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We Will Miss You, Louisville

Editor in Chief

rstanley{at}uabmc.edu

Times change, and we change with them too. Owen's Epigrammata (1615)

Over the past 31 years, I have had the privilege and pleasure of serving as an oral board examiner in Louisville either for the primary certifying examination of the American Board of Radiology in June or for the conditional examination in November, every year but one. For countless residents (including me) who had completed training, the examination was a profound rite of passage, never to be forgotten. And the experience for the examiners produced a similarly memorable effect for virtually all who took part. For many of us, the gathering in June was like a giant class reunion and provided the opportunity for much bonding and networking among the subspecialists.

At the time I first began serving as an examiner, I and my fellow examiners were urged to bring along our own case material to supplement the cases maintained by the ABR. A pair of viewboxes served for evaluating radiographs, and the examination methodology allowed room for subjectivity and variability. The relative weaknesses of the examination method were recognized and dealt with by successive generations of the Board of Trustees. A major improvement occurred with the introduction of computers and monitors, which allowed far greater control of the conduct of the examination by the examiner, more uniformity of the case material, and significantly reduced subjectivity. Over this same period of time, more subspecialties of radiology were introduced into the examination to more appropriately encompass our expanding field. And the monitors allowed the incorporation of video loops that were closer to the real-life imaging process.

The evolution of testing methodology has been a gradual one, but in the relatively near future the examination will change in a very substantive way. Although the changes will not affect residents who are currently in training, those who begin their training in the years 2009, 2010, or 2011, depending on when the new computer-based examination is deemed ready, will no longer make the trek to Louisville and share the experience that so many in times past have endured.

The new process will involve an initial computer-based radiology core examination that will be given 30 months from the start of a radiology resident's training. This image-rich examination will replace the current written examination and may or may not be administered as an integrated single examination incorporating physics and clinical components.

The final certifying examination will be administered 15 months after the completion of the diagnostic radiology residency, annually in September or October. This computer-based and image-rich examination will be made available through multiple commercial examination centers, rather than in one single location. The examination will be tailored to reflect the training emphasis, experience, and future anticipated practice of the individual candidate, quite similar to the concept of the planned 10-year recertification examination that is part of the Maintenance of Certification (MOC) program of the ABR, with the first 10-year period being completed in 2012. The 15-month delay between the end of residency training and the administration of the examination will now have Radiology in conformance with many of the other specialties in the American Board of Medical Specialties (ABMS). Until now we have been in the distinct minority by holding the examination immediately at the completion of the residency training program.

The ARRS, as one of the sponsoring organizations of the ABR, has actively participated in the development of the MOC program. With material coming from the AJR and AJR Integrative Imaging, self-assessment modules have been created as part of the continuing education program. And with the AJR now having been online for over 7 years, one of the main sources of educational material is presented in a format similar to that which will be used for testing. Other resources of the ARRS, such as the ARRS GoldMiner^TM and the RSS (Really Simple Syndication) service, also provide important complementary educational material vital in today's computerized world. All of the planned examination changes reflect the generational changes taking place in our readership with each passing decade, which we recognize and must accommodate.

To return to my original theme of Louisville, I will once again have an opportunity to serve as an examiner this coming June, and my time spent there will be somewhat bittersweet. In all likelihood, it will be my last time to serve, and it will represent one of the last three or four examinations that will be held in Louisville. There is still something to be said for the face-to-face oral examination method that will be lost when future candidates interact exclusively with a sophisticated computer-based examination. I might say that the end product of our oral examinations up until now has been quite good. But the world is changing and so must we. I heartily extend my congratulations to the members of the Board of Trustees of the American Board of Radiology who have been planning and crafting this evolutionary process for the past 10 years. I for one will be most eager to see the new examination in operation.

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