Tag: core exam

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What Are The Consequences Of Postponing The Core Exam?

postponing the core exam

It’s no surprise that the ABR decided to delay the core exam. For years, they were unwilling to go virtual, even before Covid, claiming they needed their computers at the RSNA to give an appropriate “image-rich” examination. And, then, of course, they were not prepared at all when the Covid disaster struck. How do you force over a thousand residents to go to Tuscon or Chicago to take an exam amid Covid? In any case, now, this is water under the bridge. So, what are the real consequences to the current fourth-year residents of postponing the core exam? Will the damage be permanent? Here are some of my thoughts on this issue.

Less Time For Mini-Fellowship Studies

Mini-fellowships have been all the rage since the conversion from the oral boards to the core exam. One reason for this change was more time for residents to dedicate toward more independent learning during the final year. No longer did they need to study for a board exam at the end of the fourth year. Well, now this has mostly changed. Since the examination will be in February, you lose most of your fourth year for studying for the core exam again. (almost like the good old days of the oral boards.) Likewise, the time residents can concentrate on subspecialization without worrying about an exam will suffer.

More Time Spent On Learning Facts Of Equivocal Utility

It’s taken eons to get to the point I am today. I have spent years trimming the useless radiology facts from my brain and concentrating on what is critical. Now, the residents will begin this process a bit later than before. They will regurgitate some of the less useful information at the expense of the critical information needed to become a practical radiologist for several additional months. It’s having completed the core exam that would have allowed this process to begin earlier.

Postponing The Core Exam Will Cause A More Anxiety Filled Year

Residents will continue to spend the majority of this year in the “what-if” phase. What do I mean? They will continuously think about what will happen if they don’t pass the examination. A clear, calm head is much more conducive to enjoying the experience of residency. Test-taking prevents the settling down process.

Less Time For Gearing Up For Fellowship

Some residents like to begin to get ready for their next phase of training. That may mean reading a bit extra on their favorite subspecialty. Or, they may spend time practicing the nuances of bone biopsies if they are going into MSK. Now, residents will be less apt to increase their experiences in their future areas of interest. It’s much harder to concentrate on other topics when a test looms ahead of you.

Missing Out On The Full Fourth Year Experience (It’s Now A Four-Month Experience)

Finally, residents no longer receive the authentic fourth-year experience (However, I never had that as I studied for the oral boards!). It was kind of like an unwritten promise that you will have a great last year if you complete and pass the core examination. Now, it is back to the grind for the majority of the year.

Postponing The Core Exam: Is It The End Of The World?

The short one-word answer to this question is NO! However, for every action, there is a consequence. And postponement of the exam is no exception. After a tough three years, it is a bit of a slap in the face for residents. Many of you have paid to have a great fourth year of residency with blood, tears, and sweat (literally!), working diligently during your training. “Fourth-year” will now only last a few months after the exam.  

Nevertheless, remember, in the end, all of you will still become radiologists. Life always throws a few curveballs. And, your residency will become no more than distant memory soon enough!

 

 

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Independent Call: Which Radiology Residency Year Should Take The Most?

independent call

Call burdens can vary widely in residency programs throughout the country. You have those programs with the dreaded 2nd-year crush. Others distribute calls more equally. Some have the third and fourth years taking the majority of overnights. Whatever the case, each program weighs its independent call schedule slightly differently by residency year. Any program can choose to structure the burdens however appropriate. (as long as 1st years are not taking independent calls as per the ACGME guidelines.) However, educationally speaking, who should bear the brunt of coverage and why? Let’s go through some of the more common call structures and the advantages and disadvantages of the call’s different weightings.

Front Loaded Independent Call For R2 Residents

Although not the most desired distribution of calls by emergency room physicians, residents get the most experience early on in their residency with this structure. It allows the R2 resident to build the radiologist’s confidence early on to practice as a radiologist. This resident can take this experience and apply the rules to the remainder of their residency. As I always have said, you are not an actual radiologist until you have had a call, a venue where you can make independent decisions. Until then, you will always be a student.

Moreover, it allows the current 2nd years to have a cushier future R4 year filled with electives and mini-fellowships (assuming they have passed the core exam). It also gives the resident extra time to study for the core exam at the end of the R3 year. And it allows for time at the AIRP during the R3 year.

Back Weighting For R3 and R4 Residents

Theoretically, weighing the call to the R3 and R4 years gives residency programs the advantage of having their more experienced residents take the most overnights. But, there is a catch-22 to this philosophy. If you want more experienced residents, you must give them independence earlier! Just because you put more senior residents on call does not mean you are getting more experienced reads. Call itself is the most critical experience for building practical knowledge, not studying from a book or reading a faculty radiologist’s final reads.

Whatever the case may be regarding back weighting and experience, the experience of having more calls toward the end of the residency sets the resident up better for independent work and moonlighting in their fellowship or as a full-fledged radiologist. The recency of critical training prepares residents better for the practice of radiology. When you finish the fellowship, it is possible to complete all your calls during your R2 year and not work independently as a radiologist three or four years later. That situation might put you in dire straits for making independent decisions at your first job. By backweighting the call, this issue is no longer a threat.

Even Distributions of R2, R3, R4 Calls (As Much As Possible)

Of course, an even distribution is the least burdensome of call distributions. It allows the resident to experience calls without the burdens of doing them all at once. Moreover, an even distribution gives the resident some experience early on. And it allows the resident to maintain skills throughout the residency. Finally, it even gives the resident the confidence to know that she has the experience to function as faculty when done.

Although it is impossible to make any call exactly, even given the constraints of studying for the core exam and the AIRP, this distribution can benefit from early experience and late reinforcement.

A Program Director’s Perspective of Independent Call Weighting In Today’s Environment

As program directors, we have political and educational concerns when a chief resident gives us a sample schedule for overnight coverage. The program directors and the chief resident often do not have complete control over distributing calls throughout the residency. Sometimes, the emergency department requires more senior residents. Other times, individual rotations such as interventional radiology prohibit residents from taking calls. So, giving the resident the perfect “educational” call weighting during residency is not always possible.

Nevertheless, some call throughout residency seems to give the most balanced education. As much as the ABR leaders say the core exam shouldn’t interfere with this training, the core exam does. A poorly thought-out core exam strikes again! Until we develop a better system than the core examination to test residents, it will always prevent programs from having the optimal mix!

 

 

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What The Core Exam Low Pass Rate Does Not Tell Us About This Year’s Test Takers!

low pass rate

In residency programs throughout the country, you don’t need to go far before you hear some chatter about the low pass rate on the core exam and the change from years before. And, then, you take a look at the article on Aunt Minnie, with headlines stating, the ‘fail’ rate is rising. Or, you check out a forum or two or social media, as they rail against the exam and the test takers. It’s no wonder that many residents are on edge. I know that at my residency, the buzz is palpable.

Similar to other years, I have seen sketchy opinions about this year’s exam and misguided words about the residents who took the exam this year. But, given the increased failure rate, these statements weigh more on the residents who have taken the exam. And, unfortunately, many of the assumptions and statements made about this class of residents taking the exam and the test itself are entirely off-base. So, I aim to dispel any misconceptions by telling you what you should not assume about this group of test-takers and the core exam. Here are some of the more common ones!

This Group Of Test Takers Are Not As Smart

I know many residents who took the exam this year. And, although more residents had trouble passing the boards this year, these residents are just as intelligent as others. Perhaps, many are not great test-takers (reflected in the USMLE board scores used for admission to residency). But, by no means, are they going to make radiologists that are inferior to any other year.

Moreover, residents throughout the country in this class practice radiology competently as judged by faculty, chairman, and program directors. This judgment is in spite of the board score results. So, instead, I am forced to fault the exam itself, and some of the reported esoterica and minutia tested, not the folks taking the exam.

They Are Lazy

The residents of the class who just took these boards have worked very hard, if not harder than in years past. In my program,  some of these residents are the best since I started. Indeed, they have studied very hard for the board examination. But, by no means, should anyone call them lazy!

They Have Been Targeted To Fail The Boards

No, no, and again no. The ABR does not seek to fail more of any particular class in general; however, misguided any exam may be. Instead, I believe they have created a test that does not measure what it claims, minimum competency to practice radiology. The ABR did not specifically target this residency class taking this particular test.

There is No Way To Predict Who Will Pass The Boards

Interestingly enough, the Radexam pre-core exam did predict the outcome of the core exam results very well. Percentages on our pre-core Radexam mirrored the real exam almost perfectly. At least in my residency, it turns out that this test is far superior to the old in-service examination. I would love to hear the experience of other institutions as well since the Radexam is so new. Based on our experience, we will continue to take it more seriously. We will do so to make sure that residents have studied enough (and the right way) to pass the core examination.

Low Pass Rate And The Residents Taking The Exam

An exam is only as good as the material it tests. And, competent residents who perform well in my residency tell me about the many esoteric questions and minutia on it. Therefore, I squarely place the blame of the low pass rate on the core exam, and not the residents taking the examination. As I’ve written before, it’s time to start reworking the test and its questions. We need to change the material tested so that residents will remember useful content for years to come, not just spit empty facts on an examination and quickly forget.

And just as importantly, let’s stop putting all the blame on the residents taking the exam. Based on the judgments of our faculty, we already know that they are competent and will make great radiologists. We do not need a faulty test to tell us otherwise!

 

 

 

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Radexam- A Bridge To Getting Rid Of The Core Exam?

For years and years, programs throughout the country have been utilizing the ACR in-service exam as a way to find out if residents have been keeping up with the material. And, from my experience, the correlation of the test with the Dow Jones Industrial Average on any given day is higher than that measure. And, many program directors believe the same. Now, for the past year or so, programs throughout the country have been utilizing the new Radexam to drill down on radiology topics to check the same measures. But, is this exam all that it cracked up to be and what do we know about it? What would be the optimal exam if I had my druthers? Should we be using any monthly or annual review to test residents at all? Or, perhaps, we should eventually overhaul the current core exam process in favor of Radexam-like alternative?

What We Know About Radexam Currently

Unlike the previous in-service examination, the ACR created Radexam as a crowdsourced evaluation tool. Academic radiologists are constantly vetting the questions. Also, dissimilar to the in-service, the exam evaluates the resident based on her specific rotation. You will be able to tailor particular question banks to your individualized monthly requirements at your institution, whether modality or topic based. If you have a cardiovascular MR rotation, theoretically, you can create an exam that tests on that rotation. And finally, you can evaluate residents with this tool on a monthly basis.

After I have seen an exam from the batch, the test looks hopeful as a tool for making sure that residents are keeping up with the material. But, the only way to know for sure is to correlate the test with resident evaluations and the core examination. That should be coming to a theater near you soon!

The Optimal Exam

OK. Deciding upon the optimal exam is a tough one. But, let’s give it a whirl. Well, first and foremost, we have to remember the purpose of an examination for residency. And, no the target of an exam is not to correlate with board passage rates. Instead, we should be thinking farther down the road. Is the test evaluating residents on the skills that they will need to become a good radiologist? Test authors often get hung up on creating an exam for the exam’s sake and forget about this end purpose. If I were a test creator, I would have none of that.

What else? Well, I would create an examination such that if you were able to pass it, you could demonstrate to your government, colleagues, and patients that you have the necessary skills to practice radiology. Forget about curves and complicated statistical mumbo-jumbo. I would not care if the pass rate was 87 percent, 100 percent, or 2 percent. All I care about is that our residents have the abilities and skills that they need to practice. In the end, that is all the public should care about too.

Additionally, it would not happen at one sitting. No more travel to Chicago, Tuscon, etc. Instead, you would take it continually throughout your residency at your program as a way to show you have gradually mastered the competencies that you need to practice.

Finally, the exam should be relatively reasonably priced on resident budgets so that they can afford the fees to create it. Theoretically, this is a tough one, I know. But, with large amounts of student debt racked up over medical school and residency, it cannot be more critical.

How Does Radexam Match Up To The ABR Core Exam?

Well, this is the million dollar question that residency directors throughout the country are trying to answer. The success or failure of this exam hinges on this answer. Unfortunately, we don’t know the answer to this right now. But, I suspect that the correlation will be higher than the previous in-service exam. It does not take much. So, in that respect, you would be able to call it a success.

Advantages Of A Monthly Exam Versus Annual Exam

The more often that we evaluate a resident during residency, the more likely that we can closely follow the learning process. On the downside, however, no one likes to be placed underneath a microscope at all times. Additionally, testing creates an artificial environment that differs from the day-to-day practice of radiology and medicine in general. But overall, the more often you test, the better you can check to see if the resident is completing the learning tasks necessary to become a radiologist. And, that brings me to my next and final thought.

Should We Consider Overhauling The Core Exam And Replacing It With Radexam?

If the core exam, as we know it, does not satisfy many of the criteria for an optimal examination, should we consider looking for alternatives? I believe that the curt answer is yes. And, Radexam may fit the bill if we drill down on it a bit.

First of all, it tests residents more often than a core exam, so that it allows a more accurate evaluation of the resident’s medical knowledge and skills throughout residency. Second, you can have residents take it on a home computer in a more realistic setting instead of some impersonal test center of some sort, leading to test-taking anxieties. Third, Radexam is crowdsourced and overhauled continuously throughout the year. Instead, the core exam questions are vetted, but only at a few intervals. And, finally, you can attune the Radexam to your program. Not all programs teach the same material throughout the country. Moreover, not all the content on the core exam will be relevant to your future practice of radiology. Radexam may resolve that issue.

Final Thoughts About The Radexam

We are still not quite there yet when it comes to knowing about exactly how Radexam will play out. In any case, I am hopeful that the outcomes will match up with the medical knowledge and skills that residents need to learn. And, as a bonus, I also would like to see a better correlation of Radexam with the core exam outcomes. (which I think we will) If these correlations are high, perhaps, we should consider Radexam as an alternative to entirely replace the in-service that we use right now and maybe sometime down the road, the core exam. Although no test is perfect, many of its features are significantly closer to my optimal examination than the current ones. Let’s start the debate to consider our best options.

 

 

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The 2017 Annual AUR Meeting- A Radiology Residency Status Report

Each year in the heart of spring in the United States, academic/teaching radiologists get together at a different part of the country to discuss the newest teaching methods, radiology residency issues, and hot academic topics at a meeting called the annual Association of University Radiologists (AUR) meeting. For new applicants and radiology residents, this meeting is extremely important as it outlines significant changes to the training of radiologists throughout the country. This year is the first annual update from Hollywood, Florida. I am going to go over what I think are the most relevant and important topics at this conference for radiology trainees.

Increasing Competitiveness of Radiology Residency

Traditionally, it is somewhat difficult to measure competitiveness of radiology residency compared to other specialties. One of the more accurate methods is the United States senior U.S. fill rate. Since 2014, there has been a gradual uptick in the senior U.S. fill rate to 72% (last year 68%). In addition, the applicant pool is up 31 percent over the past 4 years. So, it appears that all this talk about artificial intelligence has not yet dampened the enthusiasm of radiology candidates!

There are always two sides to every story, however. Since U.S applicants usually get first priority, it is a bit more difficult for international medical graduates (IMGs) to get radiology residency slots. In fact, on a survey at the AUR meeting, it stated that only 64 percent of programs are willing to take international medical graduates. That number tends to go down as radiology becomes more competitive. Furthermore, programs are no longer able to accept foreign non-ACGME accredited preliminary year internships to satisfy the requirements of the clinical year.

Improving Radiology Job Market

According to the recent AUR survey, practices are increasing both new and current radiology job hires. In fact, projections show an increasing number of available jobs numbering about 2000 today (vs. 1300-1500 jobs a few years ago). The most popular specialties are body imaging, interventional radiology, and neuroradiology.  However, practices need breast imagers, interventional radiologists, and neuroradiologists the most. And, the majority of jobs are in private practice. That being said, large corporate practices do continue to increase hiring radiologists the most.

IR/DR and ESIR

Now that IR/DR is its own distinct specialty, it commanded a fairly competitive match this year. For this subspecialty, the fill rate with U.S. seniors was 85% versus 72% for diagnostic radiology. So by all accounts, the match was fairly successful. In addition, many new residency programs are applying to start up both IR/DR and ESIR programs. Both of these programs allow a resident to complete his/her entire training in 6 years. Unlike radiology residencies willing to add on these programs, residencies that do not start up IR/DR and ESIR programs will force their residents to have to complete a total of 7 years of residency/fellowship for interventional radiology trained subspecialists. Accordingly, those residencies not willing to add either ESIR or IR/DR programs are likely going to have difficulty recruiting new residents.

Rad Exam

The current in-service examinations do not correlate well with resident performance. In fact, many residencies (including my own) cannot utilize the test as a determiner of residency performance given the wide variability. In addition, there is no distinction in the testing questions between different residency levels. To remedy this issue, a new crowd sourced examination call Rad Exam is being created with institutional benchmarks and a large database. Time will tell if it becomes a useful examination to replace our current in-service examination, but it sounds very promising!

Simulation

Although not a discussed in conference at the AUR meeting, a vendor called Simulation was present and had an interesting solution for programs that want a structured precall examination. This company created an excellent standardized test that assesses finding and interpretive skills using a simulated PACS system to help define if a resident is ready to partake in independent call. Additionally, the test is benchmarked to other programs. It seems like it may be significant improvement over the current precall testing options.

ABR Core Examination Frustrations

Interestingly, according to faculty surveys, most faculty members reflect fondly upon the old oral board examination and give low marks to the new core examination as a means of  testing residents to meet basic radiology requirements at the end of their 3rd year. However, even more disappointing to me, the American Board of Radiology (ABR) now takes a new formalized position that they have no role in testing communication skills. In fact, they explicitly stated that their only role is the testing of medical knowledge. According to them, communication skills should be taught at the local residency level.

Call me crazy, but radiology is a specialty of communication, both written and oral, and not just a specialty of medical knowledge. If that is the case, does it make sense that the ABR as an accrediting body is not willing to standardize testing for communication skills as well as medical knowledge to establish a baseline level of competency? I think not. Academic radiologists need to push the board to change their stance regarding communication competency standardization with oral/written board testing!!!

Increasing Required Administration Time For Program Directors

And finally, on July 1, 2018, the ACGME will likely approve an increase in the minimum administration time requirements for program and associate program directors. Presently, program directors at small programs in the United States can have a few as 0.2 FTE time dedicated to radiology residency administration. That number is ridiculously small compared to other medical subspecialties. Now, that number is going to increase based on a sliding scale corresponding to size of programs in July, 2018 assuming approval by the ACGME. How is that going to affect incoming radiology residents? I believe it will significantly increase the productivity and efficiency of residency programs on issues as wide ranging as educational conferences, evaluations/assessments, milestones, and more… It has been long since overdue.

Summary

As I see it, these are some of the most pressing issues tackled at the AUR conference. There are certainly other issues faced by academic radiology programs. Some of them mentioned at the conference and others largely ignored. There is a bit of good and bad news from this conference for everyone involved in radiology residencies throughout the country. Until next year at the AUR meeting in Nashville, Tennessee!!!

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Up To Date Book Reviews For The Radiology Core Examination

Studying for the ABR Core Exam is undoubtedly a daunting task. Not only can the sheer amount of material one needs to learn seem overwhelming, but also the vast amount of resources available can be more of a burden than an asset. I often see my fellow residents scrambling to make time to go over every single review book out there, in an effort to have all of their bases covered. This strategy is not only nearly impossible but is likely counterproductive. Rather, one should focus on one “comprehensive” review book while supplementing with case review books and question banks that work best for them.

 

When asking my peers about their thoughts on different study resources, I could never get a good consensus on what was best. Different people had the same success passing the exam with very different approaches. However, one commonality I did notice amongst those who had success on the exam was that their approach was comprehensive (covered all categories tested) and diligent. With that being said, it is best to first peruse a resource to make sure it is useful for your style of learning before fully committing your time (and money) to it. Also, it should be noted that none of these are substitutes for a comprehensive textbook (such as Brant and Helms or the Requisites series). Review books are most effective when they are, in fact, used as a review and not a primary source of learning.

 

Below are reviews for the resources my colleagues I used, some more than others, to prepare for the ABR Core Exam.

 

COMPREHENSIVE REVIEW BOOKS

 

Core Radiology: A Visual Approach to Diagnostic Imaging

 

This is an excellent review book that can be used as a single source for reference and overview of salient points. It contains lots of good quality images and diagrams (in color!), as well as tables summarizing differential diagnoses with easy ways to differentiate one entity from another. As with any review book, it may not delve into as much depth in any single topic. Supplementation with Brant and Helms, StatDX, or Radiographics articles may be required for certain topics that require more depth or clarity. This book can be easily understood by junior residents throughout their first or second years of residency, not simply just for those reviewing for the Core Exam.

 

One drawback of this textbook is its size. At 895 pages, it can be a pain to lug around. Also, compared to Crack the Core, this text lacks humor and motivational quotes. Rather it’s more of a traditional, no-nonsense, well-organized review.

 

Crack the Core

 

Written under a pen name by “Prometheus Lionheart,” this series includes two main volumes, together encompassing the main sections covered on the Core Exam. In addition to the main two-volume set, Lionheart has also written a separate dedicated physics review book as well as a case review book (which I will cover separately). This two-volume set is another excellent review source. While it covers much of the same material as Core Radiology, this text is geared specifically for passing the Core Exam by incorporating test-taking strategies in addition to providing factual information. Lionheart interjects jokes and motivational phrases to keep the reader entertained while studying (not an easy task!). This book is much more simplified than Core Radiology, but serves as an excellent review for someone with solid background knowledge of the topics included. The physics and non-interpretive skills chapters in Crack the Core is much more robust and comprehensive than in Core Radiology. Additionally, Lionheart has a video lecture series to supplement his books (at an additional cost, of course), which can be useful depending on your style of learning.

 

One of the main drawbacks of the Crack the Core series is the abundance of typos in the text. While the typos generally don’t alter the context, they can be an annoyance. Another downfall of Crack the Core is the image quality and lack of color diagrams. The supplementary video lecture series does have improved image quality and nice color diagrams and animations, however.

 

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CASE REVIEW BOOKS

 

Core Review Series (Thoracic, GU, GI, MSK, Breast, Cardiac, Nuclear Medicine)

 

The newest of the main case review books, the Core Review Series has separate books in Thoracic, Genitourinary, Gastrointestinal, Musculoskeletal, Breast, Cardiac, and Nuclear Medicine. Each book is broken down into chapters, with each chapter covering a specific subcategory (usually starting out with fundamentals of imaging for that category or normal anatomy).

 

The good: The breakdown by chapter and multiple questions per chapter allows you to hone down your studying to a specific topic and to do multiple questions in a relatively short time period. Image quality varies by book but is generally very good. Most books have online access with an easy interface for doing questions (almost feels like a Q bank). The descriptions of the answers are excellent. I feel that these books best prepare you to think the way they want you to think about the test; to understand the process of why an answer is right rather than regurgitate memorized information. Many of the books even have physics concepts integrated into the questions, which is a tactic the ABR often employs on the Core Exam.

 

The bad: When using the physical books, it can be tedious to flip between the questions and the answers (which are located at the end of the chapter). This problem is alleviated with the online versions, where the answers are available immediately after taking the question. Also, because not all subjects are covered, other sources must be used to supplement these areas (such as Interventional, Neuro, and Pediatrics)

 

 

Rad Cases (Cardiac, GI, GU, Interventional, MSK, Neuro, Nuclear Medicine, Pediatrics, Thoracic)

 

Rad Cases offers a case-based approach (rather than the more question/answer format of Core Review Series) with approximately 100 cases per book. Each case shows images and a clinical presentation on the first page. The next page then goes over the imaging findings, differential diagnosis (with brief descriptions of each diagnosis and how it may or may not explain the imaging findings), essential facts about the disease entity, other possible imaging findings, and finally pearls & pitfalls.

 

The good: This series really does a good job of allowing the reader to come up with a systematic approach to a case. The explanations do a good job of highlighting how one may have fallen into a trap or how one should tailor their thought process when approaching a case. All of these are essential aspects of passing the exam, but relate

 

The bad: While learning how to approach an unknown case is necessary to tackling exam questions, this text appears more driven to prepare residents for the old oral boards. One could argue that a more rapid-fire question/answer format is more useful when it comes to preparation for the Core Exam.

 

 

Case Review Series (Neuro, Head and Neck, Spine, Breast, Cardiac, Emergency Medicine, GI, GU, MSK, Nuclear Medicine, Pediatrics, Thoracic, Interventional)

 

CRS is another case based review, with each book separated into three different difficulty levels. The cases at the beginning of the book, “Opening Round,” are easiest, the next level of difficulty in the middle of the book is termed “Fair Game” and the most difficult cases at the end are in the “Challenge” section. Each case shows images and is followed by four questions pertaining to those images.

 

The good: The book offers excellent cases with good image quality. The multiple questions per case really force you to learn several aspects of a case. When it comes to the Core Exam, knowing the diagnosis alone usually does not suffice. Thus, being able to answer questions from several angles about a case is a valuable learning tool.

 

The bad: Similar to Rad Cases, CRS appears to be more driven toward oral board prep. While this may help with expanding one’s knowledge base, it lacks the multiple-choice question/answer that is necessary for the Core Exam. Also, the Challenge sections are often too difficult/esoteric and are often beyond the scope of the exam. It would behoove you to do only the Opening Round and Fair Game sections in order to save precious study time.

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PHYSICS/OTHER

 

Huda’s Review of Radiologic Physics

 

This is the physics review book by Walter Huda, who administers yearly review courses in radiologic physics throughout the country. It is in bullet point form and aligns closely with his course.

 

The good: The book has pretty much everything you need to know for physics for the Core Exam, with review questions at the end of each chapter and online access. It is formatted in bullet point form to be intended for quick review. I used this book while at Huda’s review course and immediately after it in order to reinforce the concepts he taught.

 

The bad: While all the facts you need to know may be in this book, there is very little in the way of explanation. You will have to use other, more thorough sources for a deeper understanding. Also, the questions at the end of the chapter serve to reinforce some basic topics but are unlike anything you will see on the exam.

 

 

Radiologic Physics “War Machine” by Prometheus Lionhart

 

This is the dedicated physics book by the Crack the Core author, with a very similar layout to Crack the Core.

 

The good: This book was a great resource for studying physics. It really simplifies topics and makes them easier to understand, and therefore memorize. He does a good job of explaining what physics is relevant to the test and what is not, which is extremely valuable (the last thing we want to do is study more physics than we need to).

 

The bad: Again, the typos. Also, there is a lot of overlap between this book and the physics section of the Crack the Core book. I have not examined them in detail, but I just studied the section in Crack the Core without using the War Machine book and felt it was more than adequate preparation.

 

 

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QUESTION BANKS

 

RADPrimer

RADPrimer is the question bank associated with StatDx and has an abundance of questions (2,221 Basic and 3,747 Intermediate level questions).

 

The good: Lots of questions with mostly very good explanations. Good image quality. What I found most useful about RADPrimer was the ability to hone the focus to exactly what I wanted to study. For example, if I had just read a section in a review book about CNS Infections, I could create an exam and do those specific questions in order to solidify what I had just read.

 

The bad: Many of the questions are too straightforward for what you will see on the test. Rather it should be used as a learning tool to reinforce recently studied material and not a means to simulate the Core Exam. Also, while there are some physics questions, there are not enough to use this as the sole source of physics practice.

 

 

 

BoardVitals

 

BoardVitals is an online question bank that offers subscriptions based on different time increments ($399 for six months, $229 for three months, $139 for one month). There are 1500 questions broken up by general category.

 

The good: The questions better simulate the real exam than RADPrimer. The explanations on most questions are good. There are more physics questions than on RADPrimer and this bank also includes non-interpretive skills questions (which I found very helpful). What I also found very helpful was that the interface was well-suited for use on mobile devices. Whether I was in a line somewhere, on a train, or on a bus I could bang out a few BoardVitals questions with ease.

 

The bad: Some of the answer explanations were one line without much information. These were once in a while but did occur and could be frustrating at times.

 

 

Face the Core

 

Face the Core is another online question bank, with 35 different modules. Each module has about 75-100 multiple-choice questions. Modules consist of several cases, with each case having approximately 4-5 associated questions. Modules can be purchased individually for $10 each or you can purchase all 35 modules for $250. Modules must be completed in full (all 75-100 questions) before you could go over the answers (no “tutorial” mode).

 

The good: I used this question bank at the end, to brush up on my weaker areas, so I liked that I could purchase just the modules I needed rather than forking over $250. The explanations were pretty good. Some of the modules even had video explanations, which was nice because they would go into more detail. The physics modules on Physics Artifacts and MRI Sequences were very helpful.

 

The bad: The main drawback is the fact that you have to do the entire module before you can go over the questions. This made the process very time consuming (at least 2 hours per module). The image quality was poor and the layout appeared somewhat haphazard. Overall it is a good resource to use at the end, to cover areas of weakness.

 

——–

 

I know it seems daunting with all the resources out there. Don’t be afraid to use many, but use them wisely. Below is a rough plan of how I approached studying for the exam. And it worked for me:

 

My approach:

6-8 months before the test

  • Used Core Radiology early and often as primary source
  • RADPrimer questions (based on exactly what I was studying in Core Radiology)

4-6 months before the test

  • Continued above
  • Started Crack the Core Physics (supplemented by various YouTube videos)
  • Started BoardVitals Questions
  • Core Review Books

2-4 months before

1-2 months before

  • Skimmed Crack the Core to fill any gaps/get different perspective
  • Continued BoardVitals
  • Started Face the Core on weak areas

< 1 month

  • Crammed facts
  • Reviewed notes
  • Questions, questions, questions

 

 

 

 

 

Good luck!!!!

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The New Core Exam- An Associate Program Director’s Lament

What are the essential ingredients of a successful radiologist? – the art of oral and written communication,  being able to distinguish one study from another, the ability to successfully analyze the findings, the masterful arrival at a reasonable differential diagnosis, and the creation of insightful management recommendations.

The oral boards enabled residents for years to learn these essential skills of a good radiologist. As much as we had heard horror stories of the trials and tribulations of the test takers in Louisville, Kentucky, it lit a fire under all of us. By the end of our fourth year and completion of our oral board at the last month of residency, all of us were artful in the realm of oral and written communications and powerhouses of essential radiological knowledge. We were immediately able to practice competently as radiologists on day one after completing our radiology residencies. This bygone era is no more…

Instead, what does the new core examination teach radiology residents? It forces residents to learn some radiological knowledge. But, more importantly it reinforces the strategies of multiple choice and matching format questions. As a radiologist, I never have options a,b,c,d, or e on a piece of paper or a computer screen. I need to have a baseline sum of knowledge to make my own assessments. On occasion, I will google a question. But, the only reason I know what question to ask is: I know the fundamentals of radiology. The fundamentals are no longer emphasized.

The style of a test can be just as important as the content because it reinforces the process of learning and communication. Now, instead of concentrating on practicing the most common methods of disseminating information to others, radiology residents are now concentrating on methods that are never used by radiologists in practice. Think about it…  A good oral test that actually forced residents to study the essence of radiology has been converted to an examination that reinforces the learning of the art of testing taking. Is that what we really want to be teaching residents?

In the latter half of every academic year, we encounter nervous third year residents fretting about the mechanics of a test that are not even utilized in daily practice at the expense of learning the fundamentals of radiology. I can understand their stresses because their role as studying residents is split twofold: to study for a test that does not directly correlate with what we do on a daily basis as well as study the fundamentals of becoming a good radiologist. There is conflict between the two. Residents waste time and energy devoting themselves to two divergent causes. It shouldn’t be like this.

So why has the ABR decided to resort to computerized multiple choice testing and changing the timing of the examinations?  I have a couple of theories.

Cost Cutting/Increased ABR Income

What are some of the biggest advantages of converting an oral examination to a written test? No longer do you have supply the manpower to meet the demand on the days of the boards. It can be extremely expensive and time consuming to host tens of seasoned radiologists at a hotel anywhere to provide the services needed for creating an oral board exam. The costs saved in the short term are enormous. In addition, you don’t need to rent out a space to accommodate these radiologists for many days. Instead, the ABR can create fixed computers in a fixed site that can be used year after year in a few sites with less manpower to run the annual examinations. The cost savings can be significant.

Annual income from the dues can still be increased without a concomitant increase in annual expenses, significantly increasing the income of the “nonprofit” organization of the ABR. Salaries within the organization can be buttressed and maintained, a possible incentive for changing the examination.

Creating More Subspecialized Radiologists Working in Academic Radiology

Notice the change in timing of the general examination from the end of fourth year to the end of third year of residency. Why would an organization want to do this? If you think about it, radiology residents study most intensely prior to taking an examination, oral or computerized/written. Before, residents would go out to their first job with a significant body of knowledge fresh in mind on day one. Now residents have a full year to forget about the information that they learned for the core examination. Sure, they take a specialty certification examination after they finish fellowship. But, the studying and content is not the same. It is instead mostly dedicated toward the individual specialty What does that mean for the first year employee? These new radiologists are less capable to practice general radiology because their general radiology knowledge is more remote and they are less comfortable with “bread and butter” radiology imaging studies. This idea matches in practice what we are experiencing with new hires. They are more likely to stick to subspecialty work and less likely to want to practice general radiology.

This outcome is even more harmful for private practices throughout the United States. According to the AUR meetings and multiple papers on the subject (1,2,3), most practices need new radiologists that are sub specialized but can also cover generalize radiology work. Because  of the new core examination timing and the content of the core exam, the needs of private practices continue to be unmet and do not match with the newly minted workforce.

So, where are more new radiologists, less competent in general radiology, forced to work? These new residents either need to work at academic facilities that can afford to harbor a highly subspecialized workforce or very large private practices and teleradiology companies that can divide the subspecialty work among its employees, providing benefits mostly to the chairmen of academic departments and the heads of very large private practices.

Who was most responsible for the decision of creating the test? It is the same representative body- chairmen of large academic departments and the largest of the private radiology practices that most likely will benefit from these changes. This represents a conflict of interest between the creators of the examination and the needs of radiology practices throughout the entire spectrum of radiology.

Final Thoughts

Examinations are important not just because it should establish a baseline of competency in a particular subject matter, but also just as importantly because it guides how the student learns. This process can change the landscape of a profession for years to come.   In addition, prior to the creation of any examination, the foreseen outcomes should be match the needs of the specialty. In my opinion, the core examination has failed on all of these accounts. It deemphasizes the fundamentals of radiology, guides the radiology resident to learn information in ways that are not relevant, and leads to the outcome of weakening private practices by causing a mismatch between the needs of radiology practices and the differing abilities of the newly minted radiologist.

Unfortunately, the core examination has already become embedded in the radiology residency process and culture. Since so much time, effort, and expense has been dedicated to changing the examination and timing, it is very difficult to navigate back to a different format that will better match the needs of the radiology specialty. But, it is something that we should consider to make a better prepared radiology resident for the job market and to sustain our specialty for years to come. We are better than that.