What does it take to pass the ABR Core Examination on the first try?

One in 10 radiology residents fail the American Board of Radiology (ABR) Core Examination on their first try. Do residents who pass the examination have anything in common?  What about those who fail?

Researchers from the University of Missouri-Kansas City School of Medicine surveyed residents who had recently taken the examination to see what they could learn, sharing their findings in the Journal of the American College of Radiology

“Although program directors and the ABR have identified proper examination preparation as an integral priority, much variability exists in how residents study for the examination,” wrote author Nabil Calisi, MD, and colleagues. “Flexibility of study time and institutional support varies, and programs currently do not recommend protected study weeks. Preparation includes a combination of clinical learning, textbooks, didactics sessions, question banks and the American College of Radiology In-Training Examination (ACR ITE), but no consensus exists on the ‘highest-yield’ resources.”

Calisi et al. developed a 34-question survey that respondents could complete anonymously. In 2018, the questionnaire was sent to fourth-year diagnostic radiology (DR) residents throughout the United States.

Overall, there were 273 respondents. The mean age was 31.9 years old, more than 67% were men and more than 90% said English was their primary language. Nearly 92% of respondents passed on their first attempt.

High scores on the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) were “strongly associated” with passing the Core Examination, the authors observed.

“This association of high scores and first-attempt board examination success has been observed in board examinations for other medical specialties,” they wrote. “In fact, respondents who failed or conditionally passed the Core Examination in our study previously underperformed on USMLE Step 1 and 2 CK compared with the national average scores for both tests, and those who passed had outperformed the national averages.”

A strong performance on the ACR ITE “also strongly predicted success.” The ACR ITE was specifically called out as “an appropriate readiness preparation tool.” Though numerous training resources were mentioned by respondents, the RadPrimer Question Bank was the only one “preferentially used among pass examinees.”

The survey also explored the possible impact of protected study time and call-free weeks (CFWs) for residents planning to take the Core Examination, something “contentiously debated in medical communities.”

“The ABR has claimed that study weeks are unnecessary, with clinical learning being more important than dedicated preparation time,” the authors wrote. “In our analysis, neither protected study time nor total number of study months improved likelihood of passing the examination, consistent with the ABR’s position. However, CFWs was a predictive factor, because examinees that passed had less call burden before the examination compared with examinees that failed or conditionally passed.”

Also, though most participants took the Core Examination in the first week of testing, that was not found to make an impact on their likelihood of success. Residents who said “felt like” they had passed after taking the examination were more likely to have actually passed than those who “felt like” they had failed.

Respondents who passed were also more likely to have trained at an academic institution and follow better sleeping habits. They were also less likely to have experienced “a significant life event in the year of the examination.”