Annual Report 2014 - 2015

ABR CERTIFICATION Partners in Evolution

“Alone we can do so little; together we can do so much.” - Helen Keller Contents 2 A Message from the ABR President 4 A Message from the ABR Executive Director

6 Certification Statistics

7 Examination Statistics

8 Maintenance of Certification Report

10 Changes in Board Governance

11 Diagnostic Radiology Report

12 Radiation Oncology Report

14 Medical Physics Report

16 Interventional Radiology Report

18 Board of Governors and Executive Staff

19 Board of Trustees and Staff Division Directors

20 New Trustees 2015

ABR Mission To certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients.

ABR Vision The ABR will be the recognized leader in advancing patient care by continuously improving the professional standards of our disciplines through certification of our diplomates. A MESSAGE FROM THE ABR PRESIDENT

Evolution of ABR Certification: self-regulatory mission: ensuring that programs Professional Organizations. It is a simple during ABR update sessions and at ABR kiosks at successfully meet the ABR’s foundational goals to truth that professions cannot survive without multiple national meetings throughout the year. Process and Partnership protect patients and the public while also provid- strong professional organizations. ABR leaders These efforts have already borne fruit as evi- ing program components that are sufficiently meet regularly with the leaders of many national denced by the recent improvements in ABR MOC nnual reports can reasonable, understandable, and easily achievable specialty and subspecialty radiology professional Part 4 (Practice Quality Improvement), based on be prosaic reading, by practicing diplomates. The Board considers societies to share thoughts on mutual areas of in- diplomate feedback. This change, which offers even for those who A setting an appropriate balance between adequate terest within the ABR’s programs. As partners in credit for quality activities already performed by have a thirst for details. requirements and diplomate support to be central serving our profession, their disparate viewpoints diplomates in the course of their practices, has By tradition, they offer to its mission. This task is not as simple as it may provide windows on the expectations placed on been very well received. And, as always, there is articles with tidbits of ef- seem. However, 80 years of evolution in societal radiologists from many perspectives, both inside more to be done. forts expended and mis- expectations, self-regulatory philosophy, and ABR and outside the radiology community. In turn, sions accomplished. This experience have given rise to better options for this influences the requirements and standards Already begun is a focused evaluation of MOC year is no exception as a advancing such an equilibrium. developed by the ABR to help radiologists meet Part 3 through consideration of options for pos- number of significant ABR those expectations. Further, professional societ- sible replacement of the current 10-year “recer- accomplishments of inter- Milton J. Guiberteau, MD In the not-too-distant past, medical self-regulation ies’ creation of products and projects in support tification” examination. Because MOC is now a est to our diplomates are bodies were regarded as ivory tower academes— of ABR programs has allowed participants easy ac- continuous process, it makes sense that a mecha- described in this report. However, often missing spouting requirements in isolation from a real cess to tools for meeting ABR requirements while nism for ongoing assessment of knowledge and are explanations of the motivations, practical world of growing external mandates and remote fostering their satisfaction with the process itself. judgement be sought. This also has the potential assumptions, and processes that underlie these from the everyday challenges and stresses of to eliminate the time, travel, cost, and anxiety of efforts. In this time of frequent change in our practicing radiologists. However, with respect to Certification and Accreditation Organizations. the current exam-center testing model, as well as professional landscape, it seems reasonable that today’s ABR, nothing could be further from the To align with the broader medical community to link the discovery of any diplomate knowledge I provide you, our stakeholders, with more than truth. Our Board of Trustees is populated by 24 beyond our own specialty, the ABR participates gaps with remediation through CME required for a presidential summary of information already practicing radiology professionals from all cor- in an exchange of ideas with our partners in the MOC Part 2. available on the pages that follow. ners of our community with a collective practice ABMS board community, as well as accreditation experience approaching half a millennium. Many organizations such as the Accreditation Coun- The Bottom Line. Board certification represents In a number of significant ways, the past year has are heads of their practices and leaders in local, cil for Graduate Medical Education (ACGME). a radiologist’s personal commitment to provide a been a pivotal one. As documented in this report, regional, and national radiology organizations. Certainly, in the past year, we have learned a lot high standard of quality patient care and is an the year included (1) completion of transitioning All are subject to the same MOC requirements from our fellow certification boards’ successes acknowledged benchmark of public trust. The the diagnostic radiology (DR) oral certification and processes (including random audits) as other and missteps in their own programs, offering us ABR’s challenge in providing Continuous Certifi- exam to a fully computer-based process; (2) the diplomates and are not shy in expressing their processes to emulate as well as to avoid. Fortu- cation is to achieve the delicate balance of creat- final steps in converting ABR Maintenance of personal concerns and those of their colleagues nately, the ABR’s MOC program has proved to be ing rigorous and meaningful programs that are Certification (MOC) to a Continuous Certification regarding perceived flaws in our programs. All are a virtual role model for adapting requirements to also relevant and appropriate for performance process; (3) the culmination of a near decade- well connected to the realities of practice and the the concerns of practicing diplomates. In addi- by busy practicing radiology professionals. This long process to establish a new medical specialty ever-expanding obligations placed on practitioners tion, the ABR continues to stress the critical need means avoiding the pitfalls of either overdiluting of interventional radiology/diagnostic radiology from every quarter, including the universal calls for ABMS to persist in seeking data for external our requirements or overreaching them by setting (IR/DR) through the formal implementation of a for professional accountability and transparency. validation of MOC programs’ impact on improv- the bar too high. fourth ABR discipline; and (4) a major restructur- As such, ABR trustees understand the importance ing the quality and safety of patient care. ing of ABR governance to better meet the chal- of our Board’s own transparency to diplomates While the Board must guard its privilege to lenges of the future. To say that these significant by disclosing the decision-making processes and Our Diplomates. The introduction of MOC and operate without interference with its mission to achievements, along with numerous more mun- sources of input we rely upon to establish and Continuous Certification fundamentally changed protect the public, it also must be open to the dane issues, have consumed much of the Board’s evolve ABR programs. the ABR-diplomate interaction from a one-time perceptions and feedback of our relevant commu- time, attention, and resources over the past few encounter with the Board to a professional nities and those who delegate to us the awesome years is an understatement. However, with mis- Three of the most important sources of guid- lifelong relationship. Thus, diplomate input into responsibilities of self-regulation. These interac- sions accomplished come new opportunities. ance are input from the radiological community this partnership has become a valuable ongoing tions ensure that our Board is operating within through fellow radiology organizations, col- requirement for development and assessment acceptable limits in reaching the program balance With full implementation and maturation of the laboration with the broader medical community of our programs. As the collective membership it hopes to achieve. Employing these methods, ABR’s MOC program, 2014-15 has represented through other specialty boards, and focused feed- of our specialty, we place our trust in the ABR the past year has enabled us to successfully re- a welcome occasion to re-evaluate MOC compo- back from our diplomates. Obtaining this input to perform the vital function of certification in evaluate and improve problematic portions of our nents regarding practicality of requirements and means we must continue to develop and build on a manner that is as robust, yet as nonintrusive, MOC program. I am convinced that through using facility of process. This included a healthy dose of our working partnerships with these resources by as possible. We obtain feedback from our diplo- the same methods, the coming year will provide Board introspection in re-assessing two funda- using the strengths that each brings to the table mates through focused online surveys, diplomate additional opportunities for positive change. mental and sometimes conflicting aspects of our 2 to advance mutual goals for our profession. advisory committees, and direct interactions 3 Photos/GraphicsA MESSAGE FROM here THE ABR EXECUTIVE DIRECTOR

Discovering ABR Teamwork Governors and Trustees. This 28-member team is composed of practicing radiology ince I began my professionals from around the country who, position as ABR among many other tasks, donate countless executive director hours working with exam committees, S formulating and writing policies, developing in July 2014, I have been amazed and excited strategic plans, assisting staff members with to discover something their projects, attending and presenting at new almost every day. society meetings, and sometimes making tough Usually, these discoveries decisions on behalf of the ABR. Above all, are small yet very they are dedicated to ensuring that ABR board meaningful: the staff certification is the most valuable credential member who doesn’t Valerie P. Jackson, MD possible, while at the same time listening and drink coffee but comes in responding to the concerns of ABR candidates early and makes it for everyone else so several and diplomates. pots will be ready when they arrive; the support our employees offer others who are out sick by Casting the net even wider, I cannot say sending cards and flowers and donating paid enough to thank the many professional time off from their own accounts to help those radiology societies, as well as our ABR volunteer who don’t have enough to cover a major illness; committee members! As of October 2015, lifetime certificate holders, to exhibit the value 2015 MOC survey, was very helpful to us in the adoption of a stray cat, now known as the this group included they see and the trust they place in the ABR determining the important changes recently ABR mascot “Ollie,” by feeding her, giving her 449 item-writing MOC program. made to our MOC program. As the most a kitty condo, and even providing veterinary volunteers and essential part of our team, your opinions are care; the ABR team that recently participated 766 potential oral Perhaps the most important members of the truly appreciated. on a Saturday morning in the local Community examiners. Without ABR team, however, are you—our candidates Food Bank walk and raised more than $1,200; their help, the work and diplomates. As of December 31, 2014, the During their breaks, some of our ABR and the genuine and touching sorrow expressed of our governors, ABR had issued 64,840 certificates since its in- staff members enjoy working on jigsaw at the sudden death of a staff member, with trustees, and staff ception in 1934, with 17,899 of those issued in puzzles, which we have set up on a table in the resulting effort to plant a tree accompanied would not be possible. the past 10 years alone. our lunchroom. A recent puzzle was titled by a stone placard in front of the building as a They come from a “Impossibles: The Borderless Puzzle with 5 memorial. variety of practice Extra Pieces.” Usually, it takes a while for staff environments across Perhaps the most important members to complete these puzzles since they These personal examples of teamwork and a the country and only work on them for a few minutes at a time, caring attitude are evident every day in our ABR mascot Ollie, relaxing in serve as committee members of our ABR team, her new “condo” and this one was particularly challenging. But staff’s dedication and hard work, bringing chairs and members, however, are you—our finally, it was done, and I walked in one day to together each of their individual talents oral examiners, self- discover this handwritten note on top of the to accomplish our goals on behalf of ABR assessment module (SAM) reviewers, and image candidates and diplomates. finished puzzle: “Impossible? I don’t think so!” candidates and diplomates. This team also asset contributors. Like our staff, they put in includes our four dedicated associate executive long hours and work hard but greatly enjoy the We consider you the most crucial members of To me, this sums up the positive attitude I’ve directors, who are part-time yet often put in benefits of teamwork, including interaction our team, and we appreciate your feedback, seen displayed by all members of our ABR many extra hours contributing to the work of with their colleagues; the exchange of ideas; the whether it’s a congratulations for a job well team—staff, trustees, governors, volunteers, the ABR. opportunity to create, assemble, and administer done, a suggestion for improvement, or even a candidates, and diplomates alike. With a team fair board examinations; and the satisfaction downright criticism. As mentioned in the MOC like ours, nothing is impossible, and I’m so But it doesn’t stop there. I know firsthand of giving back to their profession. And like our Update (see page 8), the feedback given by our proud and honored to be a part of it all! how much hard work is accomplished by the governors and trustees, they all participate in ABR MOC Advisory Committees, as well as the volunteer members of our ABR Boards of Maintenance of Certification, even if they are many responses from diplomates to an April 4 5 CERTIFICATION STATISTICS EXAMINATION STATISTICS

Medical Physics Part 1 Exam Pass Rates Diagnostic Radiology Core Exam Pass Rates All Certificates Issued by Decade (1930-2014) (first-time takers enrolled in CAMPEP program) 1934- 1940- 1950- 1960- 1970- 1980- 1990- 2000- 2010- Year Residents taking exam for first time Year TOTAL Year General Clinical Founded: 1939 1949 1959 1969 1979 1989 1999 2009 2014 2013 87% 2010 87% 87% 1934 1,413 1,844 3,303 4,175 9,318 10,083 12,391 12,994 9,319* 64,840 2014 91% 2011 88% 90% *Numbers decreased due to transition from the oral exam to the Certifying Exam in diagnostic radiology (see table below). 2015 87% 2012 92% 86%

Specialty Certificates Issued 2005-2014 2013 86% 77% Radiation Oncology Initial Exam Pass Rates 2014 70% 75% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 TOTAL (residents taking exam for first time) Diagnostic 1,094 1,133 1,162 1,207 1,233 1,239 1,257 1,328 1,329 123* 11,105 Year Clinical Physics Biology Radiology Medical Physics Part 2 Exam Pass Rates Medical 2010 96% 90% 91% 135 141 136 200 204 204 315 263 264 279 2,141 2011 94% 96% 97% First-time First-time Takers Physics Year Takers Enrolled in CAMPEP Program (Therapeutic)** (109) (121) (116) (181) (169) (181) (263) (232) (211) (217) (1,800) 2012 95% 80% 88% 2010 83% 100% 2013 93% 91% 96% (Diagnostic)** (20) (16) (16) (14) (28) (22) (41) (29) (45) (54) (285) 2011 81% 90% 2014 92% 81% 87% (Nuclear)** (6) (4) (4) (5) (7) (1) (11) (2) (8) (8) (56) 2012 86% 83% Radiation 2013 74% 78% 107 136 135 123 166 139 148 155 170 164 1,443 Oncology Radiation Oncology Oral Exam Pass Rates 2014 68% 75% Total 1,336 1,410 1,433 1,530 1,603 1,582 1,720 1,746 1,763 566* 14,689 Year Residents taking exam for first time *Due to the transition from the diagnostic radiology (DR) oral exam to the DR Certifying Exam, only those who took and passed a DR oral exam were certified in 2014. The first DR Certifying Exam was administered in October 2015. 2010 85% Medical Physics Oral Exam Pass Rates **Specific specialty of medical physics 2011 82% Year Residents taking exam for first time Subspecialty Certificates Issued 2005-2014 2012 82% 2010 59% 2013 89% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 TOTAL 2011 61% 2014 93% Neuroradiology 81 134 139 148 158 167 185 197 189 159 1,557 2012 60% Nuclear 2013 59% 7 4 2 3 2 5 7 7 13 11 61 Radiology 2014 65% Pediatric 28 24 31 34 41 40 53 59 60 57 427 Radiology Medical Physics 2014 Oral Exam Results Vascular & (First-time Takers) Interventional 77 74 88 81 103 98 117 133 150 177 1,098 CAMPEP CAMPEP CAMPEP Radiology Graduate & Graduate Residency Hospice & Residency Palliative NA NA NA 9 0 11 0 42 0 5 67 Total 39 31 29 Medicine* Pass 77% 81% 79% Total 193 236 260 275 304 321 362 438 412 409 3,210 Condition 18% 0% 7%

*Subspecialty approved in 2006; examinations offered every other year, beginning in 2008. Certificate administered by the American Board of Fail 5% 19% 14% Internal Medicine.

Number of Diplomates Participating in Maintenance of Certification Diagnostic Radiology Radiation Oncology Medical Physics TOTAL Enrolled in MOC* 19,631 (1,872) 2,983 (253) 2,452 (71) 25,066 (2,196)

6 *As of November 11, 2015. Number of lifetime certificate holders in parentheses. 7 MAINTENANCE OF CERTIFICATION REPORT

by Vincent P. Mathews, Changes in MOC Part 4 Requirements improvement methodology for PQI projects. will need to retain this information in case of MD, ABR Board of As a first step, the ABR announced the following Previously, PQI projects were required to use a an audit, so they can document that they have Governors appropriate improvements to Part 4, which took prescribed Plan-Do-Study-Act (PDSA) process indeed met the requirements of MOC. effect immediately: with inherently defined phases. In addition n early September to the PDSA process, diplomates who choose If a diplomate is audited, he or she will be asked 2015, the ABR Expanded Options for Satisfying Part 4 to do a PQI project now may use any standard to provide the following documentation: announced two Requirements quality improvement methodology, such as • For Part 1, a valid state medical license I The Board determined that in addition to the Six Sigma, Lean, the Institute for Healthcare • For Part 2, records of completing 75 AMA major improvements to its Maintenance of traditional PQI project methodology, radiology Improvement’s (IHI’s) Model for Improvement, Category 1 Continuing Medical Education Certification (MOC) professionals may demonstrate commitment to and other methods. The ABR Part 4 policy has credits, 25 of which are self-assessment program. The first, regarding requirements for quality and safety in patient care in numerous been expanded to accommodate these different CME, in the last three years Part 4 (Practice Quality Improvement), became other ways. The new expanded options focus approaches in recognition of the interval • For Part 3, no attestation will be required. effective immediately. The second, known as on giving Part 4 credit for activities that advancements in quality improvement science The diplomate will be informed of his or “Simplified Attestation,” will become available diplomates are already performing as part over the past decade. her current MOC exam status for each on myABR on January 4, 2016. In addition, the of their practices or voluntary professional certificate held and when the next exam will ABR announced that it is exploring alternatives efforts. The Board considers such engagement, need to be passed. to the current Part 3 requirement of a secure, especially in activities that increase visibility in The new expanded options • For Part 4, records of completing an proctored MOC examination every 10 years. and commitment to quality improvement both appropriate PQI project or activity in the within and external to radiology departments, focus on giving Part 4 credit for last three years Almost a decade has passed since the full as fulfilling the intent of MOC Part 4 activities that diplomates are implementation of all four parts of the ABR’s requirements. We hope this new process will reduce the burden MOC program. While the program has generally already performing. . . of MOC documentation for ABR diplomates. been well received by ABR diplomates, it had These 16 activities are listed in detail on the This will also free up staff and development become increasingly apparent to the ABR ABR website at www.theabr.org/moc-part4- resources to permit the ABR to further improve trustees, all of whom are practicing radiology activities. This information also includes Simplified Attestation on myABR not only MOC, but other areas of its diplomates’ professionals who also participate in MOC, that the required diplomate documentation of A second area of diplomate concern centered on experience with the ABR as well. portions of the program needed improvement participation for each activity, which should time-consuming MOC data entry and detailed to make MOC’s requirements more relevant be retained in case of an audit. The Board documentation on the myABR website portal. Future Focus for MOC Program Improve- to practice. Changes were also needed to expects to expand these participatory quality This has been addressed through “Simple Binary ment: Part 3 (Knowledge Assessment) reduce the dedicated cost and time required of improvement opportunities over time as new Attestation of Meeting MOC Requirements,” The above improvements represent just the participants. This was especially true given the activities become staples of radiological practice. which will become available on myABR as of beginning of the Board’s ongoing commitment ever-increasing external demands imposed by January 4, 2016. to continuously improve diplomate satisfaction institutions and healthcare systems, as well as As long as participation in such activities is with and sense of accomplishment through ABR by the government, regulators, and payors. meaningful and ongoing, it is permissible for In the current state, diplomates are required MOC participation. In this respect, the ABR is a PQI project or activity to be used repeatedly to log in to myABR each year and attest to exploring alternatives to the current Part 3 Thus, during the previous year, the Board to meet PQI requirements. This new policy the data necessary to meet participation requirement of a secure, proctored MOC had undertaken a review of MOC program regarding criteria for MOC Part 4 is in place for requirements for each of the four parts of MOC. examination every 10 years. We will be working requirements to address areas of concern diplomates to use for fulfilling requirements for This sometimes involves uploading documents closely with ABMS and its member boards, identified by its diplomates. In addition to ABR the March 2016 three-year look-back. such as medical licenses or entering PQI radiology professional societies, and experts trustee committee initiatives, this reassessment project information. It also requires validating in the field to identify innovative knowledge- was further informed by input from ABR Expanded Options for PQI Project CME activity from the CME Gateway, as well assessment tools that take advantage of new diplomate MOC Advisory Committees and Methodology as entering CME credits from organizations technological and communication norms. by responses from diplomates to an April The ABR continues to emphasize the not contributing data to the CME Gateway. Our goal is to provide less intrusive, more 2015 ABR MOC survey. This feedback was importance of PQI projects as quality With simplified attestation, diplomates will relevant, and more cost-effective knowledge very helpful in focusing and prioritizing MOC improvement tools. However, restrictions need only to attest to the fact that each of the base sampling than past traditional methods. program modifications to accommodate areas regarding methodology have been considerably requirements for Parts 1 through 4 of MOC As progress is made in this area, the ABR will most in need of improvement. relaxed. The new MOC Part 4 (PQI) policy has been met. Entering detailed data will not continue to reach out to its diplomates for input greatly increases flexibility regarding choice of be required each year; however, diplomates and feedback. 8 9 CHANGES IN BOARD GOVERNANCE DIAGNOSTIC RADIOLOGY REPORT

by Milton J. Guiberteau, tion (MOC) examinations and determining by Kay H. Vydareny, MD syllabus has been updated and incorporates all topics MD, ABR President examination goals, content, scoring, and can- Associate Executive included on the examination. (Links to the study aids didate feedback. A Board of Trustees with such Director for Diagnostic can be found at www.theabr.org/ic-dr-core-exam.) fter 80 years of a dedicated purpose will allow for a more coherent Radiology and the single governance and concentrated examination effort necessi- Subspecialties For those who finished their training in June 2014 structure at the tated by a significant increase in the number and and passed the Core Examination, the long-awaited A nce again, this has Certifying Examination was administered for the first ABR, the Board perceived frequency of examination administrations over a need for modification to the last decade. been a very busy year time in Tucson and Chicago on October 1-2, 2015. meet growing demands for the discipline A total of 1,099 candidates took the exam—846 O in Chicago and 253 in Tucson. This total includes and obligations and to A newly created, smaller Board of Governors of diagnostic radiology. better serve our candi- (7 to 11 members), composed of the ABR officers The transition to the new 8 candidates who previously conditioned the oral examination and were transitioned to the Certifying dates and diplomates. Consequently, the and members with specific portfolios of responsi- examination paradigm is now complete. For the first Exam. As expected, the pass rate on this examination ABR trustees undertook a rigorous two-year bility, is charged with the nonexamination duties time, those who gain initial certification in diagnostic was higher than that of the Core Exam; all candidates evaluation of our governance system. The of the board. These responsibilities include ABR radiology in 2015 will have passed the computer-based who finished their residency in June 2014 and passed process included external expert assessment, financial affairs, Continuous Certification (MOC) Core and Certifying examinations. The Maintenance the Core Exam also passed the Certifying Exam. internal analysis by the Board of Trustees of program processes, communications, strategic of Certification/Continuous Certification program also has continued to change to make it easier for possible options proposed by a multidisciplinary planning and priority setting, intersociety rela- The Clinical and Noninterpretive Skills (NIS) modules task force, and the guidance of a governance tions and outreach, and oversight of American diplomates to comply with the requirements. More details about these programs can be found below. administered on the Certifying Exam are identical facilitator. The Board undertook this process Board of Medical Specialty matters. In addition to those found on the MOC exam. Study guides for with the understanding that any changes would to providing efficiency for the conduct of ABR We would like to thank the 266 diagnostic radiology the clinical modules, as well as a syllabus for the NIS build upon the time-tested representation of business affairs, the establishment of a governing volunteers, serving on 31 separate committees, for module, are available on the ABR website. A study clinical practice areas; would be compatible with board requiring members with skills other than helping the ABR with these endeavors. Indeed, the guide for the Essentials of Diagnostic Radiology our internal structure of multiple radiological or in addition to academic expertise will allow for ABR could not perform its mission without the help module, which is unique to the Certifying Exam, is disciplines (diagnostic radiology, radiation a composition reflective of the broader practicing of these volunteers, who spend countless hours writ- also available. (Links to all the study aids can be found oncology, medical physics, and interventional radiology community. ing new examination questions, evaluating questions at www.theabr.org/ic-dr-certifying-exam.) radiology); and would improve the Board’s ability written by others, and compiling the examinations. to respond to the needs of our stakeholders, as We can never thank you enough for what you do! Maintenance of Certification/Continuous well as to those of the organization itself, in a Certification (MOC/CC) thoughtful and timely manner. Initial Certification As noted above, the ABR has attempted to make the The Core Examination was administered in Tucson MOC/CC process easier for its diplomates. This year After careful scrutiny of the options, a govern- and Chicago in June and November of 2015. The June has seen significant progress in this direction. Six- ance structure, which the Board believes will examination continues to be the larger one since most teen Participatory Quality Improvement Activities, as accomplish these goals and favorably impact of the candidates complete 36 months of training in well as the traditional Practice Quality Improvement our operations to achieve our mission in a more diagnostic radiology in time for that administration. (PQI) Project, are now accepted as fulfillment of MOC effective and responsive manner, was adopted We continue to shorten the scoring timeline, and Part 4 activities. Beginning Monday, January 4, 2016, in its final form at our October 2015 meeting. this year, candidates received their scores six weeks diplomates will be able to simply attest on myABR to Consequently, the many duties relevant to after the examination; this is approximately half the participation/completion of Parts 1, 2, and 4 of the the ABR’s mission of certification, previously While these changes will be transparent to time needed for those who took the June 2014 exam MOC process, rather than having to delineate the managed by a large 24-member board, have been our diplomates and others in the radiology to receive their scores. Statistics for first-time takers specifics of each part. In addition, they will no longer divided between two smaller organizational and broader medical communities, the ABR is (1,188) were similar to those of the previous examina- be required to upload documentation of their MOC components. confident that this updated structure, reflective tions: 87 percent passed, fewer than 1 percent condi- participation. The ABR will continue to audit a por- of the current operational norm in many tioned (all in physics), and 12 percent failed. tion of diplomates each year, so primary documenta- TheBoard of Trustees will retain its familiar professional organizations, will enhance our tion should be retained in case an audit is requested. structure of members with discipline and subspe- ability to serve our candidates and diplomates. The ABR continues to have an assortment of study cialty expertise, reflecting major areas of current Establishing an efficient, systematic approach aids available on the website for the Core Examina- Further details about these and other new initiatives clinical practice. It will assume responsibility for to managing our mission of board certification tion, including module blueprints and study guides, can be found on our website (www.theabr.org/moc- the ABR’s largest core obligation of creating both is crucial during this time of changing and sample topic content, a Quality and Safety syllabus, part4-activities), as well as in the MOC Update article initial certification and Maintenance of Certifica- challenging practice environments. and a practice examination. The Quality and Safety included in this report (see page 8). 10 11 RADIATION ONCOLOGY REPORT

by Paul E. Wallner, DO; Dennis C. Shrieve, required general radiation oncology module. Skin terminate the program. Participants will continue to • Robert Amdur, MD, University of Florida, head/ MD, PhD; and Anthony L. Zietman, MD cancers had been included in the head/neck category actively use the FPRB designation through 2017, neck/skin cancer chair, has been replaced by but will also be moved to general radiation oncology. the originally planned demonstration project termi- Steven Frank, MD, MD Anderson Cancer Center. n important initiative during the past year Pediatric tumors will be removed from the adult nation date. After that time, if queried, the Board was directed to improving volunteer clinical central nervous system module beginning in 2017 will indicate that the diplomate had attained the • Julia White, MD, Ohio State University, breast category activities and diversification of and will be included in a new module(s) developed recognition but that the program is no longer active. cancer chair, has been replaced by Jennifer A solely for that topic. A subcommittee under the aegis Bellon, MD, Dana-Farber Cancer Institute. committee membership. Of eight clinical committees, six now have members of the Central Nervous All eight radiation oncology clinical category in private practice. This System Committee, volunteer committees were re-organized effective The RO trustees continue to recognize the level of diversity should to be chaired by Dr. January 1, 2012. At that time, it was anticipated importance of the Holman Research Pathway as a way provide candidates Iris Gibbs of Stanford that new appointees would serve terms of up to to attract those with a strong research background and diplomates with University School of three years, with possible re-appointment, and into radiation oncology, and then to help them a greater level of Medicine, has been that rotations on and off the committees would initiate careers as independent investigators. The last assurance of fairness organized to develop the henceforth be staggered so that all appointments three years saw a decline in the number of applicants, and relevance of both new pediatric modules. would not terminate concurrently. To maintain but this year there was a spike, raising the possibility Paul E. Wallner, DO, Dennis C. Shrieve, MD, Anthony L. Zietman, the initial certification Associate Executive PhD, Trustee, Radiation MD, Trustee, Radiation stability during the organizational transition, all that these represent year-to-year variations rather (IC) and Maintenance Director for Radiation Oncology Oncology A significant change in certifying (oral) examination chairs retained their than trends in any particular direction. Oncology of Certification the new IC and MOC posts. Several of those chairs have now served for six (MOC) examinations. examinations is the or more years, and rotation of chairs has begun. The The radiation oncology trustees will be working Committee esprit and function have also been introduction of a group of questions collectively staff and trustees of the Board wish to acknowledge with the Society of Chairs of Academic Radiation significantly improved by implementation of periodic referred to as non-clinical skills. This material the extraordinary efforts and service of three oral Oncology Programs (SCAROP) to encourage face-to-face meetings rather than reliance on includes items related to quality assurance and examination chairs rotating from their posts: additional programs to recruit, support, and conference calls and webinars. In-person meetings quality improvement, patient safety, bioethics, and ultimately add Holman Pathway trainees to their are being scheduled for each committee on a biannual biostatistics. Because this formalized material is • William Regine, MD, University of Maryland, departments. basis, with the meetings devoted to development new to the Board examinations, trustees and staff gastrointestinal cancer chair, has been replaced of both qualifying (written) and certifying (oral) have developed a syllabus that will be embedded in by Michael Haddock, MD, Mayo Clinic/Rochester. examinations. the existing web-based IC and MOC study guides. A link to the new syllabus is now available on the The new MOC Part 3 modular examination was ABR website (www.theabr.org/moc-ro-comp3) and administered for the first time in October 2015. contains essentially all material in these topics felt to The examination consisted of approximately be necessary for examination preparation. An effort 200 questions, of which 140 were in a required has been made to assure that the material is relevant general radiation oncology module. Diplomates to the clinical practice of radiation oncology. had the ability to select two additional modules, each containing 30 questions. These modules were In 2010-2011, with the aid of a stakeholder’s taken from the current eight clinical categories, or advisory committee, radiation oncology staff and diplomates could choose general radiation oncology trustees developed a Focused Practice Recognition questions. in Brachytherapy (FPRB) proposal, which was ultimately approved by the American Board of As development of the modular examination Medical Specialties. The project included elements proceeded, it became apparent that several of education, clinical care, clinical research, and combinations of clinical material that had served data collection and received significant unrestricted well for the qualifying and certifying examinations financial support from Varian Medical Systems, were not appropriate for the MOC examination. Inc. Despite various organization announcements, For future examinations, bone and soft tissue publications, and presentations, participation was sarcoma questions will be removed from the thoracic significantly lower than had been anticipated, and (formerly called lung) category and included in the in February 2015, the ABR trustees decided to 12 13 MEDICAL PHYSICS REPORT

by G. Donald Frey, PhD, Finally, the ABR has instituted a rule stating be at least five years post initial certification Participatory Quality Improvement is based Associate Executive that after passing the Part 1 exam, candidates and must have previous experience on an on active participation in quality and safety Director for Medical will have no more than 10 years to become ABR question-writing committee. All new activities in your medical physics practice. A full Physics board eligible. Because some candidates pass examiners must be enrolled in Maintenance of list of 16 qualifying activities can be found at Part 1 but never continue with the certification Certification (MOC), and beginning with the www.theabr.org/moc-rp-comp4. he past year has process, the new rule will allow dormant 2016 exam, all examiners, as well as all other seen several files to be closed. This rule has already been ABR volunteers, must be enrolled in MOC. The ABR also is working to simplify its attesta- changes to the implemented, but candidates who now are tion requirements for Part 1 (Professionalism), T reaching their 10-year limit will have until 2017 Each year the examiners receive training on the Part 2 (Lifelong Learning and Self-assessment), initial certification (IC) and Maintenance of to become board eligible. oral exam and its content, and new examiners and Part 4 (Practice Quality Improvement). Certification (MOC) have additional training. The examiners are “Simple Binary Attestation of Meeting MOC programs for medical physics. These changes The Oral Examination organized into panels, and the panel chairs have Requirements” will become available on myABR may be of interest to medical physicists, as well further training on ABR procedures and scoring. as of Monday, January 4, 2016. Finally, the ABR as medical physics residents, students, and The Oral Examination in Medical Physics Following the final evaluation of the candidate is exploring alternatives to the current Part 3 program directors. is designed to test the clinical skills of the by a panel, the scores and decision of the panel requirement of a secure, proctored MOC exami- candidate and assess his or her readiness to are reviewed by the associate executive director nation every 10 years. More information about Initial Certification – Part 1 practice medical physics independently. A (AED) for medical physics and a medical physics these improvements can be found in the “MOC broad range of topics gives each candidate the trustee to verify that there were no errors in the Update” article on Page 8. To ensure that certification requirements are following opportunities: process. being met, the ABR audits a small percentage of Part 1 applications each year. Fortunately, • To demonstrate an understanding of To ensure that each question is asked in the The oral examiners are selected past audits have shown that the vast majority common medical physics equipment same way by each examiner, all examiners of Part 1 candidates meet ABR certification performance evaluations who will be asking a particular question meet from experienced medical requirements. To more closely align our • To analyze the results of these evaluations together to discuss each of the questions. physicists who have either MS requirements with CAMPEP expectations for and make appropriate recommendations During the course of the exam, the examiners graduate programs and residencies, the ABR has • To explain how patient care may be affected are observed at least twice by either a trustee or or PhD degrees. made a number of changes in the way audited by the performance of clinical equipment the AED for medical physics. candidates are evaluated. • To analyze uncommon situations and explain how the candidate would approach The oral exam categories used in all three If you were recently certified, you should be Beginning in 2016, the two required bioscience them physics disciplines were identical for many aware of the following: courses will be Anatomy and Physiology and • To communicate the results of medical years. These categories remain very relevant for Radiobiology. The ABR will also require the physics evaluations. therapeutic medical physics, but an analysis by • Continuing education (CE) and self- following medical physics courses: Radiological the oral exam committees suggested that the assessment continuing education (SA- Physics and Dosimetry, Radiation Protection The focus of the oral exam is on clinical compe- congruence between the categories and clinical CE) credit completed during the year of and Safety, Fundamentals of Medical Imaging, tence. This distinguishes it from the Part 1 and practice could be improved for diagnostic certification can be counted for your first and Radiation Therapy Physics. Variation in Part 2 exams, which focus on the fundamental medical physics and nuclear medical physics. MOC look-back. the names of these courses is acceptable as long concepts of medical physics and include Thus, new categories were developed for those • A Practice Quality Improvement as they match the CAMPEP-required courses. detailed calculations. The oral exam includes two specialties. The current categories are listed (PQI) Project or Participatory Quality Credits for the bioscience and medical physics 25 questions in five categories. Each candidate at www.theabr.org/ic-mp-study-guide#oral. Improvement Activity completed during courses must total at least 18 hours. is examined by five examiners, each of whom A statistical analysis of the revised categories your residency can be counted for MOC. asks one question in each of the five categories. showed a performance similar to that of the • You may claim up to 25 CE credits for a year The number of Part 1 applications for 2015 This ensures that the candidate’s score in each traditional categories. of fellowship in a clinical environment. remained about the same as in 2014, returning category is the average of the scores on five to historic values. The large increases in 2012 questions evaluated by five different examiners. Maintenance of Certification (MOC) As these credits will not automatically appear in and 2013 were most likely due to an influx of Improvements myABR, you should keep documentation in case candidates who chose to enter the system before The oral examiners are selected from you are ever audited. If you have any questions, CAMPEP requirements were fully implemented. experienced medical physicists who have either The ABR has added the category of Participatory please contact the ABR MOC Division by email The number of candidates certified each year MS or PhD degrees. The pool of examiners Quality Improvement Activities as an additional ([email protected]) or call the ABR Connections is closely related to the number entering the contains physicists from private practice and way to meet the MOC Part 4 requirement. Center at (520) 519-2152. 14 system. from academic departments. Examiners must 15 INTERVENTIONAL RADIOLOGY REPORT

by Anne C. Roberts, MD, initial years of implementation, some transfers transition is expected to be a seven-year process. interested in practicing in IR can seek Associate Executive of DR residents into the IR/DR certification The ACGME anticipates that the last year of certification in DR with a subspecialty in VIR, or Director for Interventional pathway are expected and will be accommodated. accreditation for one-year VIR fellowships will pursue these two certificates via the Diagnostic Radiology be 2019-2020. When the ACGME ceases to and Interventional Radiology Enhanced Clinical Candidates for the IR/DR certificate will be accredit VIR fellowships and instead accredits Training (DIRECT) pathway. (Please note, he new required to successfully complete a residency only the new IR residencies, the VIR subspecialty however, that DIRECT pathway candidates interventional at an ACGME-accredited IR program to meet certificate will sunset. Those who hold a must finish their residencies and fellowships by Tradiology/diagnostic the training requirement for certification. VIR subspecialty certificate will be issued a 2020, and no new DIRECT pathway candidates radiology (IR/DR) primary The program requirements will provide three replacement IR/DR certificate at no additional may begin training after July 2016.) Those certificate, approved by the potential ways to achieve this training: either a cost if they are meeting all MOC requirements. who have begun DR training also may have the American Board of Medical five-year integrated program of diagnostic and This process will likely begin in 2018. opportunity to transfer into an IR residency at Specialties in 2012, continues to progress, and their own institution to seek initial certification the ABR could issue the first initial certificates as Suggestions for Candidates Currently in in IR/DR. soon as 2017. The IR/DR certificate was designed Training to recognize interventional radiology as a unique Those certified in IR/DR will have The ABR will continue to provide information medical specialty, addressing the diagnosis demonstrated competency to The ABR recommends that these candidates regarding the new IR/DR specialty certificate as and treatment of diseases through expertise in continue their training and seek certification it becomes available. Please check our website at diagnostic imaging, image-guided minimally practice in diagnostic radiology, according to the current processes. Those www.theabr.org for the latest information. invasive procedures, and the evaluation and clinical management of patients with conditions as well as the full scope of amenable to these methods. Those certified in interventional radiology. IR/DR will have demonstrated competency to practice in diagnostic radiology, as well as the full scope of interventional radiology. interventional radiology (this will be the first The Accreditation Council for Graduate Medical stage for most programs), or a combination of Education (ACGME) has approved the program DR residency followed by an independent one- or requirements for the Interventional Radiology two-year IR program (this will be implemented Residency Program, and applications for program later by most programs who decide to offer it). accreditation are now being received by the The number of years spent in the independent IR Radiology Residency Review Committee (RRRC). program depends on how much interventional An onsite visit is required for all applying sites, radiology experience the resident obtained in his and for the programs that have already applied or her DR program. to the RRRC, site visits are being scheduled. The first programs may be evaluated at the November The examination structure will consist of the DR 2015 meeting of the RRRC, and if accredited, Core Examination in the 36th month of residency they should be able to enter trainees as early as training, and an IR Certifying Examination with the 2016-2017 academic year. both oral and computer-based components three months after completion of training. Expected Components and Rules Details of the examination structure and specific requirements for each exam are still being Individuals interested in IR/DR certification will determined. need to apply specifically for this new residency. Candidates may NOT be actively enrolled for Impact on VIR Subspecialty certification in both DR and IR/DR—only one training program leading to certification may be The IR/DR certificate is designed to eventually pursued at any given time. However, during the replace the VIR subspecialty certificate. The 16 17 BOARD OF GOVERNORS BOARD OF TRUSTEES

Dennis M. Balfe, MD John K. Crowe, MD Lane F. Donnelly, MD Donald J. Flemming, MD Donald P. Frush, MD Chair, Board of Trustees Diagnostic Radiology Diagnostic Radiology Diagnostic Radiology Diagnostic Radiology St. Louis, Missouri Scottsdale, Arizona Houston, Texas Hershey, Pennsylvania Durham, North Carolina

Ella A. Kazerooni, MD Mary S. Newell, MD M. Elizabeth Oates, MD Robert D. Zimmerman, Kaled M. Alektiar, MD Diagnostic Radiology Diagnostic Radiology Diagnostic Radiology MD, Diagnostic Radiology Radiation Oncology Ann Arbor, Michigan Atlanta, Georgia Lexington, Kentucky New York, New York New York, New York

From left: Lisa A. Kachnic, MD, President-elect; Milton J. Guiberteau, MD, President; and Geoffrey S. Ibbott, PhD, Secretary/Treasurer

Stephen M. Hahn, MD Dennis C. Shrieve, MD, Lynn D. Wilson, MD, MPH Anthony L. Zietman, MD John A. Kaufman, MD Radiation Oncology PhD, Radiation Oncology Radiation Oncology Radiation Oncology Interventional Radiology Philadelphia, Pennsylvania Salt Lake City, Utah New Haven, Connecticut Boston, Massachusetts Portland, Oregon

Dennis M. Balfe, MD Mary C. Mahoney, MD Vincent P. Mathews, MD Matthew A. Mauro, MD Duane G. Mezwa, MD Brent J. Wagner, MD Chair, Board of Trustees Cincinnati, Ohio Milwaukee, Wisconsin Chapel Hill, North Carolina Royal Oak, Michigan Reading, Pennsylvania St. Louis, Missouri

Jeanne M. LaBerge, MD James B. Spies, MD, MPH Jerry D. Allison, PhD Michael G. Herman, PhD J. Anthony Seibert, PhD Interventional Radiology Interventional Radiology Medical Physics Medical Physics Medical Physics San Francisco, California Potomac, Maryland Augusta, Georgia Rochester, Minnesota Sacramento, California

Executive Staff Members Staff Division Directors Donna Breckenridge, MA, Communications and Editorial Services Victoria Franz, CPA - Finance (CFO) Anthony Gerdeman, PhD - Psychometrics and Evaluation Aaron Gudenkauf, BS - Exam Services Karyn Howard, BS - Administration and Human Resources Nick LaPrell, BS - Information Technology David Laszakovits, MBA - Certification Services Valerie P. Jackson, MD Kay H. Vydareny, MD Anne C. Roberts, MD Paul E. Wallner, DO G. Donald Frey, PhD Executive Director Assoc. Executive Director Assoc. Executive Director Assoc. Executive Director Assoc. Executive Director Tucson, Arizona Diagnostic Radiology Interventional Radiology Radiation Oncology Medical Physics 18 Atlanta, Georgia La Jolla, California Bethesda, Maryland Charleston, South Carolina 19 NEW TRUSTEES 2015

The ABR welcomes the following new trustees, whose M. Elizabeth “Liz” terms of service began on November 1, 2015. ABR Oates, MD, a diplomate trustees participate in leadership and decision making to in diagnostic radiology carry out the ABR’s mission and set standards for board and nuclear radiology, certification in initial certification and Maintenance of received her education Certification. at Boston University School of Medicine and Michael G. Herman, completed a radiology PhD, is a board-certified residency at LA County medical physicist who is Harbor-UCLA Medical involved with practice, Center, as well as a nuclear radiology fellowship education, and research at Tufts-New England Medical Center. As in the Department of Rosenbaum endowed chair of radiology and Radiation Oncology at the professor of radiology and medicine, Dr. Oates Mayo Clinic in Rochester, serves as the department chair at the University Minnesota. He is professor of Kentucky in Lexington. She chairs the of medical physics and American College of Radiology’s Commission on chair of the Division of Medical Physics. He earned Nuclear Medicine and Molecular Imaging and a bachelor’s degree in engineering physics at serves on the Board of Chancellors. Dr. Oates Lehigh University and a doctorate in experimental also sits on the Diagnostic Radiology Residency nuclear physics at the University of Rochester. Review Committee. Her interests include all Dr. Herman has held leadership positions in the aspects of nuclear radiology education and American Association of Physicists in Medicine practice. and the American College of Medical Physics. He mentors clinical medical physics fellows and James B. Spies, MD, graduate students with current interests in image MPH, is chair and chief guidance, particle therapy, and patient outcomes. of service at MedStar Georgetown University Mary S. “Mimi” Hospital’s Department of Newell, MD, holds a Radiology and professor lifetime certificate in at Georgetown University diagnostic radiology School of Medicine in and is an associate Washington, DC. He professor of radiology was board certified in and associate director diagnostic radiology in 1984 and in vascular of Emory University’s and interventional radiology in 1995. Dr. Spies Breast Imaging Division earned a medical degree at Georgetown, served in Atlanta, Georgia. a residency at the UC School of Medicine in San She graduated from the University of Michigan Francisco, and completed a fellowship at the New Medical School in 1984. She currently serves York University School of Medicine. He is an as chair of the Appropriateness Criteria and interventional radiologist whose primary clinical Parameters Committee for Breast of the American and research interest is in uterine embolization College of Radiology and treasurer of the Georgia for fibroids. His special interests include uterine Radiological Society, and her areas of clinical artery embolization and gynecologic intervention. interest and special expertise include breast cancer imaging.

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