Your Interaction With The American Board of Radiology Now and In the Future James P. Borgstede, M.D., FACR President-Elect American Board of Radiology

Thanks Gary Becker and ABR staffGary Becker and ABR staff David LaszakovitsDavid Laszakovits Jennifer BosmaJennifer Bosma

Goals and Objectives Background on ABRBackground on ABR Analyze external forces affecting and motivating the ABR and other specialty boardsAnalyze external forces affecting and motivating the ABR and other specialty boards 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 1934Established 1934 Currently has 3 disciplines:Currently has 3 disciplines: –Diagnostic Radiology (DR) –Radiation Oncology (RO) –Medical Physics (MP) May have a 4 th discipline of combined DR/VIRMay have a 4 th discipline of combined DR/VIR Is one of the 24 member boards of the American Board of Medical Specialties (ABMS)Is one of the 24 member boards of the American Board of Medical Specialties (ABMS) Background 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” boards“Rogue” 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 privilegesmay be used to request clinical privileges

American Board of Radiology Mission “To serve patients, the public, and the medical profession...” “By certifying that its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill, and understanding...”

ABR ACR ABMS

External forces affecting and motivating the ABR and other specialty boards

Drivers American Board of Medical SpecialtiesAmerican Board of Medical Specialties PayersPayers Licensing agenciesLicensing agencies Public accountabilityPublic accountability Academic radiology- Society of Chairmen of Academic Radiology Departments (SCARD) and program directors (APDR)Academic radiology- Society of Chairmen of Academic Radiology Departments (SCARD) and program directors (APDR) American Board of RadiologyAmerican Board of Radiology Reactors American Board of Radiology Residents Private practice radiology American College of Radiology

The ABR Exam of the (near) Future

Outline Exam of todayExam of today –Qualifying (aka written/physics) –Certifying (aka oral) Exam of (near) futureExam of (near) future –Core –Certifying

At this year’s oral exam 6 modules will be piloted in May (MSK, Breast, Peds, Cardiac, IR, Neuro)6 modules will be piloted in May (MSK, Breast, Peds, Cardiac, IR, Neuro) Candidate can choose to take one module before or after examCandidate can choose to take one module before or after exam Passing score can raise conditioned score but will not allow a failing candidate to passPassing score can raise conditioned score but will not allow a failing candidate to pass Doing poorly on module does not affect oral scoreDoing poorly on module does not affect oral score Will allow evaluation of time, software interface, questions, etc.Will allow evaluation of time, software interface, questions, etc. Will not represent actual modules to be given during core examWill not represent actual modules to be given during core exam Will be a second pilot May 2012 to include all modulesWill be a second pilot May 2012 to include all modules

EOF Core exam – Purpose To validate that a diagnostic radiology candidate has acquired knowledge, skill, and understanding of the entire field of diagnostic radiology, including physics To validate that a diagnostic radiology candidate has acquired knowledge, skill, and understanding of the entire field of diagnostic radiology, including physics

EOF, Core exam – Timing Residents expected to take at 36 monthsResidents expected to take at 36 months –Exception – research residents with >9 months research in first 3 years can delay –Would 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 comprehension (40%) and application, analysis, synthesis, and evaluation (60%)Will assess knowledge and comprehension (40%) and application, analysis, synthesis, and evaluation (60%) Level of expertise expected for the exam is basic to intermediateLevel of expertise expected for the exam is basic to intermediate Will contain embedded RadioIsotope Safety Exam (RISE) examWill contain embedded RadioIsotope Safety Exam (RISE) exam EOF, Core exam – Structure

18 categories, each must be passed18 categories, each must be passed Organ system: MSK, Cardiac, Thoracic, Gastrointestinal, Urinary, Repro/Endo, Neuro, Pediatric, Breast, VascularOrgan system: MSK, Cardiac, Thoracic, Gastrointestinal, Urinary, Repro/Endo, Neuro, Pediatric, Breast, Vascular Modality: Ultrasound, Interventional, Nuclear Radiology/Molecular Imaging, CT, MRI, Rad/FluoroModality: Ultrasound, Interventional, Nuclear Radiology/Molecular Imaging, CT, MRI, Rad/Fluoro Fundamental concepts: Patient safety, physicsFundamental concepts: Patient safety, physics Items presented in random orderItems presented in random order EOF, Core exam – Timing

Study guides posted on ABR website ( January 2011Study guides posted on ABR website ( January 2011 Exam will take two half daysExam will take two half days Given in central locations – Chicago, Tucson – 2x yearGiven in central locations – Chicago, Tucson – 2x year

BreastCardiacGIMSKNeuroPedsThorax Repro / Endo UrinaryVascularQ# CT 60 IR MR NM/Molecul ar 60 Rad/Fluoro US Physics 90 Safety 60 Q# minimum 60 questions per row/column

Practical, image-basedPractical, image-based More questions than other categoriesMore questions than other categories Physicist included on each of thePhysicist included on each of the item-writing committees EOF, Core exam – Physics

EOF, Core exam – Scoring Criterion-referenced exam (not graded on a curve)Criterion-referenced exam (not graded on a curve) Must pass each row/columnMust pass each row/column Condition exam = fail 1-5 categories (including physics)Condition exam = fail 1-5 categories (including physics) –RISE will not count as one of these categories, but will be scored separately

EOF, Core exam – Transition If fail last attempt (3 rd time) at clinical exam- go to coreIf fail last attempt (3 rd time) at clinical exam- go to core If fail last attempt (3 rd time) at oral – go to coreIf fail last attempt (3 rd time) at oral – go to core

EOF, Certifying exam – Purpose To validate that the candidate has acquired and is able to apply the requisite knowledge, skill, and understanding that: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%) (CPAs)

EOF, Certifying exam – Timing To be taken 15 months after finishing residencyTo be taken 15 months after finishing residency Will be given 2x/yearWill be given 2x/year

EOF, Certifying exam – Structure Image-rich examImage-rich exam Emulate practiceEmulate practice Focus assessment on application, analysis, synthesis, and evaluationFocus assessment on application, analysis, synthesis, and evaluation Level of expertise expected for the exam is intermediate to advancedLevel of expertise expected for the exam is intermediate to advanced Will include normals, normal variants, artifactsWill include normals, normal variants, artifacts

Each module at least 60 scorable unitsEach module at least 60 scorable 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 and the certifying exam for the residencyIs both the first MOC exam and the certifying exam for the residency

EOF, Certifying exam – NIS What every physician should knowWhat every physician should know Domain includes: ethics, governmental regulations, systems-based practice, etc.Domain includes: ethics, governmental regulations, systems-based practice, etc.

EOF, Certifying exam – Essentials What every radiologist should knowWhat every radiologist should know Includes but not limited to Emergency Radiology, common on-call dxIncludes but not limited to Emergency Radiology, common on-call dx

EOF, Certifying exam – CPA Candidate chooses 3 modulesCandidate chooses 3 modules –If more than 1 in an area, will contain more advanced content CPAs: Breast, Cardiac,GI,MSK, Neuro, Pediatric, Thoracic, Reproductive/Endocrine, Urinary, Vascular-Interventional, Nuclear Medicine, Ultrasound, and General Radiology.CPAs: Breast, Cardiac,GI,MSK, Neuro, Pediatric, Thoracic, Reproductive/Endocrine, Urinary, Vascular-Interventional, Nuclear Medicine, Ultrasound, and General Radiology. – Each will include relevant Peds, Physics

EOF, Certifying exam – Scoring 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 (as a group)Must pass NIS, Essentials and CPAs (as a group) If fail, must keep CPAs the same for next administration of the examIf fail, must keep CPAs the same for next administration of the exam

EOF, Certifying, Transition from present If condition oral on last (3 rd ) attempt – take one module in each conditioned section + NIS + EssentialsIf condition oral on last (3 rd ) attempt – take one module in each conditioned section + NIS + Essentials –If fail, take entire Certifying exam (5 modules)

ABR expectations continued… More complete evaluation of resident’s abilities since can’t evaluate communication, etc. on CBEMore complete evaluation of resident’s abilities since can’t evaluate communication, etc. on CBE –Milestones may help with this

ABR of the future and you

The ABR of the Future Increased demands to demonstrate relevance of certificationIncreased demands to demonstrate relevance of certification Increasing expectations of accountability to our diplomatesIncreasing expectations of accountability to our diplomates –ABR has established advisory committees –Relevant exams (our EOF) –Maintenance of Certification Increased demands from a more robust American Board of Medical Specialties (ABMS)Increased demands from a more robust American Board of Medical Specialties (ABMS)

The ABR asks you to assist the ABR in demonstrating to our patients, the public, and the medical profession that our diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill, and understanding. It’s the mission of the ABR and it’s your future.