Has the American Board of Radiology (ABR) finally thrown up its hands and said it can no longer do its job? That was the take home message from my recent excursion to the AUR meeting. The explicit role of the American Board of Radiology is to standardize the quality of trained radiologists throughout the country. In fact, if you read the mission statement of the ABR website you will read verbatim- “Our mission- to certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients.” What are the most crucial skills in order to become a radiologist? Well, two of the most important pillars for creation of a competent radiologist is medical knowledge and communication. For the first time at this meeting, the ABR explicitly stated that they will abandon the role of testing radiology resident communication skills and will leave this responsibility for maintaining minimum standards to the individual programs while continuing to standardize testing of medical knowledge. What???????
If you leave the responsibility of testing and maintaining communication skills to individual programs, you are certainly not ensuring the baseline quality of our future radiologists. There are no accrediting bodies out there that can ensure the outcome of training as well as a governing/testing body such as the ABR. Without the lead of an accrediting board such as the ABR, I can see wide variability among different programs in the ability of residents to dictate and communicate results to their fellow clinicians. Some residencies will shine and produce a resident product that will competently communicate results to clinicians and others will no longer create residents with the minimum level of communications skills since there is no impetus to do so. We no longer have an oral board exam that can assess some basic communication competencies. How can the ABR accrediting body support such a position?
Government funding for medical education is at an all time low and hampers the ability of regulating bodies to do their job. Now we are leaving the responsibility of the ACGME/RRC with less teeth and funding to regulate these competencies? On the other hand, the ABR is funded by private radiology resident and radiologist dollars. Each of us spends thousands of dollars on getting and maintaining board accreditation during our lifetimes. And with all this money being spent, the ABR is saying that they cannot ensure a minimum communication competency. This is absurd.
Other licensing boards are actually moving in the opposite direction because they know it is the right thing to do for patient care. For instance, the USMLE has added on a clinical skills section to their test because creating doctors that can’t assess and communicate results to patients makes no sense. Why should testing by the ABR in the field of radiology be any different?
Please ABR… Step back and think about your position on testing communication skills. If you want to stay relevant in today’s day and age, there are other accrediting bodies out their that may take on the role of maintaining standards if you can’t do so yourself. Rethink your position statement and honestly reassess if it is in the best interest of the radiology community to forgo testing of minimum competency in communication skills. I don’t think so.
How should the ABR test communication skills? Isn’t that up to the residency programs? The ACGME maintains 6 core competencies. Only 1 of those 6 (medical knowledge) can be tested by board exams. Others like professionalism and interpersonal/communication skills cannot.
I believe that testing and standardizing some basic communication skills prior to graduation is a necessity. As it stands right now, there is significant variability in the quality of communication teachings in different residencies. To that end, there are many ways that the ABR could test communication skills. First, the resident may be able to answer questions in an appropriate dictation format to demonstrate he/she understands the mechanics of dictation. (At least that would ensure that graduating residents understand the basics) Grading would be a bit more challenging, but there is no reason why the ABR cannot create such a format. Second, the previous oral boards, albeit imperfect, did test residents ability to communicate the examination, the findings, the impression/differential, and management. I’m sure we could come up with a new and improved oral board type of examination to test the ability of communicating radiological findings to clinicians and patients in a much improved way. Perhaps, we could create a part 2 to the the core examination. If the USMLE examination can do it, there is no reason why the ABR cannot test for the same things, but directed toward the needs of radiologists.
I agree that testing professionalism is tougher nut to crack. Furthermore, unlike communication, professionalism is not really a skill set but a way of acting ethically within the profession. You can’t standardize minimum requirements for professionalism in a test format. I agree- let’s leave that to the individual programs. But, you can certainly standardize basic minimum competencies for communication skills. And, I think that should be the responsibility of the ABR.
I believe that we create excuses for ourselves to say it is not possible. It is certainly possible and it is done in our own field of medicine as well as other fields. To say that it is impossible or too hard is just pure laziness. It would just take time, rededication of funds, and getting together some intelligent radiologists and educators to figure it out. If called upon, I would be happy to give my input!!!
Testing should simulate real life. Applicants should sit at a work station, go through a work list and clear it. Reports should be graded in part for style, but also for making correct diagnoses, further recommendations, pointing out technical limitations and communicating with clinicians when appropriate in a timely manner and applying appropriate documentation of such communication.
This NIS stuff is nonsense as is random physics that has no bearing on clinical practice. We should focus less on random low value issues and focus more on being helpful to the system, our colleagues and most importantly, our patients.
Agree entirely with your thoughts! Why would the ABR make a statement like we are not responsible for maintaining minimum standards of communications? Maybe because they have been concentrating on the wrong things (useless information in the noninterpretive skills section!), probably since it is easier than looking into the real issues including teaching communication skills that make a great practical radiology residency education. On the top of this list of important communication skills to be learned, formal dictation requirements would certainly be one of the most practical. As you say, going through a worklist and dictating reports would be a very reasonable first step toward assessing communications. Having a simulation approach would be another. Regardless, the ABR has a tendency to emphasize the unimportant instead of the worthwhile to the disadvantage of all radiologists and trainees.