ABR Exam of the Future: Update from APDR - Slide 1
Transcript of ABR Exam of the Future: Update from APDR - Slide 1
APDR/APCR ABR UPDATE APDR/APCR ABR UPDATE March 2010March 2010
Duane Mezwa MDDuane Mezwa MDWilliam Beaumont HospitalsWilliam Beaumont Hospitals
Past President, APDRPast President, APDRGI Trustee, ABRGI Trustee, ABR
Exam of the Future (EOF): Exam of the Future (EOF): StructureStructure
Core examinationCore examination
Certifying examinationCertifying examination
R1 R2 R3 R4 Fellowship/employment
Internship
12 mos 12 mos 12 mos 12 mos 12 mos 12 mos 3 mos
Core Exam CertifyingExam
EOF: Core ExaminationEOF: Core Examination
Given at 36 monthsGiven at 36 months
Covers Covers allall of diagnostic radiology of diagnostic radiology– Only comprehensive exam in EOFOnly comprehensive exam in EOF– Candidate must pass every category to Candidate must pass every category to
qualify for certifying examinationqualify for certifying examination– Level of knowledge expected: Level of knowledge expected:
basic/intermediatebasic/intermediate
EOF: Core Exam CategoriesEOF: Core Exam Categories
Organ Systems* (10):Organ Systems* (10):– Breast, Cardiac, Endocrine/Reproductive, Breast, Cardiac, Endocrine/Reproductive,
Gastrointestinal, Musculoskeletal, Neuro, Pediatric, Gastrointestinal, Musculoskeletal, Neuro, Pediatric, Thoracic, Urinary, VascularThoracic, Urinary, Vascular
Modalities (6):Modalities (6):– Rad/fluoro, CT, MR, Nuclear/Molecular, US, Rad/fluoro, CT, MR, Nuclear/Molecular, US,
InterventionalInterventional
Fundamentals (2)Fundamentals (2)::– Physics, patient safetyPhysics, patient safety
* Clinically relevant anatomy, pathophysiology, etc
BreastBreast CardiacCardiac GIGI MSKMSK NeuroNeuro PedsPeds ThoraxThoraxRepro / Repro / EndoEndo UrinaryUrinary VascularVascular Q#Q#
CTCT 45
IRIR 45
MRMR 45
NM/MolecularNM/Molecular 45
Rad/FluoroRad/Fluoro 45
USUS 45
PhysicsPhysics 90
SafetySafety 45
Q#Q# 45 45 45 45 45 45 45 45 45 45 500
minimum 45 questions per category
EOF: Core Exam Blueprint
BreastBreast CardCard GIGI MSKMSK NeuroNeuro PedsPeds ThoraxThorax Repr/endoRepr/endo GUGU VascVasc Q#Q#
CTCT 4545
IRIR 4545
MRMR 4545
NM/MolecNM/Molec 4545
Rad/FluoroRad/Fluoro 4545
USUS 4545
PhysicsPhysics
SafetySafety 4545
Q#Q# 4545 4545 4545 4545 4545 4545 4545 4545 4545 4545 500500
0
25
90
Minimum of 45 questions if categoryis to be scored separately
EOF: Examination Blueprint
15
EOF: Core Exam—ScoringEOF: Core Exam—Scoring
Each organ systemEach organ system
Each methodEach method
Patient safety, physicsPatient safety, physics
Assuming sufficient breadth of content that Assuming sufficient breadth of content that a confident pass/fail decision is possiblea confident pass/fail decision is possible
Minimum 45 questions/categoryMinimum 45 questions/category
} Scored pass/fail
EOF: Core Exam - Physics EOF: Core Exam - Physics ContentContent
Minimum of 90 questionsMinimum of 90 questions
Each item writing organ system-based category Each item writing organ system-based category has a physicisthas a physicist
Questions: “Clinically relevant” physicsQuestions: “Clinically relevant” physics– How can image quality be improved?How can image quality be improved?– What is the source of this artifact?What is the source of this artifact?– How would you design this examination to minimize How would you design this examination to minimize
excessive radiation exposure?excessive radiation exposure?
EOF: Core Exam—Example EOF: Core Exam—Example Physics QuestionPhysics Question
Repeat CT is requested Repeat CT is requested to determine whether to determine whether the CBD lesion is a the CBD lesion is a tumor or a stone. What tumor or a stone. What is the most appropriate is the most appropriate maneuver?maneuver?
a) Decrease kVpa) Decrease kVpb) Increase kVpb) Increase kVpc) Decrease masc) Decrease masd) Increase masd) Increase mase) Buy new unite) Buy new unit
Update on Physics ActivitiesUpdate on Physics ActivitiesCurriculumCurriculum– Revision completed: Revision completed: www.aapm.org– Teaching objectives: spring 2009Teaching objectives: spring 2009– Questions matched to curriculumQuestions matched to curriculum
Web-based modules – RSNA WebsiteWeb-based modules – RSNA Website– Phase 1 (completed - RSNA 2009)Phase 1 (completed - RSNA 2009)
X-ray, CT, Nucs, US, MR, BiologyX-ray, CT, Nucs, US, MR, Biology32 modules developed by radiologist/physicsist32 modules developed by radiologist/physicsist
– Phase 2 (target June ’10 or so)Phase 2 (target June ’10 or so)Processing, display, quality, perception, PACSProcessing, display, quality, perception, PACS30 additional modules30 additional modules
AAPM Summer School on Teaching Medical Physics: AAPM Summer School on Teaching Medical Physics:
Innovations in LearningInnovations in Learning July 2010.July 2010.
Bloom’s Bloom’s HierarchicalHierarchical Taxonomy of Taxonomy of Educational ObjectivesEducational Objectives
1. Knowledge
2. Comprehension
3. Application
4. Analysis
5. Synthesis
6. Evaluation
“Written”
“Written”
Oral
Oral
Oral
Oral
Define, Describe, List
Distinguish, Convert
Interpret, Solve
Identify, Analyze
Plan, Categorize
Rank, Rate
EOF: Core Exam—Contrast with EOF: Core Exam—Contrast with Current Written ExamCurrent Written Exam
Written examWritten exam– Fact retrieval onlyFact retrieval only– Individual organ systems and imaging methods not Individual organ systems and imaging methods not
separately evaluatedseparately evaluated– ? Relevance of some physics questions? Relevance of some physics questions
Core examCore exam– Roughly 40% fact retrievalRoughly 40% fact retrieval– Comprehensive, all systems/methods scoredComprehensive, all systems/methods scored– Questions based on specific imagesQuestions based on specific images
EOF: Core Exam—Contrast With EOF: Core Exam—Contrast With Oral ExamOral Exam
Oral examOral exam– ObservationObservation– SynthesisSynthesis– ManagementManagement– CommunicationCommunication
Core examCore exam– 60% will test all of the above60% will test all of the above– Communication skills?Communication skills?
EOF: Core Exam—ContentEOF: Core Exam—Content
Entire spectrum of diagnostic radiologyEntire spectrum of diagnostic radiology
Basic/intermediate level*Basic/intermediate level*
Probably at least 500 questionsProbably at least 500 questions
Administered over 1Administered over 1½ days½ days
*Clearly needed: a curriculum for every *Clearly needed: a curriculum for every scorable categoryscorable category
EOF: Core Exam—Conditions of EOF: Core Exam—Conditions of ContestContest
Pass all categories:Pass all categories: PassPass
Fail 5 categories:Fail 5 categories: ConditionCondition
Fail > 5 categories:Fail > 5 categories: FailFail
Conditioned candidates retake only the Conditioned candidates retake only the failed category(ies)failed category(ies)
Failed candidates retake entire examFailed candidates retake entire exam
Both will be offered in six monthsBoth will be offered in six months
EOF: Core Exam—Effects on EOF: Core Exam—Effects on Training ProgramsTraining Programs
ABR-RRC meeting yearlyABR-RRC meeting yearly
All residents exposed to every clinical All residents exposed to every clinical category to be testedcategory to be tested
Board preparation displaced into 3Board preparation displaced into 3rdrd year year
Structure of 4Structure of 4thth year year– Smaller programs—may be no changeSmaller programs—may be no change– Larger programs—may be competition for Larger programs—may be competition for
highly sought clinical subspecialtieshighly sought clinical subspecialties
EOF: Core Exam—What We NeedEOF: Core Exam—What We Need
Written curricula for all categoriesWritten curricula for all categories
About 100 item-writersAbout 100 item-writers
About 2000 questions before 2013About 2000 questions before 2013
Sage advice from all of youSage advice from all of you
Goodwill of the radiology communityGoodwill of the radiology community
EOF: Certifying Exam— 2015 EOF: Certifying Exam— 2015 Underlying DualityUnderlying Duality
Conceived as the first MOC exam, but Conceived as the first MOC exam, but alsoalso
Final certifying exam given by ABRFinal certifying exam given by ABR
– Must pass test of public scrutinyMust pass test of public scrutiny
– Must test competenciesMust test competencies
– Need not test entire breadth of radiologyNeed not test entire breadth of radiology
EOF: Certifying ExamEOF: Certifying Exam
Given 15 months after residency graduationGiven 15 months after residency graduation
Will contain 5 modulesWill contain 5 modules
– Noninterpretive skills (common to physicians)Noninterpretive skills (common to physicians)
– Essentials of radiology (common to radiologists)Essentials of radiology (common to radiologists)
– 3 modules chosen by candidate3 modules chosen by candidate
General radiologyGeneral radiology
Subspecialty radiologySubspecialty radiology
EOF Certifying Exam—ContentEOF Certifying Exam—Content
Emulate practice of radiologist at workEmulate practice of radiologist at work– Some normal examsSome normal exams– Many “real-life” decisionsMany “real-life” decisions
Differential (not single) diagnosesDifferential (not single) diagnosesManagement decisionsManagement decisions
More complicated question typesMore complicated question types– Many possible right answersMany possible right answers– Layout mimicking real patient workupsLayout mimicking real patient workups
What are the clinical practice areas on the certifying examination? The clinical practice area choices will reflect current radiology practice: Breast, Cardiac, GI, MSK, Neuro, NM, Peds, Repro/Endo, Thoracic, Ultrasound, Urinary, Vascular-Interventional and General Diagnostic Radiology. The ABR will monitor the numbers of candidates taking each module and modify this list as seems appropriate after 3 years depending on the choices made by candidates.
Clinical Practice AreasClinical Practice AreasBreastBreastGENERALGENERALCardiacCardiacGIGIMSKMSKNeuroNeuroNuclearNuclear
PediatricPediatricReproductive/EndoReproductive/EndoThoracicThoracicUltrasoundUltrasoundUrinaryUrinaryVascular-InterventionalVascular-Interventional
EOF: Certifying Exam—Example EOF: Certifying Exam—Example CaseCase
A 43 year old man experienced intermittent A 43 year old man experienced intermittent episodes of hematochezia. Capsule endoscopy episodes of hematochezia. Capsule endoscopy showed angiodysplastic changes in the ileal mucosa. showed angiodysplastic changes in the ileal mucosa. Which of the following radiologic examinations is Which of the following radiologic examinations is MOST appropriate for further evaluationMOST appropriate for further evaluation
a) CT enterographyb) MR enterographyc)c) Selective angiographySelective angiographyd)d) EnteroclysisEnteroclysis
Warning: Once you have made
a selection, you may not return
to this screen
What is the MOST likely diagnosis?a)Carcinoidb)GI stromal tumorc) Adenocarcinomad)Metastatic melanoma
What is the MOST likely diagnosis?a)Carcinoidb)GI stromal tumorc) Adenocarcinomad)Metastatic melanoma
Exam PhilosophyExam Philosophy
“The important thing is to make the lesson of
each case tell on your education.”
William Osler
Certifying Exam- 2015Certifying Exam- 2015
How will the exam be graded?How will the exam be graded?
5 modules: Noninterpretive skills, 5 modules: Noninterpretive skills, essentials, three candidate-selected essentials, three candidate-selected modulesmodules
Each will be graded with own passing Each will be graded with own passing standardstandard
Candidate must pass all 5 componentsCandidate must pass all 5 components
No “condition” statusNo “condition” status
Rationale:
*Both psychometric and “face” validity are necessary to our various stakeholders. We are currently the only board with a condition category at this time.
*Elimination of “condition” is reasonable because we have narrowed the scope of the exam and eliminated subjectivity of an oral exam.
Assuming that the examination is available in testing centers every six months, additional preparation by candidates and prompt reexamination will be feasible.
Certifying Exam:Certifying Exam:
Of the three clinical modules, how many can be chosen in the Of the three clinical modules, how many can be chosen in the same category?same category?
All 3. Candidates allowed free choice to construct their exam All 3. Candidates allowed free choice to construct their exam among General or Subspecialty Categoryamong General or Subspecialty Category
Rationale: The clinical modules will comprise only 60% of the Rationale: The clinical modules will comprise only 60% of the exam. Allowing free choice permits early subspecialization, while exam. Allowing free choice permits early subspecialization, while still testing all of DR.still testing all of DR.
It is expected that candidates selecting more modules in a given It is expected that candidates selecting more modules in a given subject will be answering questions of higher difficulty.subject will be answering questions of higher difficulty.
We are testing what the candidate feels is most important to his/her future practice, not what their past training has been.
EOF: Certifying Exam—What We EOF: Certifying Exam—What We NeedNeed
Even more help!Even more help!
Sufficient material and question-writing Sufficient material and question-writing expertise to create graded spectrum of expertise to create graded spectrum of sophistication within every categorysophistication within every category
Example: Neuroradiology contentExample: Neuroradiology content
Core General Modules CAQ
Increasing sophistication
EOF: Certifying Exam—Effect on EOF: Certifying Exam—Effect on Training ProgramsTraining Programs
Restructured 4Restructured 4thth year year– Depends on size and orientationDepends on size and orientation– Will not include Boards frenzyWill not include Boards frenzy
Effect on FellowshipsEffect on Fellowships– Research-orientedResearch-oriented– Narrowly definedNarrowly defined
Recent DecisionsRecent Decisions
Orals ResultsOrals Results
Distribution of Orals resultsDistribution of Orals results
Beta tested in Louisville last OctoberBeta tested in Louisville last October
Very successfulVery successful
Results were available on line quicker than Results were available on line quicker than US mailUS mail
Will do this for upcoming exam in May.Will do this for upcoming exam in May.
PD to get results very close in time to PD to get results very close in time to release of results to residents.release of results to residents.
September 30 RuleSeptember 30 Rule
If a candidate plans to take the current If a candidate plans to take the current Orals then training must be completed by Orals then training must be completed by Sept 30Sept 30thth of that year. of that year.
Certificate will be held until completed.Certificate will be held until completed.
Extenuating CircumstancesExtenuating Circumstances
Exception must be attested by PDException must be attested by PD
Review by ABRReview by ABR
Enough is Enough RuleEnough is Enough Rule
Applies to candidates that repeatedly try to pass Applies to candidates that repeatedly try to pass the Examthe ExamCurrently 10 yearsCurrently 10 yearsIn EOF it will be 5 years to pass Core after In EOF it will be 5 years to pass Core after becoming eligible ( 36 months of training).becoming eligible ( 36 months of training).In EOF it will be 5 years to pass Certifying after In EOF it will be 5 years to pass Certifying after first qualifying to take exam. (15 mos)first qualifying to take exam. (15 mos)Additional year of training if not able to meet the Additional year of training if not able to meet the requirement.requirement.No need to take Core again once passed.No need to take Core again once passed.
20132013
Last year of full Orals June 2-5, 2013Last year of full Orals June 2-5, 2013
First year of Core ExamFirst year of Core Exam
Week of September 30-October 4, 2013Week of September 30-October 4, 2013
Following year will move Core earlier to 3Following year will move Core earlier to 3rdrd week of June---probablyweek of June---probably
Transition PlanTransition Plan
What happens to those in process who do not What happens to those in process who do not finish Written or Orals when we convert in 2013?finish Written or Orals when we convert in 2013?
Elaborate timing diagram with every permutation Elaborate timing diagram with every permutation with Condition and Failwith Condition and Fail
Fail Written 3 times Fail Written 3 times Core Core
Fail Orals 3 times Fail Orals 3 times Core Core
Condition Orals 3 times Condition Orals 3 times Certifying Module Certifying Module Plus Essentials and Non-InterpretativePlus Essentials and Non-Interpretative
Louisville and BeyondLouisville and Beyond
After 2015 will go onAfter 2015 will go on
RP and RO plan on continuing their Oral RP and RO plan on continuing their Oral exams for the futureexams for the future
Now assessing the sites available to give Now assessing the sites available to give the future exams: computer storage, ability the future exams: computer storage, ability to show our exam material etcto show our exam material etc
Simulation possibilitiesSimulation possibilities
MQSA- CurentlyMQSA- Curently
"The interpreting physician shall have interpreted or multi-read at least 240 mammographic examinations within the 6-month period immediately prior to the date that the physician qualifies as an interpreting physician. This interpretation or multi-reading shall be under the direct supervision of an interpreting physician."
Exemption- CurrentlyExemption- Currently
But if you pass your Boards first time:But if you pass your Boards first time:
"Physicians who have interpreted or multi-read at least 240 mammographic examinations under the direct supervision of an interpreting physician in any 6-month period during the last 2 years of a diagnostic radiology residency and who become appropriately board certified at the first allowable time, as defined by an eligible certifying body, are otherwise exempt"
MQSA- EOFMQSA- EOF
Works in progress -Awaiting final FDAWorks in progress -Awaiting final FDAGraduates after 2014Graduates after 2014"Physicians who 1) successfully complete a diagnostic radiology residency program in 2014 (or later), 2) have interpreted or multi-read at least 240 mammographic examinations under the direct supervision of an interpreting physician in any 6-month period during the last 2 years of this residency, and 3) have passed their certifying board's core exam by the end of their residency are otherwise exempt."
Current MQSA Requirements, Before 2014
No Exemption
etc.
With Exemption
etc.
Proposed MQSA Requirements, After 2014
No Exemption (no change)
etc.
With Exemption (proposed)
etc.
Date qualifies as Interpreting Physician
R1 R2 R3 R4
F2/PR1 R2 R3
Interpreting Physician
P
960 exams in 24 months continuing experience
If not enough exams,
must requalify
F1/P F2/P or 240 exams
960 exams in 24 months continuing experience
P P
Date qualifies as
240 exams
or 240 exams
or 240 exams
Year of Residency
Oral Certifying Exam (Pass)
240 exams
960 exams in 24 months continuing experience
R4
Year of Fellowship or Practice
If not enough exams,
must requalify
Oral Certifying Exam (Fail)
P960 exams in 24 months continuing
experience
F1/P
Core Exam (Fail)
R1 R2 R3 R4 F1/P F2/P P P240
exams960 exams in 24 months continuing
experience960 exams in 24 months continuing
experience
Date qualifies as If not enough exams,Interpreting Physician must requalify
Certifying Exam
Core Exam (Pass before residency end)
R1 R2 R3 R4 F1/P F2/P P P240
exams or 240 exams
or 240 exams
or 240 exams
Exams under Supervision
Initial and Continuing Experience Requirements for New Interpreting Physicians Under MQSA
Date qualifies as If not enough exams,Interpreting Physician must requalify
960 exams in 24 months continuing experience
960 exams in 24 months continuing experience
IMG PolicyIMG Policy
Most candidates from India.Most candidates from India.
India advisory committee to ABR.India advisory committee to ABR.
Must have completed training and certification .Must have completed training and certification .
Chair is PD. Hired as junior faculty.Chair is PD. Hired as junior faculty.
All 4 years MUST be in same institution.All 4 years MUST be in same institution.
If they switch the 4 years start over again.If they switch the 4 years start over again.
Can take Certifying Exam after 4 years of Can take Certifying Exam after 4 years of training. Do not have to wait the 15 monthstraining. Do not have to wait the 15 months
Practice AnalysisPractice Analysis
Survey instruments finalizedSurvey instruments finalized
Could add question about focused practiceCould add question about focused practice
Will be distributed electronicallyWill be distributed electronically
Results to be discussed by October, 2010Results to be discussed by October, 2010
Recognized not most scientific way to Recognized not most scientific way to gather datagather data
Should look at feasibility of obtaining Should look at feasibility of obtaining CTP/ICD-9 codes from sample practicesCTP/ICD-9 codes from sample practices
ABRF ProposalABRF Proposal
ABRF –President Bill HendeeABRF –President Bill Hendee
New venture to help Residents and PDsNew venture to help Residents and PDs
RFP to go out soonRFP to go out soon
14 Ethics and Professionalism modules14 Ethics and Professionalism modules
Modeled after the Physics modulesModeled after the Physics modules
ETA: April 2011ETA: April 2011
VolunteerismVolunteerism
EOF Committees all formedEOF Committees all formed
BUT…..BUT…..
Terms of service on these committee Terms of service on these committee range from 2-4 yearsrange from 2-4 years
Still need 1000s of items for the exams, Still need 1000s of items for the exams, both Core and Certifyingboth Core and Certifying
Orals still around for a few more years….Orals still around for a few more years….
MIRCMIRC
Medical Imaging Resource CenterMedical Imaging Resource CenterA simple way to identify, index and retrieve images, A simple way to identify, index and retrieve images, teaching files and other radiology information teaching files and other radiology information The ability to search multiple imaging libraries as if they The ability to search multiple imaging libraries as if they were a single library organized by medically important were a single library organized by medically important categories categories An authoring tool that makes it easy to create radiology An authoring tool that makes it easy to create radiology teaching files and other electronic documents in flexible teaching files and other electronic documents in flexible formats with a common underlying structure formats with a common underlying structure Tools to enable sites to manage and exchange images Tools to enable sites to manage and exchange images and research data sets for imaging clinical trials and research data sets for imaging clinical trials
17 Ways ABR Communicates17 Ways ABR Communicates
Leadership meetingsLeadership meetings Discussions at ABR boothDiscussions at ABR booth Trustee presentations at Trustee presentations at
society meetingssociety meetings The BeamThe Beam Email from ABREmail from ABR Web content, FAQsWeb content, FAQs 1-on-1 phone 1-on-1 phone
conversations in officeconversations in office ““Open microphone”Open microphone”
Pamphlet distributionPamphlet distribution Paper & electronic Paper & electronic
newsletters of societiesnewsletters of societies Major journal articlesMajor journal articles Snail mail from ABRSnail mail from ABR Responses to email Responses to email
questions (individual)questions (individual) SurveysSurveys Annual reportAnnual report VideoVideo Phone or Webex with Phone or Webex with
practicespractices
EOF: Final ThoughtsEOF: Final ThoughtsABR mission, to protect the public, is vitalABR mission, to protect the public, is vital
No part of its mission is possible without the work of No part of its mission is possible without the work of hundreds of volunteershundreds of volunteers
Thanks to everyone who has or will contribute their Thanks to everyone who has or will contribute their cases and writing expertise to continue our missioncases and writing expertise to continue our mission
If we are to survive, we must establish the culture If we are to survive, we must establish the culture of lifelong learning in each of our diplomatesof lifelong learning in each of our diplomates
Concluding ThoughtConcluding Thought
“One never notices what has been done, one can only see what remains to be done.”
Mdm Marie Curie
Contact :[email protected]