A recent national survey suggests that most radiology program directors support the American Board of Radiology’s (ABR) switch back to oral certifying exams for residents, yet challenges lie ahead.
For one, given that the last oral board exam administration occurred in the spring of 2013, approximately 15,000 radiologists have never taken a diagnostic radiology oral board exam, noted Elana Smith, MD, of the University of Maryland in Baltimore, and colleagues.
“This poses a challenge that many faculty must prepare residents for an exam they have never personally taken,” the group wrote. The study was published February 18 in Academic Radiology.
In 2013, the ABR changed the format of initial certification for diagnostic radiology from a written examination followed by an oral exam to the current method: a computer-based qualifying (core) exam followed by a computer-based certifying exam. Yet based on concerns that grew over esoteric questions, exam recalls, subjectivity, cost, logistics, and increasing subspecialization, the board decided to reinstate the oral exams, beginning in 2028.
To better understand how residency programs are adapting to this transition, Smith and colleagues surveyed members of the Association of Program Directors in Radiology (APDR). They sent a voluntary, anonymous 20-question survey of 262 APDR members and received responses from 87 (33.2%).
According to the results, 76% of program directors support the transition to the oral boards. The authors noted that those who personally took the oral boards viewed this change more favorably than those who did not (p = 0.048). Three main challenges surrounding the transition were identified, as follows:
Timing (58.8%): The oral board exam will be administered during fellowship rather than at the end of residency, and thus, programs will have limited ability to help prepare residents, respondents noted.
Lack of faculty experience with the oral exam (52.5%): Many faculty are in the difficult position of preparing residents for an exam format they have no personal experience with, and this challenge is compounded by ongoing staffing shortages, burnout, and increasing clinical demands.
Uncertainty about exam content (43.8%): The new oral board format is unfamiliar territory for most current faculty and program directors, and there is inherent uncertainty about what the exam will look like in practice. Respondents noted, however, that this concern is likely to diminish in subsequent years once programs gain experience with the format.
“Addressing these concerns will be essential to the successful implementation of the new exam format,” the group wrote.
To prepare residents, many programs plan to increase hot-seat sessions and decrease didactic and multiple-choice question-based conferences, and over half plan to offer mock oral board exams, primarily to senior residents, the authors noted.
Ultimately, the survey results support the transition back to oral exams, according to the group. By design, oral board exams test the skills needed in daily clinical practice, including a radiologist’s ability to identify imaging findings, synthesize information into differential diagnoses, and recommend appropriate management, they noted.
“Transitioning to an oral certifying exam may help reverse unintended consequences of the computer-based core and certifying exams, such as fragmented study habits and a perceived decline in readiness for general practice,” the researchers wrote.
The full study is available here.
