Your Interaction With Your Interaction With The American Board of The American Board of

RadiologyRadiologyNow and In the FutureNow and In the Future

James P. Borgstede, M.D., FACRJames P. Borgstede, M.D., FACRPresident-Elect President-Elect

American Board of RadiologyAmerican Board of Radiology

Thanks

• Gary Becker and ABR staff Gary Becker and ABR staff • David Laszakovits David Laszakovits • Jennifer BosmaJennifer Bosma

Goals and ObjectivesGoals and Objectives

• Background on ABRBackground on ABR

• Analyze external forces affecting and Analyze external forces affecting and motivating the ABR and other specialty motivating the ABR and other specialty boardsboards

• Understand the ABR exam of the futureUnderstand the ABR exam of the future

• ABR of the future and youABR of the future and you

•Established 1934 Established 1934 •Currently has 3 disciplines:Currently has 3 disciplines:

– Diagnostic Radiology (DR)Diagnostic Radiology (DR)– Radiation Oncology (RO)Radiation Oncology (RO)– Medical Physics (MP)Medical Physics (MP)

•May have a 4May have a 4thth discipline of combined DR/VIR discipline of combined DR/VIR•Is one of the 24 member boards of the American Is one of the 24 member boards of the American Board of Medical Specialties (ABMS)Board of Medical Specialties (ABMS)

Background on the ABRBackground on the ABR

• ABMS member boardsABMS member boards•support ABMSsupport ABMS•abide by ABMS rulesabide by ABMS rules•cannot make unilateral changescannot make unilateral changes

• ““Rogue” boardsRogue” boards•can be legal entitycan be legal entity•do not have “standing”do not have “standing”•do not follow ABMS rulesdo not follow ABMS rules•may be used to request clinical may be used to request clinical

privilegesprivileges

American Board of American Board of RadiologyRadiologyMissionMission

““To serve patients, the public, and theTo serve patients, the public, and themedical profession. . .”medical profession. . .”

““By certifying that its diplomates By certifying that its diplomates have have acquired, demonstrated, and acquired, demonstrated, and maintained maintained a requisite standard of a requisite standard of knowledge, skill, knowledge, skill, and and understanding. . .” understanding. . .”

ABR ACR ABMS

External forces External forces affecting and affecting and

motivating the ABR motivating the ABR and other specialty and other specialty

boardsboards

DriversDrivers• American Board of American Board of

Medical SpecialtiesMedical Specialties• PayersPayers• Licensing agenciesLicensing agencies• Public accountabilityPublic accountability• Academic radiology-Academic radiology-

Society of Chairmen of Society of Chairmen of Academic Radiology Academic Radiology Departments (SCARD) Departments (SCARD) and program directors and program directors (APDR)(APDR)

• American Board of American Board of RadiologyRadiology

ReactorsReactors• American Board of American Board of

RadiologyRadiology• ResidentsResidents• Private practice Private practice

radiologyradiology• American College of American College of

RadiologyRadiology

The ABR Exam of The ABR Exam of the (near) Futurethe (near) Future

OutlineOutline

• Exam of todayExam of today– Qualifying (aka Qualifying (aka

written/physics)written/physics)– Certifying (aka oral)Certifying (aka oral)

• Exam of (near) futureExam of (near) future– CoreCore– CertifyingCertifying

At this year’s oral examAt this year’s oral exam• 6 modules will be piloted in May (MSK , Breast, 6 modules will be piloted in May (MSK , Breast,

Peds, Cardiac, IR, Neuro)Peds, Cardiac, IR, Neuro)• Candidate can choose to take one module Candidate can choose to take one module

before or after exambefore or after exam• Passing score can raise conditioned score but Passing score can raise conditioned score but

will not allow a failing candidate to passwill not allow a failing candidate to pass• Doing poorly on module does not affect oral Doing poorly on module does not affect oral

scorescore• Will allow evaluation of time, software Will allow evaluation of time, software

interface, questions, etc.interface, questions, etc.• Will not represent actual modules to be given Will not represent actual modules to be given

during core exam during core exam • Will be a second pilot May 2012 to include all Will be a second pilot May 2012 to include all

modulesmodules

EOF Core exam – PurposeEOF Core exam – Purpose

• To validate that a diagnostic To validate that a diagnostic radiology candidate has acquired radiology candidate has acquired knowledge, skill, and knowledge, skill, and understanding of the understanding of the entire field entire field of diagnostic radiology, including of diagnostic radiology, including physicsphysics

EOF, Core exam – TimingEOF, Core exam – Timing

• Residents expected to take at 36 monthsResidents expected to take at 36 months– Exception – research residents with >9 Exception – research residents with >9

months research in first 3 years can delaymonths research in first 3 years can delay– Would be few other exceptions grantedWould be few other exceptions granted

• First exam September 30 – October 4, 2013First exam September 30 – October 4, 2013

• Subsequent exams – third week of JuneSubsequent exams – third week of June

• Image-richImage-rich• Will assess knowledge and Will assess knowledge and

comprehension (40%) and comprehension (40%) and application, analysis, synthesis, and application, analysis, synthesis, and evaluation (60%) evaluation (60%)

• Level of expertise expected for the Level of expertise expected for the exam is basic to intermediate exam is basic to intermediate

• Will contain embedded RadioIsotope Will contain embedded RadioIsotope Safety Exam (RISE) exam Safety Exam (RISE) exam

EOF, Core exam – EOF, Core exam – StructureStructure

• 18 categories, each must be passed18 categories, each must be passed•Organ systemOrgan system: MSK, Cardiac, : MSK, Cardiac, Thoracic, Gastrointestinal, Urinary, Thoracic, Gastrointestinal, Urinary, Repro/Endo, Neuro, Pediatric, Repro/Endo, Neuro, Pediatric, Breast, VascularBreast, Vascular

•ModalityModality: Ultrasound, Interventional, : Ultrasound, Interventional, Nuclear Radiology/Molecular Nuclear Radiology/Molecular Imaging, CT, MRI, Rad/FluoroImaging, CT, MRI, Rad/Fluoro

•Fundamental conceptsFundamental concepts: Patient : Patient safety, physicssafety, physics

• Items presented in random orderItems presented in random order

EOF, Core exam – TimingEOF, Core exam – Timing

• Study guides posted on ABR Study guides posted on ABR website website (www.theabr.org) (www.theabr.org) January 2011January 2011

• Exam will take two half daysExam will take two half days

• Given in central locations – Given in central locations – Chicago, Tucson – 2x yearChicago, Tucson – 2x year

   BreastBreast CardiacCardiac GIGI MSKMSK NeuroNeuro PedsPeds ThoraxThoraxRepro / Repro / EndoEndo UrinaryUrinary VascularVascular Q#Q#

CTCT 60

IRIR 60

MRMR 60

NM/NM/MolecularMolecular 60

Rad/FluoroRad/Fluoro 60

USUS 60

PhysicsPhysics 90

SafetySafety 60

Q#Q# 60 60 60 60 60 60 60 60 60 60

minimum 60 questions per row/column

• Practical, image-basedPractical, image-based

• More questions than other More questions than other categoriescategories

• Physicist included on each of the Physicist included on each of the

item-writing committeesitem-writing committees

EOF, Core exam – PhysicsEOF, Core exam – Physics

EOF, Core exam – EOF, Core exam – ScoringScoring

• Criterion-referenced exam (not Criterion-referenced exam (not graded on a curve)graded on a curve)

• Must pass each row/columnMust pass each row/column• Condition exam = fail 1-5 Condition exam = fail 1-5

categories (including physics)categories (including physics)– RISE will not count as one of RISE will not count as one of these categories, but will be these categories, but will be scored separatelyscored separately

EOF, Core exam – EOF, Core exam – TransitionTransition

• If fail last attempt (3If fail last attempt (3rdrd time) time) at clinical exam- go to coreat clinical exam- go to core

• If fail last attempt (3If fail last attempt (3rdrd time) time) at oral – go to coreat oral – go to core

EOF, Certifying exam – EOF, Certifying exam – PurposePurpose

• To validate that the candidate has To validate that the candidate has acquired acquired and is able to apply and is able to apply the requisite the requisite knowledge, skill, and understanding that:knowledge, skill, and understanding that:– every practicing physician should every practicing physician should

possess. (20%) ( possess. (20%) ( NISNIS))– every practicing radiologist should every practicing radiologist should

possess. (20%) (possess. (20%) (EssentialsEssentials))– this particular practicing radiologist this particular practicing radiologist

should possess to begin independent should possess to begin independent practice in chosen clinical practice practice in chosen clinical practice area(s). (60%) area(s). (60%) (CPAs(CPAs))

  

EOF, Certifying exam – EOF, Certifying exam – TimingTiming

• To be taken 15 months after To be taken 15 months after finishing residencyfinishing residency

• Will be given 2x/yearWill be given 2x/year

EOF, Certifying exam – EOF, Certifying exam – StructureStructure

• Image-rich examImage-rich exam• Emulate practiceEmulate practice• Focus assessment on application, Focus assessment on application,

analysis, synthesis, and evaluation analysis, synthesis, and evaluation • Level of expertise expected for the Level of expertise expected for the

exam is intermediate to advancedexam is intermediate to advanced• Will include normals, normal Will include normals, normal

variants, artifactsvariants, artifacts

• Each module at least 60 Each module at least 60 scorable unitsscorable units

• Exam will be ~ 5 hours longExam will be ~ 5 hours long

• Administered 2 X / yearAdministered 2 X / year

• Is both the first MOC exam Is both the first MOC exam and the certifying exam for and the certifying exam for the residencythe residency

EOF, Certifying exam – EOF, Certifying exam – NISNIS

• What every physician should What every physician should knowknow

• Domain includes: ethics, Domain includes: ethics, governmental regulations, governmental regulations, systems-based practice, etc.systems-based practice, etc.

EOF, Certifying exam – EOF, Certifying exam – EssentialsEssentials

• What every radiologist should What every radiologist should knowknow

• Includes but not limited to Includes but not limited to Emergency Radiology, Emergency Radiology, common on-call dxcommon on-call dx

EOF, Certifying exam – EOF, Certifying exam – CPACPA

• Candidate chooses 3 modulesCandidate chooses 3 modules– If more than 1 in an area, will contain If more than 1 in an area, will contain

more advanced contentmore advanced content

• CPAs: Breast, Cardiac ,GI ,MSK, Neuro, CPAs: Breast, Cardiac ,GI ,MSK, Neuro, Pediatric, Thoracic, Pediatric, Thoracic, Reproductive/Endocrine, Urinary, Reproductive/Endocrine, Urinary, Vascular-Interventional, Nuclear Vascular-Interventional, Nuclear Medicine, Ultrasound, and General Medicine, Ultrasound, and General Radiology. Radiology. – Each will include relevant Peds, Each will include relevant Peds,

PhysicsPhysics

EOF, Certifying exam – EOF, Certifying exam – ScoringScoring

• Criterion referenced i.e. no curveCriterion referenced i.e. no curve

• Will be pass/fail onlyWill be pass/fail only

• Must pass NIS, Essentials and CPAs Must pass NIS, Essentials and CPAs (as a group)(as a group)

• If fail, must keep CPAs the same for If fail, must keep CPAs the same for next administration of the examnext administration of the exam

EOF, Certifying, EOF, Certifying, Transition from presentTransition from present

• If condition oral on last (3If condition oral on last (3rdrd) ) attempt – take one module in attempt – take one module in each conditioned section + NIS each conditioned section + NIS + Essentials+ Essentials– If fail, take entire Certifying If fail, take entire Certifying exam (5 modules)exam (5 modules)

ABR expectations ABR expectations continued…continued…

• More complete evaluation of More complete evaluation of resident’s abilities since can’t resident’s abilities since can’t evaluate communication, etc. evaluate communication, etc. on CBE on CBE – Milestones may help with Milestones may help with thisthis

ABR of the future ABR of the future and youand you

The ABR of the FutureThe ABR of the Future

• Increased demands to demonstrate Increased demands to demonstrate relevance of certificationrelevance of certification

• Increasing expectations of accountability to Increasing expectations of accountability to our diplomatesour diplomates– ABR has established advisory committeesABR has established advisory committees– Relevant exams (our EOF)Relevant exams (our EOF)– Maintenance of CertificationMaintenance of Certification

• Increased demands from a more robust Increased demands from a more robust American Board of Medical Specialties American Board of Medical Specialties (ABMS)(ABMS)

The ABR asks you to assist the ABR The ABR asks you to assist the ABR in demonstrating to our patients, the in demonstrating to our patients, the

public, and the medical profession public, and the medical profession that our diplomates have acquired, that our diplomates have acquired,

demonstrated, and maintained a demonstrated, and maintained a requisite standard of knowledge, requisite standard of knowledge,

skill, and understanding.skill, and understanding.

It’s the mission of It’s the mission of the ABR and it’s the ABR and it’s

your future.your future.