How Will the ABR’s Changes to Diagnostic Radiology Boards’ Structure and Timing Affect You?

We are all well aware that the American Board of Radiology (ABR) has planned changes to future certification exams in radiology. This will affect residents beginning in 2010, and will not alter the training of those already in residency. The last time this topic was discussed on the blog, many of you voiced your concerns over the decision to delay the certifying exam to 15 months out of residency, and how the changes may create too strong an emphasis on subspecialization.

These changes have been in deliberation for years — those who agree with the changes believe fourth-year residents should concentrate on their responsibilities, and not have to balance studying at the same time; those on the other side believe that residents in their fourth year are best suited to handle the core competency-based format and therefore the exam should remain static.

In response to the many questions ACR members had regarding these changes — rather than deliberate the pros and cons to each side of the debate — the College created a task force to consider the potential impact of changes in the diagnostic radiology boards’ structure and timing. I served as chair, and my fellow members included a mix resident physicians, and private and academic practice members.

So, what will these changes mean for those of us at present — those already in practice?

We realized that there would be no easy solution to this question, and we immediately determined a need to create two subcommittees — one to examine the impact of the ABR’s decision on the future practice of radiology and the ACR, and the other to focus on how the change might affect residency training programs and trainees. Our discussions are summarized at length in a white paper in the November issue of the Journal of the American College of Radiology (JACR). To read the paper in its entirety, login to the ACR Web site and then click on the JACR links on the bottom left-hand side of the page.

Was the task force successful at addressing your questions and concerns about this major change in radiology?

How do you think the number of individuals choosing to complete fellowships immediately after residency will change?

And, what other issues, if any, do you foresee?

I look forward to your thoughts.

Comments

[Lisa esserman]

I think that it will make it very difficult for radiology residents to delay their boards. It is great to be studying with a group of residents. Private practice can be very grueling and some people may be specializing making it even harder> It can be a big adjustment from residency to private practice in terms of work load, pace and responsibility. It is good to have the boards behind you at that point and to feel confident after passing the boards.

[Robert Penkava, M.D.]

Looking for a potential employee/partner, I would feel more comfortable with one that already has passed the boards, vs. someone that was going to take them in the future.

This delay falsely elevates the less well qualified residents up to a plane equal to the more qualified that would have passed their boards prior to employment.

[Richard L. Goldwin, MD, FACR]

I have long lamented that we "loose" our seniors for the last 6 months of their training, when they should be polishing skills acquired during the previous 3 1/2 years of training.

I sat for oral board in Dec 1977, the first opportunity after graduation afforded us at that time, and it was not that difficult -- nerve racking, but not difficult. Granted there has been an explosion in information required to be a quality radiologist. Employers and graduates will have to adjust. Law graduates don't sit for the bar exam before they really begin practice.

[Mahr A. Malik, MD]

The current structure of the Boards favors rote memorization, pattern recognition and spitting out pre-programmed knee jerk responses in a limited time frame. Although, I mastered these techniques for my boards with excellent results I do not neccessarily think that "studying for the boards" made me a good radiologist. Also, the boards as currently structured were probably was not the best way to assess my core competencies anyways, as I certainly don't practice radiology on a knee jerk response basis in real life. Hence, the exam structure needs to be reassessed.

Taking an exam, any exam is nerve wracking at any point in time. Be it final year of training or as a junior partner in a private practice. The pressures are different but nonetheless exist. Folks whether they are employers or job seekers will just have to learn to deal with it like ALL other medical subspecialties do.

[Chad Williams]

Are we blogging just to lament and vent re: the decision to delay boards- to smooth our ruffled feathers by "getting it off our chest" and then ultimately accept the change and all of the negative impacts? Or are we contributing to a thoughtful consideration to reverse the decision to delay boards?

Having read the ACR white paper I am more convinced than ever that the decision creates more problems than solutions. Are we limited to just discussing how we are to deal with the impacts or can we imagine not having the impacts at all?

Proponents of the Boards delay "believe fourth-year residents should concentrate on their responsibilities, and not have to balance studying at the same time;...".

Fellowship directors and group practices believe that the graduate should focus on his/her responsibilities and not have to balance this with the studying that they should have completed in residency. I get that the academic centers would have more service from the residents and less responsibility to educate under the new paradigm.

I don't get how they think this responsibility is more appropriately handled by the individual resident, fellowship programs and group practices after residency. Again, I don't think pointing to the way law schools or other specialties do it has any bearing on what is the best way to do it.

I am also wondering what happens to the individual who tests in one subspecialty area but ends up practicing in another. Does that individual have to be re-examined?

[Steven L, Hirsh, MD]

I believe the board has made a BIG mistake. Your decision benefits the academic, insular world and hurts the residents.

15 months after finishing residency can find a candidate much less prepared for the broad range of the exam as compared to real world experience.

Yes, the programs will benefit by having senior residents full attention on their duties. However, the newly minted will lose their "edge" very quickly.

This is a very selfish act on your part and again shows the distance from your towers to main street and the real world has just continued to grow.

Are your programs about the narcissistic needs of academic departments or about training residents to succeed.

Shame on you!!

Been there, done that.

[Alfonso Gay, Jr., M.D.]

I feel sorry for all future residents having to take the boards after residency. The argument that lawyers and other medical specialties do it that way seems fairly weak. It sounds like the way children argue. Could it be that Radiology has always had it right? The amount I learned in my fellowship year probably equaled 2 years of what I learned in residency since I was unencumbered with the task of having to study for the boards. I had that foundation behind me and was able to focus on what was important in practicing real life Radiology. As an employer it will be difficult to imagine hiring a non-board certified radiologist if a board certified candidate is available. It seems like this topic is another divisive issue between private practice and academic medicine. Are there any academicians who think the delay is a bad idea?