The ABR Certifying Exam: What You Should Know
As an early career radiologist, I took and passed both the ABR Core Exam and ABR Certifying Exam rather than the previously instituted oral and written ABR exams. Many Radiology Review listeners and readers have recently passed the Core Exam and will, in the near future, take the Certifying Exam. The purpose of this article is to describe key differences between preparing and taking the Core Exam versus the Certifying Exam.
Is the ABR Certifying Exam Easier than the ABR Core Exam?
Thankfully, I found the Certifying Exam to be less time consuming to prepare for than the Core Exam. I, and others I have discussed this with, have found that the magnitude of preparation necessary to pass the Certifying Exam was a fraction of that necessary to pass the Core Exam. Don’t misunderstand—you do need to prepare for the Certifying Exam. However, the timing of the Certifying Exam requires most test-takers to adopt an extremely streamlined approach to preparation.
I took the Certifying Exam only a few months after I started as a new assistant professor at the Mallinckrodt Institute of Radiology in St. Louis. Given that moving to a new city and starting my career required most of my available time and mental bandwidth in the months prior to the exam, I simply could not allocate the same number of hours to prepare for the Certifying Exam as I had for the Core Exam. It is possible that you—future test taker—may also not have surplus time to study for this exam..
A key messages for future ABR Certifying Exam test-takers is this: Don’t despair if you are short on study time for the Certifying Exam. Nearly all of you will complete a radiology fellowship and this should sufficiently prepare you for much of the Certifying Exam.
As a brief summary, the ABR Certifying Exam (as of August 2021) is administered as soon as 12 months after completing a radiology residency. The exam allows five hours to complete 274 questions and is currently administered remotely twice yearly. For a more complete description of the ABR Certifying Exam please refer to the ABR Website.
The ABR Certifying exam is not the same for all test-takers.
Unlike the Core Exam, you have the advantage of choosing three subspecialty areas of focus for the Certifying Exam. These are referred to by the ABR as “clinical practice modules”. These can be three different subspecialty areas. Alternatively, two or even all three of these selections can be the same subspecialty area. Therefore, a neuroradiology fellow may desire to choose all three areas in neuroradiology. However, if you select two or three areas in the same clinical practice area you will be given “advanced” questions on the Certifying Exam. If you choose only one clinical practice module for a given subspecialty area you will take easier “fundamental” questions for that section.
I, having completed fellowships in Nuclear Radiology and thereafter Women’s Imaging, chose one section of nuclear medicine and two sections of breast imaging—which mirrors my actual subspecialty practice mix. By design, the Certifying Exam is designed to focus on the actual subspecialty focus areas that a given test-taker encounters in clinical radiology practice.
Additionally, the test will present a final section on Essentials of Diagnostic Radiology—basically testing knowledge that all radiologists should be proficient in regardless of subspecialty focus. Included in this section are Non-Interpretive Skills questions (that’s right—you aren’t done with these questions after the Core Exam). The Certifying Exam also presents the second portion of the Radioisotope Safety Exam (RISE). It is necessary to pass RISE questions on both the Core Exam and Certifying Exam to achieve RISE certification which can be especially important for future nuclear medicine authorized users. According to the ABR websites (August 2021) the RISE questions are focused on “clinically oriented practice scenarios”.
How did I prepare for the Certifying exam?
My primary preparation for the Certifying Exam was having completing fellowships in the areas I selected for my clinical practice modules. My secondary preparation was self-study for which I used online qbanks, reviewed portions of key texts (such as Nuclear Medicine Requisites and the ACR BIRADS Atlas given my selection of nuclear medicine and breast imaging clinical practice modules). I also reviewed, in detail, the most recent version of the ABR Non-Interpretive Skills study guides. If The Radiology Review Podcast had been in existence I believe I would have also used this while running or commuting. In my opinion, Crack the Core was not as useful for the Certifying Exam as it was for the Core Exam—at least for the more advanced subspecialty level questions. However, Crack the Core still may have some value for exam preparation, particularly if choosing three separate subspecialty areas for the clinical practice modules for which “fundamental” but not “advanced” level questions will be asked. For me, in contradistinction to the Core Exam, I barely cracked open Crack the Core while studying for the Certifying Exam.
What about qbanks?
I found the qbanks helpful for the Certifying Exam, not only to identify areas of potential weakness and review some key material, but also to get back in the mode of multiple choice test-taking. There are strategies to multiple choice test-taking that one can forget over time. For example, I had to remind myself to read the question stems in entirety, and understand specifically what was being asked, before selecting an answer. Beyond reviewing radiology content, using qbanks to hone your multiple-choice test-taking skills may maximize your chances for success.
I personally used BoardVitals as my primary qbank for Certifying Exam preparation. If you are interested in purchasing a BoardVitals subscription and would like a 10% discount on most subscription plans use the discount code radreview at checkout. The Radiology Review may receive referral fees if you choose to use this discount code.
Did I specifically study for the Essentials of Diagnostic Radiology section on the Certifying exam?
Yes, I did study for this portion of the exam (with a caveat). I used qbank questions on BoardVitals designed for this section (including Non-Interpretive Skills and RISE questions) which I found to be helpful. I also reviewed imaging diagnoses I assumed would be high yield that were a bit weak in my memory, such as identifying the age of intracranial blood products on CT or MRI, names and patterns of various kinds of skeletal fractures that I had not seen since before fellowship, different manifestations of bowel obstruction, pneumothorax, and so forth.
I was ultimately given advice, however, that I did consider and partly implement. The advice can be paraphrased as follows: Given that only one out of the four sections will cover select key-diagnoses from the vast entirety of Radiology, any given sub-specialty will only have a few specific entities tested. Therefore, what are the odds that your studying the vastness of neuroradiology (or any other subspecialty) will identify that one specific neuroradiology topic that ends up being tested that you don’t already know? The odds may not be as high as you may think. Therefore, extensive review of each subspecialty area may not be as high yield as it was for the Core Exam.
When I considered this, I realized that it was not entirely feasible for me to review all radiology subspecialty sections for Certifying Exam preparation and expect to substantially boost my a priori performance. I therefore focused the majority of my available study time for the Essentials of Diagnostic Radiology portion of the exam on those areas where the content was more predictable and focused, such as the Non-Interpretive Skills ABR study guide and the RISE portions of the exam.
How did you study for the Non-Interpretive Skills and the RISE portions of the exam?
Non-interpretive skills: I used the most recent ABR Non-Interpretive skills study guide from the ABR website. I did read and study this in detail.
RISE: I read the last chapter of Mettler which was very helpful for both the Core and Certifying exams. I also reviewed information from Nuclear Medicine Requisites as well.
I also studied qbank questions on these topics.
Note that I have covered some of these NIS and RISE topics on The Radiology Review Podcast which you can find by clicking here.
Any parting advice?
Request time off from your new employer to take the exam (and travel to a testing center if in-person testing is somehow re-instituted in the future). Many test-takers waiting in line with me for my in-person Certifying Exam were not automatically given time off for travel and at least one was even on call the evening before and arrived at the ABR testing center after an overnight flight—not ideal). It is probably best to not be on call the night before the exam for remote examinations. Arrange your schedule with your employer accordingly.
The ABR Certifying exam also has a registration fee (and potentially travel fees). Consider asking your employer to cover these costs as part of your initial employment negotiation prior to signing your employment contract, assuming these expenses are not already covered by your employer.
Ask recent test-takers you know about their experience and for additional advice pertaining to the Certifying Exam.
Take the Certifying Exam seriously but don’t despair. Study consistently during your fellowship training to master your subspecialty areas, fill in any final gaps during the months prior to the exam, and perhaps listen to a few episodes of the Radiology Review Podcast. And, as always, prepare to succeed.
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