Academic Radiology
Volume 10, Issue 1, Supplement , Pages S63-S66, January 2003

American Board of Radiology

American Board of Radiology, Tucson, Ariz, USA

Article Outline

 

The purpose of this article is to provide a quick overview of the American Board of Radiology (ABR), with an emphasis on current activities and potential future policies that have implications for resident training programs and program directors in diagnostic radiology. Although the ABR is concerned with diagnostic radiology, radiologic physics, and radiation oncology, only issues related to diagnostic radiology are discussed in this article.

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Web Site 

The Web site address for the ABR is www.theabr.org. Program directors are urged to become familiar with the site contents about the ABR, diagnostic radiology, subspecialties, important dates, the Holman Research Pathway, and combined programs, and to carefully read the newsletter and Board updates. Since the Web site enumerates the current requirements of certification for diagnostic radiology, radiation oncology, and radiologic physics, ABR content is not presented in detail in this article. For example, the Web site includes the complete text of information sent to candidates for the entire ABR examination process.

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Holman Research Pathway 

The ABR sponsors the Holman Research Pathway, which was specifically designed to address the shortage of physician-investigators in both diagnostic radiology and radiation oncology. It is designed for exceptional individuals who wish to pursue a career in research after training. The residents who are selected participate in research during their 4 years of training, while gaining enough experience to be competent in clinical diagnostic radiology. The ABR welcomes applicants, and program directors are asked to identify those interested in pursuing an academic career by this means, including medical students, radiology residents in their clinical year, and residents early in radiology training. Details on this pathway are available at the Web site.

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Mission Statement 

The mission of the ABR is to serve the public and the medical profession by certifying that ABR 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.

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Trustees 

The ABR consists of 15 diagnostic radiologists, six radiation oncologists, and three radiologic physicists, each nominated by one of the ABR-sponsoring organizations. The 2001–2002 trustees for diagnostic radiology were Philip O. Alderson, MD (New York, NY); Gary J. Becker, MD (Miami, Fla); George Bisset, MD (Durham, NC); Robert R. Hattery, MD (Rochester, Minn); Valerie Jackson, MD (Indianapolis, Ind); Robert R. Lukin, MD (Cincinnati, Ohio); John E. Madewell, MD (Houston, Tex); Christopher Merritt, MD (Philadelphia, Pa); Andrew K. Poznanski, MD (Chicago, Ill); Anthony V. Proto, MD (Richmond, Va); Anne Roberts, MD (La Jolla, Calif); Robert J. Stanley, MD (Birmingham, Ala); Michael A. Sullivan, MD (New Orleans, La); Kay H. Vydareny, MD (Atlanta, Ga); and James E. Youker, MD (Milwaukee, Wis).

The 2001–2002 Executive Committee included Robert R. Hattery, MD, president; William R. Hendee, PhD, vice-president; Steven A. Leibel, MD, secretary-treasurer; Anthony V. Proto, MD, assistant executive director for diagnostic radiology; Lawrence W. Davis, MD, assistant executive director for radiation oncology; Bhudatt R. Paliwal, PhD, assistant executive director for radiologic physics; David H. Hussey, MD, chair of the radiation oncology committee; and John E. Madewell, MD, M. Paul Capp, MD, is a former executive director of the ABR, and Dr Hattery is the current executive director.

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Time-Limited Certificates 

Since 2002, those who pass the ABR oral examination in diagnostic radiology are awarded 10-year time-limited certificates. Certificates are also issued in the following subspecialties of diagnostic radiology: pediatric radiology and vascular and interventional radiology (since 1994), neuroradiology (since 1995), and nuclear radiology (since 1999). All 24 member boards of the American Board of Medical Specialties (ABMS) have adopted the policy of awarding time-limited certificates.

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Computerized Testing Center Consortium 

The Boards of Pathology, Psychiatry and Neurology, and Radiology have developed a consortium of computerized testing centers in Tampa, Fla, Chicago, Ill, and Tucson, Ariz, respectively. For radiation oncology 2 years of maintenance of certification examinations have been completed, and the general written examination will be computerized and administered only at the testing centers. All subspecialty maintenance of certification examinations in pediatrics, neuroradiology, and vascular and interventional radiology will be available at the computerized testing centers beginning in 2004.

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Newsletter 

The ABR Examiner is sent to all diplomates and residents in May and November. The ABR trustees believe strongly that the newsletter improves communication and, most important, keeps diplomates and residents well informed of Board activities. The ABR welcomes any suggestions from diplomates.

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Examinations 

In 2001, 16,499 written and oral ABR examinations were given, including 13,992 in diagnostic radiology (1,075 in subspecialties), 1,483 in oncology, and 1,004 in physics.

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Certification, Maintenance of Certification, and Competency 

The ABMS boards have discussed maintenance of certification and competency, and numerous subcommittees have been appointed. The Accreditation Council for Graduate Medical Education and each residency review committee will initiate changes in training programs to address future accreditation. The four components of maintenance of certification (professional standing, lifelong learning and self-assessment, cognitive expertise, and practice performance) have been approved by the ABMS Assembly. Practice performance remains under discussion, but already the following 12 principles have been adopted by the ABMS:

1.The assessment process should reflect the activities of a diplomate related to patients or patient care.

2.Standards for measurement of clinical practice performance should be based on evidence-based guidelines, explicit expert consensus, or normative peer comparison.

3.The assessment process should compare the diplomate's practice performance against evidence-based guidelines or explicit expert consensus, where available, and against the performance of peers. After an initial baseline assessment, diplomates should be asked to develop an implementation plan for improvement and should submit a follow-up assessment of that plan. Each board should have guidelines for dealing with diplomates whose performance does not meet acceptable expectations.

4.Each of the six general competencies should initially be assessed at least once during a board's cyclical maintenance of certification. By the end of the second cycle, this assessment should be continuous.

5.Assessment of patient care initially will focus on a sampling of patients in a practice with a key disease or clinical process (eg, asthma, diabetes, pregnancy, immunizations, surgical procedure, or process central to that specialty) at least once in a cycle. By the end of the second cycle, each board should move to a more continuous sampling of patients that will enable diplomates to demonstrate, at any time, the quality of their care for a defined number of consecutive patients or specialty-related key activities.

6.For effective assessment and improvement of clinical performance, boards should consider joining collaborative efforts with other practices and using shared databases.

7.In the measurement of practice performance, proven methods of education and assessment should be used.

8.A program of practice assessment should be phased in, periodically evaluated for effectiveness, and systematically improved. Diplomates should be kept informed of the development of practice performance assessment.

9.Practice assessment should provide performance feedback, improve workflow, improve efficiency of practice, and not duplicate other assessment efforts.

10.Practice assessment should include appropriate collaboration with specialty societies and other organizations with relevant expertise in education and assessment.

11.Boards should develop a consistent approach regarding the maintenance of certification for diplomates who are not involved in direct patient care.

12.The assessment of physician performance should begin during residency and continue throughout practice. The board's evaluation of physician performance during residency should be linked to the six general competencies: medical knowledge, patient care, interpersonal skills and communication, professionalism, practice-based learning and improvement, and systems-based practice. Approved by both the ABMS and the Accreditation Council for Graduate Medical Education, these competencies have been incorporated into the graduate medical education program requirements.

In an attempt to measure competency, the ABMS boards adopted measures other than the examinations that all boards have used for many decades. Three new components—professional standing, lifelong learning and self-assessment, and practice performance—have been added to the existing examination component of cognitive expertise. The ABR accepted the following statement on commitment to maintenance of certification: “The Member Boards of the ABMS agree to transition their programs of recertification to programs of maintenance of certification. Member Boards' current programs and processes for recertification may be integrated into their programs and processes for [maintenance of certification]” (ABMS Assembly minutes, March 16, 2000).

In December 2001, the ABR met with the following sponsoring societies: the American College of Radiology (ACR), American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, American Society for Therapeutic Radiology and Oncology, American Association of Physicists in Medicine, American Radium Society, and Council of Medical Specialty Societies. In the past only the ABR and ACR have discussed maintenance of certification. The addition of the sponsoring societies and the subspecialty societies allows all the radiology communities to share information regarding the importance of maintaining certification and future mechanisms for doing so. The committee will continue to discuss details and will also discuss the progress toward maintenance of certification in physics, radiation oncology, and diagnostic radiology (including its four subspecialties).

Incorporating these components of maintenance of certification will take time. Obviously, this incorporation will not affect diagnostic radiology until 2012, when the first time-limited certificates will be due for renewal. For the other diagnostic subspecialties and radiation oncology, however, incorporation will occur much sooner. The ABMS has voted unanimously that these components must be measured and be psychometrically sound. The primary measure of professional standing will be an unrestricted license. For lifelong learning and self-assessment, continuing medical education credits will be required, as well as some self-assessment process. The ABR has discussed with other radiologic societies the possibility of adopting self-assessment strategies. Cognitive expertise will be measured by computerized examination. Measuring the last component, practice performance, will be the most difficult; pilot studies to test measurement methods are being done by ACR, other groups, and academic medical centers. Incorporating these methods with information technology should provide assessment methods that are reliable, valid, and practical, but this process is expected to take many years. The obvious purpose behind maintenance of certification is to assure patients and the general public that radiologists, radiation oncologists, and physicists are evaluating themselves and requiring that all certified individuals remain competent.

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Timing of Written and Oral Examinations 

To ease the pressure on 4th-year residents, the ABR has allowed residents to take the written examination in the physics of radiology at the beginning of their 2nd year and the written examination in clinical diagnosis in the 3rd year. This strategy was initially and has continued to be supported by program directors over the past few years. The diagnostic oral examination (comprising 10 individual 25-minute examinations) has been held in Louisville, Ky, since 1975. That location continues to be the best suited and most cost-effective for this purpose.

The timing of the examination (May or June of the 4th year) has always been a point of discussion. Some believe the examination should be given 1 or 2 years after training. Others believe it should be given after the completion of 1 or 2 years of a fellowship, and still others believe it should remain as is. Many existing senior radiologists were examined 1 year after training, which was ABR policy until the mid-1970s. With the inauguration of fellowships the examination was postponed to the end of training. The discussion will persist, and the ABR will continue to evaluate this policy.

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Preparation for Examinations 

The trustees of the ABR periodically discuss the preparation necessary for the diagnostic oral examination. The examination is case based, with an emphasis on observations, synthesis, and management. The following principles may be useful guides to preparation:

1.Study throughout the 4 years of training; do not try to cram content in the last 6–12 months.

2.Attend daily conferences, and complete all rotations and night call, especially in the 4th year.

3.Study together and practice taking the oral examination with your peer group.

4.Help the faculty develop mock board examinations, with the faculty playing the role of the oral examiners.

5.Mentor each other, and develop a tutoring program to fill gaps.

6.Practice analytic skills and critical thinking, and work on the 4 D's: detect, describe, differential diagnosis, and diagnosis.

7.Work closely with the faculty in the clinical and hospital setting, especially during the 4th year, to learn the subtleties of their analytic thinking and their procedural skills. These skills cannot be learned in the library or textbook.

8.Practice keeping cool under pressure.

9.Review teaching files and daily cases to hone skills in observation, synthesis, and management.

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Practical Reminders 

The ABR receives too many late applications, and it charges a $200 penalty for each. While residents frequently blame the program director's office, the resident is responsible for timely application. Nevertheless, program directors are urged to submit their residents' applications on time, either collectively (preferred by the ABR) or individually.

With regard to transferring residents, the ABR requires the following: “In a four-year diagnostic program, the resident is expected to remain in that program for all four years. If transfer to another program is necessary or desired, that transfer must have verification from the initial program director that the resident has successfully completed the training in their institution, with a listing of the specific rotations. This training must be accepted by the new program director” (1). In other words, the Board must have verification from the first program director that a resident has satisfactorily completed his or her rotations and verification from the second program director that he/she has accepted this training. Responsibility ultimately belongs to the last program director who has signed the ABR form stating that the resident is now “professionally qualified” to sit for the oral examination.

Further information can be obtained by contacting the ABR office at 5441 E Williams Blvd, Suite 200, Tucson, AZ 85711; telephone: (520) 790-2900; fax: (520) 790-3200; info@theabr.org

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References 

    Reference
  1. American Board of Radiology Diagnostic radiology training requirements. Available online at: www.theabr.org/1_DiagTrainReq.htm. Accessed November 6,2002.

PII: S1076-6332(03)80153-8

doi:10.1016/S1076-6332(03)80153-8

Academic Radiology
Volume 10, Issue 1, Supplement , Pages S63-S66, January 2003

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