A resident looks at the current ABR physics certification process; finds it well worth the effort

Recently, my fellow first year residents and I met to put together our study schedule for the upcoming American Board of Radiology (ABR) physics exam in September 2010. It's a daunting idea when you actually sit down and think about it. From April through September, we will be meeting once or twice a week on our own time to review study guides and test questions. In addition, most of us are planning on attending a review course. All of this while working our regular ten hour work days and taking call. Needless to say, I don't plan on having much time for anything else besides sleeping, eating, the occasional shower, and hopefully exercising. Essentially, physics will be my life for the next six or so months.

All of this planning got me thinking about the upcoming changes to the ABR certification process, so I decided to do a little research on the subject. There has been quite a stir about the topic including many heated debates at recent national and state meetings I have attended. My class is the last group that will go through the "old" process, which involves a written physics examination that can be taken any time after the first year of residency, followed by written and oral exams in the fourth year encompassing the entire breadth of radiology. The new process will involve a composite exam in the resident's third year integrating anatomy, pathophysiology, diagnostic radiology, and physics. The second exam will take place fifteen months after the resident graduates and will include five modules. Three modules will be chosen by the resident from the various subspecialtie,s and the other two will be mandatory modules concerning the fundamentals of diagnostic radiology and practice essentials. Due to these changes, our residency program director completely revamped our schedules by altering the length of our rotations and the amount of call each class is required to take. Of course, I was not too happy to find out my class will be required to take an extra week or two of night float in our fourth year while we are busy studying for our written and oral examinations.

As one might expect, there are people for and against the upcoming changes to the ABR certification process. During my research, I found an interesting article from the AJR, which discussed the declining emphasis on physics education in radiology residency programs over the past decade. This trend is attributed to increasing resident workloads, pressure to complete exams in less time, limited time available to master the principles of radiology, lack of emphasis on physics and technology education, and lack of clarity concerning the need for physics education. The author goes on to explain why he and the ABR believe the new certification process in addition to web-based learning modules are going to help to reinvigorate physics education in residency. In addition, since the second examination will occur fifteen months after graduation, it is also hoped more residents will go on to subspecialize by taking a fellowship. The main complaint that I have heard is graduates will not be board certified upon graduation.

I will admit, like many of my peers, physics has never been one of my favorite subjects. In fact, I often struggled with the subject during high school and college courses. After only eight months of residency though, there is no doubt in my mind physics permeates every aspect of radiology. It is the backbone of our specialty, an essential tool of the trade, if you will. Without physics, quality imaging and interpretation would not be possible. I will agree the current certification process does create a "just get it over with" attitude amongst residents. Most feel they should take the exam as early as possible (in the second year) to get it out of the way, so they can get back to studying clinical radiology. I am taking the exam in my second year mainly because I believe the earlier I can master these essential principles of radiology the better my understanding will be of the more complex topics built upon the concepts. I personally doubt changing the timing and format of the certification process is going to yield an improved emphasis on physics education. Nor do I think those residents who would have chosen not to take fellowships before these changes will necessarily decide to once they take effect.

The bottom line is no one really knows for sure how the upcoming changes will ultimately affect resident training. My hope is once they occur there will be an honest examination of whether or not they have accomplished their intended goals. After all, residents are the future of radiology and in an ever-evolving field we must constantly re-evaluate our ability to produce competent radiologists.