ABR Certifying Exam

  • The American Board of Radiology (ABR) certifies that their diplomates demonstrate the requisite skill, knowledge, and understanding of their disciplines for their patients’ benefit. Individuals can take the certifying exam after passing the ABR’s core exam(1).
  • The certifying exam includes a general-radiology module and three clinical practice modules that test-takers select(2). The ABR scores the certifying exam based on a pass or fail system, releasing its results and then the RISE scores(3).
  • Examinees of the certifying exam can prepare using various resources, including the internet, videos, and books. 

What Precisely Is the ABR Certifying Examination?

Individuals can take the computer-based certifying examination of the American Board of Radiology (ABR) at the first administration, 12 months after completing diagnostic radiology residency(4). 

A candidate must pass the core exam before becoming eligible to take the certifying exam(5). The ABR administers the certifying exam remotely. 

This certifying exam is a key step in the certification process. Here are the main steps a candidate must complete(6):

  • Step 1: Complete one year of clinical training.
  • Step 2: Complete one of the following: 

1) Accreditation Council for Graduate Medical Education (ACGME) 

2) Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited diagnostic radiology program

  • Step 3: Pass the ABR core exam.
  • Step 4: Provide proof of a valid medical license (state or provincial).
  • Step 5: Demonstrate both high moral and ethical principles. 

Exam Content, Coverage, and Format 

Here are the main components of the ABR’s certifying exam:

Essentials of Diagnostic Radiology

This compulsory module includes basic knowledge that all radiologists should know. Examples include(7):

    • Pneumothorax: Collapsed lung
    • Shock bowel: Bowel appears in a state of hypotension (low blood pressure)
    • Subdural hematoma: Buildup of blood on the brain’s surface
    • Recognizing child abuse

The diagnostic radiology module also contains non-interpretive skills (NIS) content, including(8): 

  • General topics of significance to the practice of radiology (for example, recognition and management of contrast reactions)
  • Error prevention
  • Communication skills
  • Professionalism
  • Ethics

Clinical Practice Modules

An individual selects the other three modules based on clinical practice areas. They may select up to three practice areas. The clinical practice areas include(9):  

  • General radiology
  • Breast 
  • Cardiac
  • Gastrointestinal
  • Genitourinary
  • Interventional Radiology 
  • Musculoskeletal (MSK)
  • Neuroradiology
  • Nuclear
  • Pediatric
  • Thoracic
  • Ultrasound
  • Vascular radiology  

Every clinical category has modules with two difficulty levels: fundamental and advanced. If an exam-taker has more than one module in a particular category, content is at the advanced level for the second and third module (if applicable). 

Each clinical practice area also includes items relevant to physics and pediatric radiology. Furthermore, the certifying exam integrates the Radioisotope Safety Exam’s (RISE) second portion on radiation safety. 

The RISE elements focus on clinically oriented practice scenarios. These scenarios evaluate practical knowledge of radioisotope safety and handling and regulatory compliance. 

Background

The primary goals of ABR activities, services, and initiatives include(10): 

  • Ensure safe and competent patient care 
  • Maintain patient and public confidence in the knowledge and skills of ABR diplomates. 

The ABR achieves these goals through: 

  • ACGME’s complementary functions 
  • Accredited training
  • ABR initial qualifying and certifying examinations
  • Maintenance of Certification (MOC)

In MOC, the cognitive examination is one component of the four-part process. 

The Certifying Exam Experience: Length and Timing Breakdown and Location

Length and Timing Breakdown 

The certifying exam is a single-day computer-based exam containing 298 questions(11). It differs from other ABR exams with its oral exam element.  

The exam takes a total of approximately five hours. 

The breakdown includes four hours for the ABR exam. Meanwhile, check-in time takes 30 minutes, and break time is 30 minutes. 

The question types include linked question sets and multi-question drop-down pick lists.

Location

The previous in-person test-taking experience was identical to the core exam. In addition, the check-in experience, shuttle bus experience, and nursing accommodations were similar for the Chicago, Illinois, and Tucson, Arizona locations.

However, now ABR administers the certifying exam remotely.  

Scoring and Results  

Scoring 

ABR scoring is criterion-referenced(12). In other words, the ABR establishes a passing standard before the exam. The exam has no set percentage of failure due to the ABR not grading on a curve. 

The ABR scores the certifying exam as pass or fail and provides feedback to the examinees(13). Test-takers must pass the one required module and three elective modules as a group. 

Examinees with a “fail” result must retake the entire exam(14). 

Results 

After the ABR scores the exam, it posts the candidates’ results on myABR website(15). Program directors and chairs receive identical information for each of their candidates. 

The ABR posts results of the certifying exam approximately one month following the exam(16). 

After a candidate passes the board’s certifying exam, the ABR scores the RISE exam based on RISE content in the core exam and certifying exams(17), this result does not impact the certifying exam’s pass result. 

Certifying Exam Preparation 

Individuals can use study guides for each clinical practice module. However, one may need supplementary materials to prepare for the exam. 

Many test-takers consider the ABR certifying exam to be fair. This feedback may be related to topic coverage and the ability to select modules. 

Questions and Practice Test or Modules

One should consider choosing modules in which they completed their fellowship.  Suppose one selects a second module on the same topic. It will be somewhat more challenging on the fellowship level.

The third module on the same topic provides more questions on the advanced level. No third “master level” exists.    

Study Plan 

Individuals can use case-based reviews through online question banks or books. These reviews help maintain public safety protocols during the COVID-19 pandemic. 

One’s fellowship’s subject likely exposed them to several topics in their field, such as neuroradiology. Neuro- refers to the nervous system or nerves. 

For example, individuals may have to conduct a differential diagnosis in a case study to determine the possible cognitive causes of a symptom. 

Other review series include the University of California, San Francisco (UCSF). Individuals can travel to complete review courses for the ABR certifying exam.  

Video Reviews 

Examples include case-style board review videos, including DVDs. These videos can offer high-quality fellowship-level training. Remember that some versions may be outdated. 

Web Resources

Various online question banks like BoardVitals address ABR’s radiology certifying exam. Individuals can find low-cost question banks with practice exam questions similar to the actual exam. Before trying a particular practice exam, review feedback from past users. 

One can also find other online resources for the core exam or certifying exam.  

Books 

It is common for test-takers to read a few books before taking the exam. That is because they are engaged in a second fellowship or just started a job. One option is to focus on case-based reviews and review books from one’s residency. Some examples include case review series. 

Accreditations

When preparing for the ABR certifying exam, look for sites the American Board of Radiology has qualified. They should meet the criteria for self-assessment for fulfilling requirements in the ABR MOC program. 

Individuals should also look for websites that the Accreditation Council for Continuing Medical Education (ACCME) has accredited to provide physicians with continuing medical education (CME).  

Examples include the American College of Radiology (ACR), which has accredited thousands of facilities.

Tips to Help Pass the ABR Certifying Exam 

Suppose one is a radiologist preparing for an upcoming ABR certifying exam. Individuals may be balancing study time with their first year in private practice. 

This situation can be stressful. Hence, individuals should wisely use their study time. Some helpful tips can help one pass the exam. 

Tip #1: Ensure Registration Is Completed 

This step is crucial. Individuals must register by email invitation. However, one may not receive a registration invitation after passing the core exam. 

Individuals should generally expect to receive an email registration invitation a few months before the core exam. Individuals can select their elective modules, which they can change until registration closes.  

It is crucial to learn the registration deadlines and register for the certifying exam before the deadline. 

Besides registering for the exam, individuals must select a payment method such as a credit card. 

Tip #2: Individuals Should Select Modules Best for Them 

The certifying exam’s three elective modules cover numerous aspects of practice. Individuals may select over one module in a particular area of expertise. 

Suppose an individual focuses on the area overlapping one’s fellowship. This option can make their study plan simpler. 

In other cases, a test taker’s deep experience covers over one subject area. In this case, selecting one other basic module can be helpful. 

Both of these strategies can be effective. Individuals should be honest about their strengths and weaknesses and select suitable modules.  

Tip #3: Budget Study Time Effectively 

Leading up to the certifying exam, an individual is likely in a fellowship or clinical practice. This situation differs from the core exam. 

Radiologists can schedule full-time studying for two to four weeks before the exam. Another option is to prepare for the exam during weeknights and weekends. 

Factors affecting how much study time an individual needs include their background and the modules selected.

Following the core exam, physics appears again in the certifying exam. The exam includes physics as radioisotope safety exam (RISE) questions. 

Individuals should plan based on their fellowship program or practice group. Here are some options: 

  • Consider vacation time in the weeks before the exam.  
  • Reschedule night and weekend responsibilities weeks before the exam. 
  • Plan distracting non-work commitments to occur outside one’s study period. This step can prevent interfering with a candidate’s focus and rest. 

Tip #4: Read About Nuclear Physics Safety 

Read about “nucs” safety before taking the exam. The exam includes questions related to nuclear physics and nuclear safety. Individuals can download content through the iBooks app using an iPhone, iPad, or Mac. One can also find print versions at sources like Amazon. 

In addition, specific modules may include related physics concepts. For example, breast modules may cover:

  • Magnetic resonance imaging (MRI)
  • Ultrasound
  • Mammography 

Meanwhile, interventional radiology (IR) may include fluoroscopy physics in the context of a clinical setting. 

Tip #5: Trust Non-interpretive Skills 

The ABR periodically updates the non-interpretive module’s material. The primary source to prepare for this module should be the latest version of the ABR’s non-interpretive skills resource guide. 

The ABR revises this guide frequently. Hence, avoid studying outdated resources. 

Here are some studying options to consider. Individuals should be alert when reviewing material. In addition, they can use a question and answer (Q&A) format or PowerPoint slides to review the material more rapidly than by taking notes. 

Flashcard apps may be effective if one views all the cards. 

Determine which studying options are most effective for high retention. 

 FAQs

  1. When and where is the ABR certifying exam administered?

The ABR administers the exam twice every year.  It has administered the certifying exam remotely since 2021. Individuals find the certifying exam schedule at the Exam Dates and Locations link.  

  1. Is the certifying exam offered at local testing centers?

No. Currently, local testing centers cannot facilitate the modular exam content and case structure. Furthermore, commercial vendors cannot control room lighting or calibrate monitors. 

  1. How do I select content for the certifying exam?

The ABR can examine an individual through three clinical practice modules. Training experience, practice pattern, and experience can be the foundation of the modules.  

Each clinical category has modules with two difficulty levels: fundamental and advanced. 

If an individual selects more than one module in a category, content is at the advanced level on the second and third modules. The individual can also select a third module based on a subspecialty.

  1. How does ABR score the certifying exam? 

The board scores the exam as pass or fail and provides feedback to the test-taker. ABR scores the required and elective modules together. A test-taker must retake the entire exam if the overall result is “fail.” 

Individuals that do not participate in question-writing determine the passing standard. 

  1. What are “non-interpretive skills”?

This term refers to general topics related to radiology. They include various general topics in the image-rich field. 

In the past, NIS was a stand-alone module. However, the ABR now includes the topic in the essentials module.

  1. Does the ABR’s diagnostic radiology certificate indicate if an individual is AU-eligible?

Yes. Suppose the individual meets the requirements of an “authorized user” eligibility. Examples include satisfactory documentation of:

  • Training and experience requirements 
  • Passing the RISE items in the core and certifying exams 

The individual’s certificate will then indicate “AU-eligible.” 

  1. How much time does one have to pass the certifying exam?

After completing the training, an individual has six years to complete the initial certification process (core and certifying exams). One can then become ‘board eligible.” 

Afterwards, they must complete one more year of training in a department with ACGME or RCPSC accreditation. Then they can enter the certification process. 

Conclusion 

Individuals may take the American Board of Radiology’s (ABR) certifying exam 12 months after completing their diagnostic radiology residency(18).  

Examinees must complete four modules. Content includes essential knowledge radiologists should know and three clinical practice modules at fundamental or advanced levels(19).   

The certifying exam includes nearly 300 questions(20). It takes a total of approximately five hours to complete. Test-takers must meet pre-established standards to pass the exam(21).

Individuals can take various steps to increase their chance of passing the exam. They include wise module selection, reviewing online resources and books or e-books, and good time management to prepare effectively.

  1. Certifying Exam
    https://www.theabr.org/diagnostic-radiology/initial-certification/certifying-exam
  2. ibid.  
  3. Scoring and results
    https://www.theabr.org/diagnostic-radiology/initial-certification/certifying-exam/scoring-results
  4. Certifying Exam
    https://www.theabr.org/diagnostic-radiology/initial-certification/certifying-exam
  5. ibid.
  6. Certification process
    https://www.theabr.org/diagnostic-radiology/initial-certification/certification-requirements
  7. Certifying exam
    https://www.theabr.org/diagnostic-radiology/initial-certification/certifying-exam
  8. ibid.
  9. ibid.
  10. ABR Examinations: The Why, What, and How
    https://pubs.rsna.org/doi/10.1148/radiol.13130384
  11. Certifying exam
    https://www.theabr.org/diagnostic-radiology/initial-certification/certifying-exam
  12. Scoring and results
    https://www.theabr.org/diagnostic-radiology/initial-certification/certifying-exam/scoring-results
  13. ibid.  
  14. ibid.  
  15. ibid.  
  16. ibid.  
  17. ibid. 
  18. Certifying Exam
    https://www.theabr.org/diagnostic-radiology/initial-certification/certifying-exam
  19. ibid.  
  20. ibid.  
  21. Scoring and results
    https://www.theabr.org/diagnostic-radiology/initial-certification/certifying-exam/scoring-results
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