On August 15, 2019, the American Board of Radiology (ABR) released the results of the core examination for the current fourth year class who took the examination in June of this past year. It is with great pride that I can say that all of our residents passed the examination, and in nearly all of the indicators given to us by the ABR, our residents scored above, and in some cases, well above, the national average. That should not come as a surprise to anyone who knows this group of residents, nor our program as a whole. However, looking at the bigger picture, the failure rate this year shows a disturbing trend.

Over the past three years, the failure rate has gone from 6.3% to 13% to a whopping 15.9% this year. That is almost tripling in three years. The reason for this is not entirely clear. Are these residents not as smart as former residents? Are residents studying incorrectly? Or is it simply the exam isn’t testing what it should be testing? Wherever the disconnect comes from, we face a mini crisis in Radiology education with our core examination and the answer is not readily apparent.

In a recent article in the American Journal of Roentgenology, Horn et al[1] examined predictors for failing the core examination. They surmised that residents who read less exams would perform poorer than residents that read higher numbers. In fact, there was no correlation at all between core performance and number of exams read. Instead, it was standardized test performance on previous exams that correlated with core performance. So, instead of traditional markers of what we consider success in Radiology (reading a lot of studies and being able to interpret them eloquently), it was being a good test taker that predicted your ability to do well on the core exam. While I am pleased our residents performed well this year, I hope that the ABR is paying attention and looking at this disturbing evidence that the core may not be serving our residents well. We will continue to look at how our residents study for the exam and improve upon what has been working to ensure our success going forward.


Peter Bream, Jr.
Diagnostic Radiology Program Director

Horn GL, Herrmann S, Masood I, Andersen CR, Nguyen QD. Predictors for Failing the American Board of Radiology Core Examination. Am J Roentgenol. 2019:1–5. doi:10.2214/ajr.18.21007