Rise from the Ashes of the ABR Core Exam

The sweetest victories begin with failure

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Photo Credit: Sgt. Michael J. MacLeod, US Army

ou’ve just opened your email from the American Board of Radiology (ABR), and the blood drains from your head when you read the letters on the monitor: FAIL. Questions flood your mind like a flock of panicked, self-doubting pigeons. Am I good enough to be a radiologist? Will I ever be able to earn a living as a physician? What should I do next to pass this exam?

Only those who dare to fail greatly can ever achieve greatly

— Robert F. Kennedy

Failing is part of life, and all of us face it more than once. It’s also a defining event — it makes us empathetic when others fail, and it sweetens the taste of success. Consider the table below documenting other commonly encountered failures to place your temporary setback with the Core Exam in context:

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Estimated probabilities of various life events. Estimated lifetime lawsuit risk assumes 7% annual risk.

The frequency of failure in our lives means that recovering from failure will get easier — the skills you learn in this experience will strengthen you for other moments of adversity. To help you chart your recovery, here are three action items to get you up and running again towards your goal of board certification.

1. Keep perspective

You’re in the company of great academic and private practice radiologists who also failed the Core Exam. We combined data from 2013 through 2019 and found the overall pass rate rounded out to 11% with a total of 8,328 examinees. Here’s a graph we generated of Core Exam pass rates since its introduction in 2013:

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Failure on the Core Exam has varied between a low of 6.3% in 2017 and a high of 15.9% in 2019.

The Core Exam is unusual in comparison with other specialties in terms of the sheer volume of trainees failed. As a result, most radiologists who have entered practice in the last six years will know at least one person who failed, and most of those people have gone on to thriving practices, indistinguishable from those who passed on their first attempt.

2. Eliminate systemic score inhibitors

During his 12-year run as coach of the UCLA basketball team, John Wooden led 10 NCAA championship victories and became an icon for organizational leadership. In the ups and downs of a regular season, he understood that evolving after failure was critical to achieving subsequent success.

Failure is not fatal, but failure to change might be

— John Wooden

When residents fail the Core Exam, they far more frequently fail multiple sections rather than any single section. If that describes your scores well, take a hard look for systemic score inhibitors — life events or circumstances that suppressed your scores across a range of disparate topics. Here are some examples:

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Identify the big contributors to your score in the last round. Switching programs is usually unrealistic, but it helps to understand contributing factors broadly and separate the controllable from the uncontrollable.

Studying for the Core Exam requires subsistence — quiet time for intense review and sufficient time for sleep and memory consolidation. Systemic inhibitors deprive you of this subsistence. Part of the problem here is the disconnect between the breadth of clinical knowledge required by the Core Exam, and the more routine collection of cases radiologists get on a daily basis. No matter how many negative head CTs you churn through on service, none of that will prepare you to recognize that frontoethmoidal encephaloceles occur more commonly in southeast asians.

The bulk of resident training is an apprenticeship, i.e. learn-by-doing, but deliberate studying off service — the exact kind of studying the ABR says you don’t need — is essential to reinforcing the much wider distribution of cases presented on the exam. The randomness of rotation schedules and the variability of practice settings within and across residency programs guarantees that everyone will have substantial gaps without deliberate study.

Some systemic score inhibitors are massive in magnitude, so you may need to give yourself the allowance of weeks, months or more than a year at times. Being honest about the time you need to recover goes a long way towards being ready for your next study cycle.

3. Prepare your study plan

Once you’ve decided when you’re going to take the exam, prepare study goals in large buckets for each month between now and the exam. Start with the subjects you feel weakest with, but don’t entirely ignore the ones where you scored poorly. It’s important to review the entire scope of topics to ensure you’ll perform well on the repeat exam, so schedule accordingly.

One pattern of performance some residents observe after repeating the exam several times is that their scores fluctuate randomly. This makes sense, because each subject only has a few tens of questions. Statistically speaking, this isn’t enough data to provide a stable assessment of mastery.

Also, recognize that your knowledge base will drift. The longer you spend away from a topic, the weaker you become in that subject. Education products like Duolingo and Anki recognize the forgetting process and incorporate that into how they schedule questions. Topics you haven’t visited in a long while surface for review periodically. It’s not hard to manually incorporate this into your sessions with question banks.

In Conclusion

Missing the Pass mark on the ABR Core Exam hurts, and there’s no denying the pain. But be gentle on yourself. Avoid casting your struggle in epic terms. Understand that you’re on the pedestrian mission of passing a standardized multiple choice exam that’s only partly related to your overall service to your patients. While you think about what went wrong and what to do differently, keep a positive inner monologue. The exercise of getting knocked down and rebuilding yourself — that’s what builds you into an empathetic leader to your friends, family, and colleagues, and it’s what makes victory so much sweeter.

— Orbit Staff

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Busy radiologists across the country are switching to Orbit to earn ABR SAM, MQSA, Cardiac, Fluoroscopy, and other credits from browsing activity in the reading room. Get started free at orbitcme.com/radiology

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