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ABR UpdateABR UpdateRSNA 2009RSNA 2009

The ExaminationsOf

The Future

Core ExaminationCore Examination

Only comprehensive examination given by ABRMajority of items will be based on imagesMore than simple fact retrieval

Image interpretation, diagnosisCase managementPractical use of scientific knowledge

Physics will be integrated, not separatedIn most cases, physics items linked to imagesPhysicist “embedded” in every writing team

Nuts and Bolts: Core ExamNuts and Bolts: Core ExamGiven at 36 monthsExpected level of mastery: basic/intermediateEighteen categories tested

Each will have sufficient items to make a pass/fail decision (≥ 45 items)

Candidate must pass all to qualify for Certifying

Condition status exists (≤ 5 categories)Test administered every six months

Test administration at testing center1.5 days for candidate to take Core exam

Core Exam: Core Exam: Categories and ContentCategories and Content

Fifteen categories have item-writing committeesOrgan system: MSK, Cardiac, Thoracic,

Gastrointestinal, Urinary, Repro/Endo, Neurologic, Pediatric, Breast, Vascular

Modality: Ultrasound, Intervention, Nuclear Radiology/Molecular Imaging

Fundamental concepts: Patient safety, physics

Three categories do notRadiography/fluoroscopy, CT, MRI

Committee ResponsibilitiesCommittee Responsibilities

Create detailed outline of content to be tested (goal: on Website by 7/2010)

Create questions based on content outlineParticipate in assembly for each form

Ensure each category adequately sampledPrevent repetitionAssemble condition examination forms

Categories without committees: similar responsibilities; “virtual” committees formed

Potential Question Types:Potential Question Types:Core ExaminationCore Examination

Single best answer multiple choiceMultiple true/falseExtended matching (R-type)Labeling“Storyboarded” vignettes

General Comments:General Comments:New Item TypesNew Item Types

ImplementationCan it be easily shown?Can ABR IT create the interface?

InterpretationIs it psychometrically meaningful?

Pre-examination instructionWill the candidate be sufficiently

comfortable with the question type?

Elements of Extended Elements of Extended Matching (R-type) QuestionMatching (R-type) Question

ThemeOption listLead-in statementStems (3-4)

Example: Extended MatchingExample: Extended MatchingSolitary Liver MassSolitary Liver Mass

For each patient whose clinical and imaging information is shown, select the most appropriate diagnosis from the list below. Each option may be used once, more than once, or not at all.

a. Focal nodular hyperplasia h. Biliary cystadenomab. Liver cell adenoma i. Lymphomac. Cavernous hemangioma j. Solitary metastasisd. Inflammatory pseudotumor k. Intrahepatic

cholangiocarcinomae. Pyogenic abscess l. Hepatocellular carcinomaf. Fungal abscess m. Fibrolamellar carcinomag. Nodular focal fat deposition

a. Focal nodular hyperplasia b. Liver cell adenoma

c. Cavernous hemangioma d. Inflammatory pseudotumor

e. Pyogenic abscess f. Fungal abscess

g. Nodular focal fat deposition h. Biliary cystadenoma

i. Lymphoma j. Solitary metastasis

k. Intrahepatic cholangiocarcinoma l. Hepatocellular carcinoma

m. Fibrolamellar carcinoma

1: 35 year old woman who underwent sonographic evaluationfor mild abdominal discomfort. She was referred for MR imagingto characterize a solitary liver mass seen on that ultrasound. Imagesare obtained 30 seconds (A), 70 seconds (B) and 1 hour (C) afteradministration of gadobenate intravenously.

A B C

a. Focal nodular hyperplasia b. Liver cell adenoma

c. Cavernous hemangioma d. Inflammatory pseudotumor

e. Pyogenic abscess f. Fungal abscess

g. Nodular focal fat deposition h. Biliary cystadenoma

i. Lymphoma j. Solitary metastasis

k. Intrahepatic cholangiocarcinoma l. Hepatocellular carcinoma

m. Fibrolamellar carcinoma

A B C D

2. 60 year old man with abdominal pain. Imaging performed elsewhere showeda liver mass, and he is referred for CT imaging to characterize it. Images areobtained before (A), 20 seconds after (B), 50 seconds after (C), and 5 minutesafter (D) intravenous administration of iodinaed contrast material.

Strengths of R-Type Strengths of R-Type MatchingMatching

Tests beyond knowledge, comprehension

More analysis, management, judgmentBetter discriminator c/w T/F or A-TypeComparable results with one-third fewer

itemsCan test more of domain in same time

LabelingLabeling

Normal anatomy or pathologic processIntuitiveEasy question type to program

A coronal CT image obtained in a patient with ascites is shown.

Label the following structures:

a) Left subphrenic spaceb) Lesser sac, inferior recessc) Lesser sac, superior recessd) Transverse mesocolone) Gastrohepatic ligamentf) Morison’s pouchg) Left paracolic gutterh) Root of intestinal

mesentery

Simulation?

Example: LabelingExample: LabelingPeritoneal SpacesPeritoneal Spaces

Case Simulation VignetteCase Simulation Vignette

Familiar example: USMLE Step IIIComponents

Case presentationClinical questionChoice

Imaging study vs. nonradiologic maneuver

New data from choice—new questionsMay require blocked return at some point

Core Exam:Core Exam:Where Do We Stand?Where Do We Stand?

All 15 committees formedAll have met in Tucson

Assignments for specific topicsWriting cycle 1 currently under way

Writing content outlines for Web

Physics UpdatePhysics Update16 modules available for review, go-live today!URL:

http://www.rsna.org/Education/physics.cfmRadiation effects and risksImage quality and doseFluoroscopy, interventional dose/safetyCT (3 modules)USMR (5 modules)Nuclear medicine

14 more in developmentPhase 2 (30 more modules) planned

Certifying ExaminationCertifying Examination27 months after the comprehensive examCandidate has had option to subspecializeInherent duality

Candidate’s first MOC examABR’s primary certification exam

Must meet standards of public scrutinyMust test competenciesNeed not test entire scope of diagnostic

radiologyTest design complex: five modules

Noninterpretive skillsEssentials of diagnostic radiologyThree modules chosen by candidate

Noninterpretive Skills Noninterpretive Skills ModuleModule

ABR Foundation RFP calling for creation of Web-based educational modules on topics related to noninterpretive skills

11 modules currently plannedPrivacy/confidentialityConflicts of interestResearch principles and conductRelationships with vendorsPublication ethicsEducator/student and employer/employee

RFP will be released January 2, 2010Modules planned for late 2010

Clinical Practice ModulesClinical Practice ModulesChosen by the candidateDefined by the ABR (unlike MOC)Thirteen module categories

Breast, Cardiac, GI, General Radiology, MSK, Neuro, Nuclear Radiology, Peds, Repro/Endo, Thoracic, US, Urinary, VIR

Candidates can choose any combinationAny module chosen more than once will

contain more difficult questionsEntire exam must be passed; no condition

statusAdministered every six months

EOF Certifying Exam—Content:EOF Certifying Exam—Content:Clinical Practice ModulesClinical Practice Modules

Emulate practice of radiologist at workSome normal (or variant normal) examsSome “surprises”—findings outside

categoryMany “real-life” decisions

Differential (not single) diagnosesDifferential (not single) diagnoses Management decisionsManagement decisions

More complicated question typesMany possible right answersLayout mimicking real patient workups

Certifying Exam:Certifying Exam:Additional Question TypesAdditional Question Types

Structured reportModeled on templates for voice-

recognition systems in wide useEmulates workstation behaviorWill be problematic to score

Script concordance testingWill require pre-test familiarity

Certifying Exam: Certifying Exam: Where Do We Stand?Where Do We Stand?

All fourteen module teams have ChairsMany have picked committeesWill hold meetings in Tucson next year

Produce content outlines/study guides

Item-writing cycle to begin in 2010Will require thousands of cases

EOF: Certifying Exam—What EOF: Certifying Exam—What We NeedWe Need

Even more help!Sufficient material and question-

writing expertise to create graded spectrum of sophistication within every category

Example: Neuroradiology content

Core General Modules CAQ

Increasing sophistication

EOF: Final ThoughtsEOF: Final ThoughtsABR mission, to protect the public, is

vitalNo part of its mission is possible without

the work of hundreds of volunteersThanks to everyone who has or will

contribute their cases and writing expertise to continue our mission

If we are to survive, we must establish the culture of lifelong learning in each of our diplomates