Tag: ABR

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MOC And Practice Based Improvement: Easiest Ways To Satisfy The Requirement!

practice based improvement

As a steward to my private practice to keep everyone up to date for ABR maintenance of certification, one area more than any other has caused more confusion. And that is practice-based improvement. In the beginning when the ABR created this requirement, it was not clearly defined. And, it has undergone a more significant change than any of the other requirements that the ABR demands. Now, to this day, I still get radiologists in practice asking me – “How can I satisfy this requirement?” No doubt it isn’t all that apparent.

So, let me refer you to the ways to meet these ABR requirements (just click this link). It will describe what you need to satisfy the requirements of the ABR. But, for those of you that hate reading meaningless dry lists, let me give you my interpretation of six of the easiest ways that you can meet this obscure requirement!

Easiest Ways To Satisfy The Practice-Based Improvement Requirement!

“Participation as a member of an institutional/departmental clinical quality and/or safety review committee”

Most radiologists who work with or for a hospital have to be a part of a safety committee. For me, I am part of the nuclear medicine QA and MRI quality committees. So that fits the bill as meeting this requirement. But almost any committee that has anything to do with safety would satisfy this ABR requirement if, god forbid, you had an audit!

“Publication of a peer-reviewed journal article related to quality improvement or improved safety of the diplomate’s practice content area”

This requirement is also pretty benign for those who work for or with a radiology residency program. Nowadays, most academic and pseudo-academic world departments need to work on a quality improvement project with residents. It is pretty easy to get your name on one of these articles if you have a residency program. Most residents would be happy to have you on their project to help them out a bit!

“Participation as a member of a root cause analysis team evaluating a sentinel or other quality- or safety-related event”

Left up to interpretation, this can mean being a compliance officer or part of a team responsible for morbidity and mortality conferences. Many practices have baked this conference into their partners’ meetings already. So, you may be satisfying this requirement and may not even know it!

“Regular participation (at least 10/year) in departmental or group conferences focused on patient safety.”

Again, you may be doing this already. Many radiologists have to participate in tumor boards, surgery conferences, or other morbidity and mortality conferences. All these conferences count toward the requirement. You may already have more than ten. Just make sure to record them!

“Creation or active management of, or participation in, one of the elements of a quality or safety program”

If you are desperate and have a residency program, this can mean giving a lecture on a safety topic to residents. You can provide a pre-test and a post-test. Then, all you need to do is to show improvement. Oualaa… A quick way to satisfy the requirement if you can’t meet the others.

“Active participation in applying for or maintaining accreditation by specialty accreditation programs such as those offered by ACR, ACRO, or ASTRO”

For many, this is another easy one. Yearly, I am bombarded with questions for continuing accreditation for the ACR from my technologists, physicists, and more. And, there is a good chance that your practice requires ACR accreditation too. All you have to do is document your participation!

Meeting The MOC Practice-Based Improvement Requirement

So, there you have it, six relatively painless ways to satisfy the MOC requirements. Many of these you may be doing already and not even realize it. It seems silly to have these as a requirement to maintain accreditation in radiology because many of them are on the fringes of what we do as radiologists. But whatever works and makes our lives easier so that we can continue our ABR accreditation!

 

 

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Hard Proof That The Radiology Core Examination Does Not Work! Need We Say More?

radiology core examination

I can still remember these words, “All you need to do is to study and attend your rotations. If so, you will pass the core radiology examination.” And also, “Residents should not need additional time off to study for the test. They get all the time they need.” Lawrence Davis, MD, the former head of the Radiology Review Committee (RRC), stated these comments with confidence at an Association of University Radiologists (AUR) meeting a few years back. According to the recent article in Aunt Minnie, ARRS: Residents who passed Core Exam valued test prep; nothing could be farther from the truth.

Here is a direct quote from the article, “survey respondents who passed the Core Exam and got a higher overall score used a greater number of test-prep resources, had more time off to study, and had higher U.S. Medical Licensing Exam (USMLE) Step 1 scores (240 versus 221) compared with residents who scored lower or failed.”

Based on this new information, this group entirely invalidated the former RRC head thoughts in one fell swoop. Furthermore, the data stands directly against the ABR mission to create an exam to test basic competency. Now, the evidence to support my theory in a previous article about the new test is live and “in the flesh.”

But, I am going to take it one step further. The results of this new study signals that the ABR needs to revamp the entire radiology core examination once and for all. And, let me tell you why.

The Core Radiology Examination Is Not Based On Practical Knowledge

One of the stated goals of the ABR is to demonstrate competency of recent radiology graduates. But, how can the ABR test those stated goals if the core exam performance depends on residents needing more study time? All the knowledge that they need should come from day-to-day studying and working alone, not from taking additional time off to study.

Additionally, a medical career examination should test for baseline competency, not test-taking skills or superfluous facts. If you need to buy all these supportive test-prep resources, then you are testing for more than baseline competency. In reality, you are checking for skills outside of the purview of radiology, the ability to take a test. Who do you want to hire a good quality worker/radiologist or a great test-taker?

We Are Supporting The Test Taking Support Companies At The Residents Expense

Once again, the resident is an afterthought when it comes to all the fees that we make them pay. The typical resident has to shell out thousands of dollars to the ABR. And then, the ABR forces upon them the indignity of paying for additional test prep resources on top of everything else. Whether it is books, courses, online question banks, or index cards, each dollar spent on these resources adds to the enormous debt of the typical radiology resident. When are they going to start thinking about the needs of radiology residents?

Now, there are traditional resources such as subspecialty books that residents can and probably should buy. But, are we helping residents by having them pay for the additional resources to pass a test that does not measure what the ABR intends. Who finally wins out in the end? Well, the test taking companies, of course. They earn hundreds of thousands of dollars on the backs of indebted radiology residents.

Let’s Stop Playing Games Once And For All!

The ABR needs to stop deluding themselves that the core exam serves the purpose that the organization had expected. The evidence against the utility of the test is now officially on the table. Let’s now start the process of creating a new examination that works as intended. Back to the drawing board, folks!

 

 

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Transparency And The ABR: Are The Leaders As Transparent As They Like To Think?

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At the recent Association of University Radiologists (AUR) meeting, the American Board of Radiology (ABR) adopted the theme of transparency in its lectures. However, as I sat and listened to the seminar on the ABR updates, the words did not jibe well with the theme.

How The ABR Supported Its New Found Transparency

Brent Wagner, MD, the President-Elect of the organization, attempted to show as a nonprofit entity, the books are wide open. And that, the money that they raise from testing fees and MOC mostly goes to the upkeep of the organization. In fact, they showed the public income tax form they filed with the IRS. In it, he stated that anyone could pretty much look up the finances of the organization and its members. So, I pulled up a copy of the nonprofit 990 IRS form for the 2016 tax year at the following link:  http://990s.foundationcenter.org/990_pdf_archive/410/410773787/410773787_201703_990O.pdf

Yes, much of the money does go to the running maintenance of certification, testing, and other appropriate uses. But, that is not all. If you look at the form, you will see listed the compensation for the executive board listed on page 7. According to the document, compensation for the president was 720,000 dollars for 50 hours of weekly work. In addition, the ABR paid the associate executive directors on the list who worked 20 hours over 260,00o dollars including all compensation. Of course, this compensation does not include any other outside remuneration that these individuals may receive from outside practices and institutions. So, if you take all the income into consideration, it is significantly more than the typical radiologist’s. But yes, it was available for all to see.

My Issues With ABR Executive Compensation

So, what is that did not sit well with me about the executive compensation? For one, you have an army of volunteers that the ABR does not pay for all their time and effort. Meanwhile, you have a small group at the top who collect significant rewards. Yes, this is a nonprofit organization and the folks that run it should get paid for its work. However, at the top, these folks earn a lot more than a typical radiologist. When I pay my annual dues, I don’t believe there is much value in paying a president of this organization over 700,000 dollars not including additional outside compensation that she may receive.

I mean, what exactly is the point of the organization? Simply, the ABR should dedicate itself to the high standards of the end product of residency, the radiologist. Additionally, the organization should make sure that it’s diplomates meet the minimum requirements to practice radiology safely while maintaining a relationship with the public and government. Should the leader at the top earn almost twice the average radiologist for this mission (not including other side income)? It’s certainly hard for me to justify.

And just because the organization exists as a nonprofit entity and must distribute all profits by the end of the year does not mean that the nonprofit model is fair. A nonprofit is only as good as its ability to distribute its funds appropriately for the betterment of a cause. Rewarding the executives with salaries above and beyond the typical radiologist does not qualify as a cause I want to support.

Moreover, finally, in order to justify the salaries it paid to its executives, the speaker compared itself to other nonprofit organizations. However, just because other nonprofit entities overpay its executives does not mean that the ABR should do so as well.

My Final Thoughts About ABR Transparency

Alright, I will give the ABR some points for coming clean with the whereabouts of its funding. And, I will give them some credit for talking about the remuneration of its members. As well, they gave us the means to access the information. On the other hand, the ABR is not forthcoming with providing the reasons for the exorbitant compensation of its leaders. We should advocate for more transparency and demand more from the ABR. Creating more equitable compensation to its employees and leaders should take a higher priority.

 

 

 

 

 

 

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Maintenance of Certification (MOC)- A Controversial Necessity?

MOC

A groundswell of controversy about maintenance of certification (MOC) has been building slowly for the past decade. In truth, no quality evidence-based study has shown a link between quality of care and MOC. Therefore, multiple entities in the United States are abuzz, attempting to create anti-MOC legislation to prevent boards from gaining a legal foothold in states requiring MOC for practicing medicine. Some of you may hear about these issues in the press. (1,2) These issues are not just unique to radiology.

But before we discuss the individual controversies, we need to delve into MOC a bit further, especially for those just starting. What exactly is the maintenance of certification once you complete your residency in the United States? What do you have to do to satisfy the requirements? Why do you need to meet the requirements for MOC? And when do the requirements for maintenance of certification begin? Some of the answers to these questions are not so obvious. So, these are some of the questions I hope to answer in this post.

What is MOC?

According to the “experts,” maintenance of certification is a way to show that you are continuing to keep up with the educational demands of your specialty. Theoretically, it should ensure continued minimal competency to practice medicine. The American Board of Radiology and your state of practice require specific essential documentation for diagnostic radiology. For instance, the ABR requires 25 hours of continuing education credits (CME) per year, passing a test every ten years or completing online email questions correctly to certify competency, verification of state licensure, and quality improvement projects or leadership roles.

Individual states also require their primary means of determining competency to maintain licensure. When I first obtained my license in New Jersey, I had to take a required orientation course. Every year, I need to submit 50 CME credits each year. In addition, the state requires me to satisfy an end-of-life care course requirement every three years. Each state can significantly differ in what is needed to keep a license. Go to the site called mycme.com for more information on your particular state.

How Do I Get CME Credits?

Typically, radiologists can get continuing medical education credits in one of many ways. First, many online radiology society websites, such as RSNA and ARRS, develop education portals for radiologists to complete either articles or lectures. The radiologist then takes a short quiz they must pass at the end of the episode to document that he has completed the task.

Second, you can attend conferences at many locations throughout the country and then collect the CME credits at the end of the course. Usually, the conference presents the physician with a certificate of completed CME at the end of the meeting.

And then, internally within your hospital or practice, you can participate in tumor boards, conferences, etc. Subsequently, you can obtain the CME credits after documenting what you have experienced as long as the creators of the conference have applied for CME.

What Happens If I Don’t Participate In MOC?

Unfortunately, for most radiologists, it is not an option to forgo MOC. Most hospitals require certification by the ABR and state licensure bodies to maintain staff privileges. And individual practices often stipulate that you need MOC to remain in practice.

But, you may hear about other specialty physicians in the news who have not renewed their certification. Many of these folks are leading political and internal movements to eliminate the MOC requirements. Individuals and organizations are suing certification boards who are teaming up with insurance companies and hospitals. Some of these boards aim to make MOC a requirement for radiologists to get reimbursed for the interpretation of images. Usually, the physicians not participating in MOC have been practicing for a while, so they have the clout to abandon the MOC process.

When Do I Need To Start With The MOC Process?

Over time, the ABR requirements about when to start MOC have changed. The MOC process begins on day one since the ABR now considers MOC to be continuous. According to the ABR, you need 75 CME credits over three years of practice to maintain certification. That means you could theoretically begin CME on the first day of practice or wait a bit to start.

On the other hand, each state has different requirements for when to begin MOC. You should look up your state online to determine which rules are correct. Again, refer to the site called mycme.com, which outlines the specific requirements for each state. For the state of New Jersey (my state of practice), they give you a grace period of two years to begin CME after the first renewal of your state licensure.

Former Actions Against MOC

According to a Medscape article from 2017 (1), many state organizations have been banding together to prevent the overreach of MOC. This article documents many of the individual state medical society activities. I thought these activities were particularly fascinating.

To summarize some of the activities in this article, multiple state medical societies have attempted to pass anti-MOC bills in their states. Most of these attempts are in process or have been temporarily tabled. One state, Georgia, became the only state to pass a bill that prevents using MOC as a condition of licensure, employment, reimbursement, or malpractice insurance at certain hospitals.

At the time of the writing of the Medscape article, several states have initially failed in their attempts to pass MOC legislation. Three state medical societies (Arizona, Kentucky, and Michigan) created stipulations stating state medical boards “may not require a specialty certification or maintenance of a specialty certification as a condition of licensure.” However, legislatures did not pass the bills. Oklahoma became the first state to attempt to enact legislation to remove MOC as a requirement for physicians to obtain a license, get hired and paid, or secure hospital admitting privileges. However, at the last minute, the bill failed after significant lobbying by ABMS (American Board of Medical Specialties).

Other state medical associations are in the throes of creating anti-MOC bills. Both Tennessee and the Florida Medical Associations aimed to create bills to defeat efforts by the ABMS and FSMB to impose MOC as conditions for reimbursements and licensure. Finally, numerous other states, including Maryland, Missouri, North Carolina, Texas, Alaska, California, Maine, Massachusetts, New York, and Rhode Island, are trying to enact anti-MOC bills.

More Recent Defeat Against The Anti-MOC Movement

Most recently, in 2021, the federal court of appeals affirmed the dismissal of physicians’ claims against the American Board of Internal Medicine claims that challenged the MOC process. However, other litigation is still ongoing. 

Summary

Regardless of your stance on MOC, it is integral to most radiologists’ practice. It will be present in some form or another for a long time, perhaps in a more weakened state. Follow the current rules when starting, and you will get to practice radiology. Be a revolutionary against the system, and you may have difficulties. Either way, the final decision is up to you!!!

(1) Chesanow, N (6/21/2017) The War Over MOC Heats Up. Retrieved from http://www.medscape.com/viewarticle/881274

(2) Reese, N. (8/3/2016) MOC Exam: Take It Or Not? Retrieved from http://www.medscape.com/viewarticle/864922

 

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Radiology Residency Chain of Command

radiology residency

No, we are not the military, but there is a radiology residency chain of command! Lots of different entities in radiology residency are responsible for your day-to-day activities and training. It is more than your faculty and program directors. It is a whole hierarchy. And, it is was not until later on in my career that I understood the roles that each of these entities played in managing a residency program. But, it would have been nice to understand it all from the very beginning and know who to address for each radiology residency issue. To that end, in today’s post, I am going to define each of the different titles and offices in charge of your radiology residency training and describe the parts that they play. For fun, each role I will associate with a military position! Let’s start at the bottom and work our way up.

Radiology Resident (Private)

A radiology resident is the “lowest” but the most integral part of the chain of command. It is his/her responsibility to be trained in the art and science of diagnostic radiology during the four years of residency. To become a member of this club, he/she needs to graduate from medical school and complete one year of clinical training. After that, he/she answers to all the other “higher” positions listed next!

Radiology Chief Resident (Corporal)

Typically selected by the residents and program directors, this person is the first rung in the ladder of the radiology residency command (also previously discussed in a prior post). When there is a fundamental residency level issue or problem, he/she rises to the occasion. The chief resident is often responsible for scheduling, board reviews, interclass conflict, drinks with peers, performance issues, and noon conferences. In addition, any residency program issue that does not need to go to the attending is under the purview of the chief resident. And, the chief resident is also responsible for communicating faculty-related issues to the residents.

Radiology Residency Coordinator (2nd Lieutenant)

He or she is responsible for the day-to-day running of a residency program but is typically an administrator and not a physician. Most residency coordinators make phone calls, transcribe letters of recommendation, report issues to the faculty, send out evaluations, deal with class conflicts, ensure that the learning portfolios are complete, arrange end-of-the-year parties, and more. Some play a significant role in admissions committee screening. And, the coordinator is often the first-line resource for radiology residents when they have issues with colleagues or attendings. The radiology residency coordinator is an integral part of a radiology residency. (I think of this person like the Class Mom/Dad)

Radiology Faculty (Captain)

Full-time faculty members are responsible for the direct and indirect supervision of residents. The ACGME guidelines require all faculty members to teach. In addition, there are specific minimum numbers of faculty members that are necessary to run a residency program. Teaching involvement, however, varies widely by each faculty member. Residency programs expect all residents to follow the faculty lead when it comes to reading, procedures, and training in any of its forms.

Radiology Section Chiefs (Major)

This designation can be a bit technical. Theoretically, the radiology section chief for a radiology residency program can be different from the head of the section in a department. However, these individuals run the individual subspecialty rotations for a radiology residency. Individual faculty members answer to their respective section chiefs in one of many academic areas. The section chief may also perform many other duties such as setting up protocols for technologists, introducing new procedures, signing off on resident competencies and curriculums, ensuring that the subspecialty curriculum is appropriate, and more.

Associate Program Director (Colonel)

Although not an official designation by the ACGME, the Associate Program Director is the second in command for running the residency program. Suppose there are issues that the radiology chief resident, faculty, coordinator, or section chief cannot take care of. In that case, these problems fall into the lap of the Associate Program Director. He/she is also responsible for curriculum planning, enforcement of residency rules and regulations, maintaining education quality, dealing with residency conflicts, answering both the program director and the residents, and more. The Associate Program Director shares these responsibilities with the Program Director.

Program Director (1 Star General)

The ACGME designates this individual as director in charge of the residency program. He/she is ultimately responsible for most issues that occur during a radiology residency. In addition, the radiology Residency Program Director signs off on each resident that he/she is competent to practice diagnostic radiology after graduation. Clinical activity for this individual varies widely depending upon the program’s size, but most have some clinical duties. However, all Program Directors are responsible for monitoring the clinical teaching in the residency program and administering the radiology residency. So, this person is ultimately accountable for a radiology resident’s training.

Radiology Department Chairman (2 Star General)

The Radiology Department Chairman is the head of the entire radiology department. This person is responsible for dealing with all faculty issues and indirectly will usually help with radiology residency administration issues. When there are complaints about individual faculty members, new radiologists to hire, budgeting, and high-level resident problems, this person steps in to help manage the situation. Frequently, the program directors will consult with the chairman before making important decisions. The chairman sometimes holds the purse strings for some residency programs.

Designated Institutional Official (DIO) And The Graduate Educational Committee (GME) (4 Star General)

The DIO is the head of the hospital GME Committee. The radiology residency program director answers to the DIO for program-level issues and high-level resident issues. The types of problems that a DIO will often work with include accrediting residency programs, monitoring pass rates for programs, dealing with probation and suspension of individual residents, checking residency action plans, adding complements to residency programs, and more. In addition, he/she often gets involved in legal residency issues. And, this is just the tip of the iceberg. Typically, this is a full-time administrative position that is very busy! Individual programs bring many of these issues to the DIO’s attention, and they are subsequently voted upon by the GME Committee for approval.

American Board of Radiology (ABR) (Military Service Chiefs)

The ABR is a private organization in charge of testing for minimum competency for the individual radiology resident. All radiology residents need to pass the boards administered by the ABR to become board-certified radiologists. Although they are not directly in charge of residency issues, they play an essential role in determining the curriculum for the individual radiology residency program since they create the board exams (the core and certifying examinations more specifically).

Accreditation Council For Graduate Medical Education (ACGME) (Chairman of the Joint Chiefs of Staff)

Now we are talking high-level!!! The ACGME is a governmental-run body that is the watchdog of residency programs, a diagnostic radiology residency program. This organization accredits each radiology residency program. They have the power to put a residency on probation or suspension. As part of the ACGME, other committees, such as the Radiology Review Committee (RRC), are responsible for setting up the individual radiology residency guidelines and requirements. They are responsible for making the maximum duty hours, faculty requirements, and more. Overall, most residents do not have direct contact with this organization. However, it is crucial to follow the ACGME rules for the individual radiology resident to graduate from an accredited residency.

Now You Know The Hierarchy

That just about covers the basics of the different levels of responsible parties for a radiology residency program. Even though some institutions have additional positions that also play a role in managing a radiology residency, the ones I described are usually the most important. (Just don’t tell that to the research manager or the radiology liaison!) Of course, additional levels can get quite complicated. But at least you have the basics of who to turn to when you have a specific issue or question. So now you know your ABCs of the chain of the radiology residency command!!!

 

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How Should The ABR Test Communication Skills?

ABR

How should the ABR test communication skills? Isn’t that up to the residency programs? The ACGME maintains six core competencies. Only 1 of those 6 (medical knowledge) can be tested by board exams. Others, like professionalism and interpersonal/communication skills, cannot.

Anonymous Attending

 

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Great Question!

Testing Communication Skills

I believe testing and standardizing some basic communication skills before graduation is necessary. Currently, there is significant variability in the quality of communication teachings in different residencies. We certainly don’t want to create new graduates of residency programs who don’t feel comfortable relaying information expeditiously to clinicians or dictating a case. 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 they understand 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 scheme for a grading system. Second, the previous oral boards, albeit imperfect, did test residents’ ability to communicate the examination, the findings, the impression/differential, and management.

So, to say that ABR can’t test communication skills does not make sense. I’m sure we could develop a new and improved oral board type of examination to test the skill of communicating radiological findings to clinicians and patients in a much-improved way. Perhaps we could create a part 2 to the core examination. If the USMLE examination can do it, why can’t the ABR test for the same things but direct it toward the needs of radiologists?

Professionalism

I agree that testing professionalism is a more challenging nut to crack. Furthermore, unlike communication, professionalism is not a skill set but a way of acting ethically within the profession. You can’t standardize minimum requirements for professionalism in a test format. As you hinted, let’s leave that to the individual programs. But you can undoubtedly standardize essential minimum competencies for communication skills. And I think that should be the responsibility of the ABR if they want to establish the minimum abilities of a graduating radiology resident.

Final Thoughts

I believe we create excuses for ourselves to say it is impossible to test communication skills. It is certainly possible, and if other professions can do it, radiology can do it, too. 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!!!

Director1

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The American Board of Radiology- Shame On You

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.

 

 

 

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How To Complete The ABR Alternate Pathway As A Foreign Physician

 

dear sir,
I have completed my radiology residency from India in 2015 and I wish to pursue radiology residency in usa.
I am unsure of how alternate pathway for radiology.ABR website says one must have a mix of radiology residency /fellowships/faculty post for four continuous years.If residency itself is for a duration of 5 years ,how would it be possible to have a combination of residency and fellowship for 4 years?
Is it possible to get 4 fellowships consecutively at the same institute?
kindly help me in this regard.

regards,
Fiona

Director1 response:
Radiology residency is for a total of 4 years in the United States. Prior to beginning a radiology residency, you need to have an additional year of clinical internship, usually medicine, surgery, or a transitional year (a year of multiple electives). The expectation from the ABR is that you will either repeat an entire 4 year radiology residency program at the same place (not the initial clinical year). The other possibility is that you have the experience to complete part of a radiology residency program and complete subsequent radiology related fellowships. So, you could theoretically have any combination or permutation of experiences, i.e. 2 residency years and 2 distinct fellowship years, 4 fellowship years, and so on/so forth. As you stated, all the years need to be performed at the same institution.

There are some large institutions that do have more than 4 different types of fellowships. But, if you did attend a United States residency program, more commonly, the foreign resident/fellow would complete a 2 or more year fellowship instead of a typical one year fellowship. (Nuclear medicine, neurointerventional, and neuroradiology fellowships can be 2 or more years) As long as you complete the prescribed 4 years in a radiology related area, you can satisfy the requirement.

Take a look at the following URL:

https://www.theabr.org/diagnostic-radiology/initial-certification/alternate-pathways/international-medical-graduates