Catching Up With the ABR

As the new Core Exam enters its fourth year, here’s what you should know about the changing world of board certification.


In 2013, the American Board of Radiology (ABR) introduced a new process for board certification that included two written examinations — the Core Exam and the Certifying Exam. These new tests replaced the previous model, which relied on two written exams and one oral exam. This month radiology residents from across the country will take the Core Exam, marking the fourth time the ABR has administered the test. Now that the dust has settled on the revamped exam, two current residents are exploring the ins and outs of becoming a board-certified radiologist.

What is the Core Exam?

The Core Exam is the first examination radiology residents must take to obtain board certification in diagnostic radiology. According to the ABR, “The Core Examination is an image-rich, computer-based examination, offered after 36 months of residency training; it covers 18 subspecialty and modality categories.” The exam includes 657 questions split over two days. Residents take the test in June of the third year of radiology residency (this is program year 4 for most residents).

How is the exam structured?

The exam covers 18 fundamental categories in diagnostic radiology: 10 organ systems and eight non-organ categories (such as CT, interventional radiology, etc.). Additionally, the Core Exam includes a portion of the Radioisotope Safety Exam, which is a requirement for Authorized User eligibility status.

The exam is approximately 13 hours in length. After registration and a tutorial session, residents have 361 minutes allotted for 360 questions on day 1 and 296 minutes allotted for 297 questions on day 2.

How is the exam scored?

Participants may pass, fail, or condition the exam. The exam is scored in two stages. Stage 1 is the overall score and, according to the ABR, is “compared against a pre-determined minimum acceptable performance level, or passing score.”2 This passing score is predetermined by a group of content experts who decide, for each question in the examination, if a minimally competent candidate would answer the question correctly. This scoring model, called the Angoff Method, is used to score a variety of medical board-certification exams.

The scale for the overall score is 150–800. Passing scores vary year by year based on what the ABR calls a “competency threshold.” A score of 350 was designated a passing score for the June 2015 Core Exam.

If a participant’s overall score meets the passing score threshold, then stage 2 scoring is applied. A passing score requires competency in all 18 categories. If a resident fails one to five categories, then the resident conditions the exam, meaning the unpassed sections must be retaken. If the resident fails more than five categories, the resident fails the exam. In this case, the entire test must be retaken.

How many people pass the exam?

The number of residents who pass the exam varies each year. In 2015, 87 percent of examinees passed the exam. The exam is not graded on a curve.

How can a resident prepare for the Core Exam?

Many resources are available. Residents should start at the ABR website, which offers a number of study guides.

By Colin Segovis, MD, PhD, RFS secretary and resident at Wake Forest University, and Amy Patel, MD, chief resident at the University of Kansas-Wichita and RFS representative to the ACR Commission for Women and General Diversity

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