Spring Forum: Timing of the Oral Boards

Abrams Conference Room, Brigham & Women’s Hospital 3/19/03

Residents and fellows in attendance:

Erik Nelson, M.D.: BU
Seth Hardy, M.D.: Lahey
Josh Rosebrook, M.D.: BWH
Amy Huang, M.D.: BWH
Tom Huang, M.D.: BU
Peter Glickman, M.D.: MGH
Sanjay Shetty, M.D.: MGH
Tara Lawrimore, M.D.: MGH
Punita Gupta, M.D.: NEMC
Karl Stien, M.D.: BWH
Bill Copen, M.D.: MGN
Aradhona Venugtesan, M.D.: MGH
Lida Chaipat, M.D.: MGH
Mark Mullins, M.D.: MGH
Cindy Stearns, M.D.: Mt. Auburn
Aparna Vootkur, M.D.: Lahey
Bang Huynh, M.D.: BWH
Rohini Nadgir, M.D.: BU
Maneesha Bhatt, M.D.: BU
Seth Katz, M.D., Ph.D.: BU
Christoph Wald, M.D., Ph.D.: Lahey

Faculty and mentors in attendance:

Sarwat Hussain, M.D.: BU
Charles Hyde, M.D.: BU
James Thrall, M.D.: MGH
Donald Bachman, M.D.: MWMC


Items:


1. Elections for the 2003-2004 year were held at 6:45

  1. A brief description of the role of the RFS officers and the benefits was provided by Seth Hardy.
  2. The following individuals were elected:
    1. Seth Hardy – President
    2. Tara Lawrimore – Vice President
    3. Joshua Roebrook – Vice President
    4. Punita Gupta – Secretary

TOP

2. The Forum started at 7:00

  1. Welcome by Seth Hardy
  2. Opening remarks:
    1. Don Bachman, M.D., the current president of the Massachusetts Radiological Society and Radiologist in private practice explained the critical importance of the American College of Radiology (ACR) for our profession including its role in accreditation, standards, monitoring adequacy of reimbursement, quality patient care, research, education, and economics both at the state and federal level.TOP
  3. Christoph Wald, M.D. Ph.D., an abdominal imaging fellow and currently chair of the ACR Resident and Fellow section (RFS), gave an overview of the activities of the section with respect to the discussion of the oral board timing:
    1. During the annual meeting of the ACR in Miami in September of 2002, the ACR RFS was made aware of an initiative by the Society of Chairmen in Academic Radiology Departments (SCARD) suggesting to the American Board of Radiology to change the timing of the oral board exam. The section subsequently established direct communication with the Executive Director of the American Board of Radiology and explained in a letter to the board why residents felt that a change would not be desirable. Furthermore, a feature article, which was published in the February 2003 issue of the ACR Bulletin, featured responses and comments of all involved parties and may be used as a reference for the arguments brought forth by the ACR RFS.
    2. During recent conversation with Dr. Hattery, from the ABR, informed Dr. Wald that ABR trustees had discussed the issue during a retreat in February. No consensus has been reached by the trustees to postpone the board exams. The ABR will continue to consider this issue during forthcoming sessions and collect data on this topic. No other immediate action was taken. The ABR is interested to receive future input from the ACR RFS on this issue.
    3. In the future, the Radiology Residency Review Committee may take up the issue of “board frenzy” and may seek to determine during site visits of programs whether inappropriate amount of leave is granted to senior residents interfering with their training.
    4. Dr. Wald urged that residents work out a compromise with their respective program leadership to balance service commitment, training requirements with the need to prepare adequately for a complex exam at the end of residency. He stressed the salient effort by the ABR in recent years to standardize the examination and carefully select and observe the examiners to guarantee a fair and reasonable board examination.TOP
  4. Remarks by James Thrall, M.D., Chairman of Radiology, Massachusetts General Hospital (MGH), explaining the position of SCARD:
    1. The past history of the timing of the Oral Boards was to wait one year.
    2. There is more to the issue than residents “checking out a few months early.”
      1. SCARD is also interested in creating an environment and a training structure conducive to increased research engagement of residents. A delay of the board exams may take resident focus off this test and allow more dedication of time to research.
        1. Research within radiology is key to securing its future and being better than other specialties.
      2. Some members of SCARD are thinking about changing the overall structure of residency. Such changes may include reducing or eliminating the clinical year and perhaps shortening the general portion of radiology training to three years with one or two years devoted to a fellowship such as with the Internal Medicine model or similar to the current approach at MGH where basic training may be followed by a two year combination of “mini-fellowship” and fellowship proper.
    3. Oral board exams may need to be pushed back two years so that fellowships are not compromisedTOP
  5. Remarks by Charles Hyde, M.D., residency program director at Boston University Medical Center, spoke on behalf of program directors:
    1. Out of the 26 specialty boards, only Radiology gives oral board exam during residency.
    2. Are a required number of read studies during the fourth year a solution? “Reading X-Rays is the best preparation for boards.”
    3. Currently residency programs deliver a well-buffed product [residents] into the workforce. Moving the timing of the boards would pass on some of this work to private practice in effect “sharing the responsibilities.”
    4. Active participation by 4th years is key to teach the younger residents. When senior residents are not in the department at their rotations this “vertical teaching breaks down.”
    5. “4th years are the best general radiologists in the hospital.” Their services are valuable and needed.
    6. The timing of the boards is part of a general review of residency organization and requirements; others factors being reviewed are the requirement of a clinical year; allowing limited residencies in only IR or neuroradiology, the “Holman” pathway.
    7. Dr. Hyde also provided two articles on the timing of the boards which will be referenced at the end.TOP
  6. General remarks by Sarwat Hussain, M.D., academic radiologist from Boston University Medical Center:
    1. “How can program directors allow” residents to disappear from their rotations?
    2. The issue of residents not doing their clinical work should be dealt with within the department. Residents cannot be expected to get good letters of reference if they do not show up to their rotations.TOP
  7. Input from Don Bachman, M.D.:
    1. The last 6 months of residency are an indispensable time to learn.
    2. Part of the problem arises from the fact that weaker residency programs offer the “plum” of a large amount to time off during the last year to study. This inconsistency betweens programs needs to be stopped.
    3. In response to a question from one of the residents, Dr. Bachman stated that private practices were more likely to hire someone who was already board certified rather than take a chance on someone who was board eligible.TOP
  8. Dr. Thrall then added
    1. It is the preparation for boards that is the most important part of the process.
    2. Now that the board cases are standardized, there is less to fear.
    3. A pledge by residents to show up to their 4th year rotations will not dissuade members of SCARD who are worried about the future of radiology and want more research training and in order to accomplish this goal, want to change the timing of boards.TOP
  9. After some questions and input from the residents in attendance the following conclusions were reached:
    1. The power of program directors over 4th years is minimal and there needs to be better trust and communication between senior residents and their program directors to balance board preparation efforts with training on the job and service commitment.
    2. Only a small number of residents appear to behave irresponsibly.
    3. A brisk readout between a 4th year and staff is the best preparation for the boards.
    4. 4th years should sit down with their program directors, early in the board preparation season, and formulate a plan so that there are no misunderstandings.
    5. Merely changing the timing of the boards would not address the issue at hand. Reviewing the way programs handle this period of residency training may be more appropriate.

TOP

Dr. Hyde’s board timing article references:

  1. Gunderman, RB. The Perils of Testing. Acad Radiol 2001; 8:1257-1259
  2. Casarella WJ. Current Structure and Purpose of the American Board of Radiology Examination Process. Acda Radiol 2001; 8:1260-1261

TOP

The forum was adjourned at 9pm.


Respectfully submitted by
Seth Hardy, MD
Secretary, MRS RFS