: best for residents
NOT to have dedicated time off from rotations
to study

Review sessions for exam
• Physics content
– Should focus on practical applications
• Diagnostic content
– 40% fact retrieval: prepare as for clinical exam
– 60% similar to orals: prepare as for oral exam

Certifying exam, Purpose
• To validate that the candidate has acquired and is
able to apply the requisite knowledge, skill, and
understanding that:
– every practicing physician should possess. (20%) ( NIS)
– every practicing radiologist should possess. (20%)
(Essentials)
– this particular practicing radiologist should possess to
begin independent practice in chosen clinical practice
area(s). (60%) (CPA’s)

Certifying exam, Timing
• To be taken 15 months after satisfactorily
finishing residency
– First administration October 2015
• Will be given 2x/year (October/Feb)

Certifying exam - Structure
• Image-rich exam
• Knowledge expected: application of knowledge,
analysis, synthesis, and evaluation
• Level of expertise expected for the exam is
intermediate to advanced
• 5 modules
– NIS - required
– Essentials- required
– 3 clinical practice modules – selected by candidate

• Each module at least 60 scorable units
• Exam will be ~ 5 hours long (1/2 day)
• Is both the first MOC exam and the certifying
exam for the residency; clinical practice
modules will be identical
• Item types: MCQ’s, extended matching,
labeling, possibly new types

Non-interpretive skills (NIS)
• What every physician should know
• Domain includes:, ethics, governmental
regulations, systems-based practice, etc.
• Study materials on ABR website (same as
MOC)

Essentials
• What every radiologist should know
• Includes, but not limited to, Emergency
Radiology, common on-call dx

Clinical Practice Areas (CPA)
• Candidate chooses 3 modules
– If more than 1 in an area, will contain more
advanced content
• CPA’s: Breast, Cardiac ,GI ,MSK, Neuro,
Pediatric, Thoracic, GU, Vascular-
Interventional, Nuclear Medicine, Ultrasound,
and General Radiology.
– Each will include relevant Peds, Radiation safety
and Quality (“physics”)

• Will emulate clinical practice
– Include normals and normal variants
– Include important findings outside of chosen area

Certifying exam, Scoring
• Will be pass/fail only
• Must pass NIS, Essentials, CPA’s as a group
• If fail, must keep CPA’s the same for next
administration of the exam

Impact on training of certifying exam
• Many residents will choose subspecialization for
all/part of 4 th year
– Many programs will need to complete nuc med,
breast imaging requirements in 4 th year
– Programs may offer 3-9 month mini-fellowships
which would add to fellowship experience
– Programs may have only general rotations
• Residents likely take general call during 4 th year
• Impact first 3 months practice

Resources available
• MOC study guides posted
• NIS syllabus posted December 2012
• Will post other materials “soon”

Test centers
• Chicago
– Close to O’Hare airport
– 560 seats
– Has already been used for MOC exams
• Tucson
– In ABR building
– 180 seats
– Ready for core pilot 2013
• Plan – to transition to distributed centers, if possible
• Use of Palm Vein biometrics

Topics
• Exam of the “now”
• Exam of the “future” (ie October 2013)
• IR-DR residency

What does an ABMS specialty have to
have
• Approval of ABMS and ACGME
• Program requirements
• Accredited programs
• Certifying examinations
• MOC program

Background
• SIR proposed primary IR certification to ABR 2007
– IR fundamentally different than DR
– Need different way of training with additional clinical
skills
• Reworked proposal - dual certification in IR/DR
• ABMS approved 9/12
– Mandated cessation of VIR fellowships since would
otherwise produce two different levels of IR expertise
– good and better

What has been done since ABMS
approval
• Apply to ACGME BOD for new specialty
training – (10/22/12)
• Committee appointed by ACGME to review –
Chair of RRC (Larry Davis), member of RRC –
Jeanne LaBerge , BOD member (12/12)
– Submitted report 1/13 which supported proposal
– Presented to ACGME BOD which approved
development of PR’s – 2/13

What still needs to be done
• Program requirements written by RRC, with help
from stakeholders
– Must be open for public comment for 45 days
– Must respond to all comments; don’t have to change
– Will also need milestones
– Ad hoc committee reviews PR and comments and
recommends whether to proceed or not 2/14
– Present to Committee on Requirements and BOD–
June 2014. If accepted, immediate effective date

Proposed plan of training
• Clinical year
• 3 years DR training (identical to DR )
• 2 years IR training, including ICU rotations and
out-patient clinics

Then…
• Programs can apply for accreditation
– Need to fill out PIF
– Will need site visits as new programs
– Reviewed by DR RRC
– Likely earliest programs could be accredited is July
2015 – ACGME very busy with NAS
– Will be evaluated under Next Accreditation System
• Phase-out period of VIR fellowship at same
institution after approval. Likely 3-5 years.

• To ACGME, IR =specialty like IM, surgery, ENT
– Can transfer between specialties (just as can go
between surgery and psychiatry)
• Released by one PD, accepted by another
• Receiving PD can decide how much of training to
accept
– Program must have a PD; can only be a PD of a
single program
– RRC will review programs – DR RRC has agreed to
do this for now

What about certification
• Dual IR/DR certification
• Likely plan
– Core exam
– Certifying exam – all or only NIS, Essentials
– Oral exam in IR
• Grandfathering for those with VIR SS
certificates
• ABR will need to develop MOC program

What is happening now
• RRC beginning to write PR’s
• ABR beginning to plan exams

Important to remember
• Still in planning stage so answers to important
questions not known
• Don’t know exact timeline
• For now, if interested in IR, tell residents and
med students to take IR fellowship

Questions