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  • 1. ABR UpdateABR Update RSNA 2009RSNA 2009 The Examinations Of The Future
  • 2. Core ExaminationCore Examination Only comprehensive examination given by ABR Majority of items will be based on images More than simple fact retrieval Image interpretation, diagnosis Case management Practical use of scientific knowledge Physics will be integrated, not separated In most cases, physics items linked to images Physicist “embedded” in every writing team
  • 3. Nuts and Bolts: Core ExamNuts and Bolts: Core Exam Given at 36 months Expected level of mastery: basic/intermediate Eighteen 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 center 1.5 days for candidate to take Core exam
  • 4. Core Exam:Core Exam: Categories and ContentCategories and Content Fifteen categories have item-writing committees Organ 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 not Radiography/fluoroscopy, CT, MRI
  • 5. Committee ResponsibilitiesCommittee Responsibilities Create detailed outline of content to be tested (goal: on Website by 7/2010) Create questions based on content outline Participate in assembly for each form Ensure each category adequately sampled Prevent repetition Assemble condition examination forms Categories without committees: similar responsibilities; “virtual” committees formed
  • 6. Potential Question Types:Potential Question Types: Core ExaminationCore Examination Single best answer multiple choice Multiple true/false Extended matching (R-type) Labeling “Storyboarded” vignettes
  • 7. General Comments:General Comments: New Item TypesNew Item Types Implementation Can it be easily shown? Can ABR IT create the interface? Interpretation Is it psychometrically meaningful? Pre-examination instruction Will the candidate be sufficiently comfortable with the question type?
  • 8. Elements of Extended MatchingElements of Extended Matching (R-type) Question(R-type) Question Theme Option list Lead-in statement Stems (3-4)
  • 9. Example: Extended MatchingExample: Extended Matching Solitary 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 cystadenoma b. Liver cell adenoma i. Lymphoma c. Cavernous hemangioma j. Solitary metastasis d. Inflammatory pseudotumor k. Intrahepatic cholangiocarcinoma e. Pyogenic abscess l. Hepatocellular carcinoma f. Fungal abscess m. Fibrolamellar carcinoma g. Nodular focal fat deposition
  • 10. 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 evaluation for mild abdominal discomfort. She was referred for MR imaging to characterize a solitary liver mass seen on that ultrasound. Images are obtained 30 seconds (A), 70 seconds (B) and 1 hour (C) after administration of gadobenate intravenously. A B C
  • 11. 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 showed a liver mass, and he is referred for CT imaging to characterize it. Images are obtained before (A), 20 seconds after (B), 50 seconds after (C), and 5 minutes after (D) intravenous administration of iodinaed contrast material.
  • 12. Strengths of R-Type MatchingStrengths of R-Type Matching Tests beyond knowledge, comprehension More analysis, management, judgment Better discriminator c/w T/F or A-Type Comparable results with one-third fewer items Can test more of domain in same time
  • 13. LabelingLabeling Normal anatomy or pathologic process Intuitive Easy question type to program
  • 14. A coronal CT image obtained in a patient with ascites is shown. Label the following structures: a) Left subphrenic space b) Lesser sac, inferior recess c) Lesser sac, superior recess d) Transverse mesocolon e) Gastrohepatic ligament f) Morison’s pouch g) Left paracolic gutter h) Root of intestinal mesentery Simulation? Example: LabelingExample: Labeling Peritoneal SpacesPeritoneal Spaces
  • 15. Case Simulation VignetteCase Simulation Vignette Familiar example: USMLE Step III Components Case presentation Clinical question Choice Imaging study vs. nonradiologic maneuver New data from choice—new questions May require blocked return at some point
  • 16. Core Exam:Core Exam: Where Do We Stand?Where Do We Stand? All 15 committees formed All have met in Tucson Assignments for specific topics Writing cycle 1 currently under way Writing content outlines for Web
  • 17. Physics UpdatePhysics Update 16 modules available for review, go-live today! URL: Radiation effects and risks Image quality and dose Fluoroscopy, interventional dose/safety CT (3 modules) US MR (5 modules) Nuclear medicine 14 more in development Phase 2 (30 more modules) planned
  • 18. Certifying ExaminationCertifying Examination 27 months after the comprehensive exam Candidate has had option to subspecialize Inherent duality Candidate’s first MOC exam ABR’s primary certification exam Must meet standards of public scrutiny Must test competencies Need not test entire scope of diagnostic radiology Test design complex: five modules Noninterpretive skills Essentials of diagnostic radiology Three modules chosen by candidate
  • 19. Noninterpretive Skills ModuleNoninterpretive Skills Module ABR Foundation RFP calling for creation of Web- based educational modules on topics related to noninterpretive skills 11 modules currently planned Privacy/confidentiality Conflicts of interest Research principles and conduct Relationships with vendors Publication ethics Educator/student and employer/employee RFP will be released January 2, 2010 Modules planned for late 2010
  • 20. Clinical Practice ModulesClinical Practice Modules Chosen by the candidate Defined 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 combination Any module chosen more than once will contain more difficult questions Entire exam must be passed; no condition status Administered every six months
  • 21. EOF Certifying Exam—Content:EOF Certifying Exam—Content: Clinical Practice ModulesClinical Practice Modules Emulate practice of radiologist at work Some normal (or variant normal) exams Some “surprises”—findings outside category Many “real-life” decisions  Differential (not single) diagnosesDifferential (not single) diagnoses  Management decisionsManagement decisions More complicated question types Many possible right answers Layout mimicking real patient workups
  • 22. Certifying Exam:Certifying Exam: Additional Question TypesAdditional Question Types Structured report Modeled on templates for voice- recognition systems in wide use Emulates workstation behavior Will be problematic to score Script concordance testing Will require pre-test familiarity
  • 23. Certifying Exam:Certifying Exam: Where Do We Stand?Where Do We Stand? All fourteen module teams have Chairs Many have picked committees Will hold meetings in Tucson next year Produce content outlines/study guides Item-writing cycle to begin in 2010 Will require thousands of cases
  • 24. EOF: Certifying Exam—What WeEOF: Certifying Exam—What We NeedNeed 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
  • 25. EOF: Final ThoughtsEOF: Final Thoughts ABR mission, to protect the public, is vital No part of its mission is possible without the work of hundreds of volunteers Thanks 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