Proposed two-year delay for oral exams would change timetable for resident testing

Radiology department chairs voted nearly unanimous support in April for recommending that the American Board of Radiology reschedule its annual oral exam for residents to a date two years after residents have completed their fourth year of training.

The vote took place among members of the Society of Chairmen in Academic Radiology Departments (SCARD) who met last month in Denver at the Association of University Radiologists meeting.

It was the first time in the history of the SCARD annual meeting, a conference generally reserved for discussion, in which members voted on an issue. The fact that members agreed to vote reflects the issue's importance, according to president Dr. Stephen Baker. Members recommended rolling back the date of the test from the June following the fourth year of residency. Academic radiologists have long complained that the fourth year of their programs is disrupted because students focus on the impending exam.

"The fourth year of residency is totally dysfunctional," Baker said. "We've created the most accelerated seniority system in the history of employment, where we have individuals with the most training that do the least work and take no call."

The Accreditation Council of Graduate Medical Education (ACGME) in Diagnostic Radiology proposed last year to disallow residents from taking independent call until they complete 12 months of training. This proposal met strong resistance within radiology, partly because the first-year ban would force senior residents to take call, thus disrupting their oral exam study time, according to Baker. The change was approved, however, and takes effect July 1, 2008.

A staw poll of approximately 100 members of the Association of Program Directors in Radiology (APDR), who were also meeting in Denver, showed that there was strong support for further discussion to delay the oral board exam, in conjunction with the American Board of Radiology modifying the exam, according to APDR president Dr. Duane G. Mezwa.

Much of the APDR membership was not present at the business meeting, however, and there has been no formal discussion of this proposal with the full APDR membership, Mezwa said.

The oral exam consists of 11 sections at 25-minute intervals. In conjuction with delaying the exam two years out of training, the exam would have to be changed, perhaps to reflect some degree of specialization gained on the job by the working residents. The written boards could be expanded as well to take some pressure off the orals, Baker said.

Support at the AUR meeting for keeping the oral boards in the fourth year of residency came mostly from chief residents. They said the current date gives residents time to solidify their education and a delay would put too much demand on them while in clinical practice.

"Nobody mentioned that these residents are also employees," Baker said. "They regard their residency as a study hall of entitlements. But there has to be a balance."

While all other medical residencies have delayed oral boards, radiology is the last medical subspecialty to administer the test in the residents' final year. An effort was made 10 years ago to delay the oral exam by a year, but it met resistance from fellowship directors who feared residents would spend their fellowship period studying for the boards.

A two-year delay could provoke radiology group practices to put forth the same complaint: that newly minted radiologists would be spending valuable time on the job studying for their exams.

The Resident Review Committee of the ACGME, which accredits residency programs, and the ABR, which certifies radiologists, will meet on June 1 to discuss the proposal, Baker said.

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