American Board of Radiology Core Exam: My Perspective

Got my board results yesterday and I passed. Thank goodness I can close that chapter of my life.

Here are resources that I used to prepare for the exam. I started studying for the exam around February and March.

Board exam:

The board exam is image heavy (about 80% of the questions have images). There are a total of 650 multiple choice questions (MCQ). It is a two-day exam. I had about 350 and 300 questions, on the first and second day. There is an extra 30-minute break each day. You get about one minute per question. The questions are similar to the ACR in-service exams. In general, the questions were straightforward and short.

The first day, I had breast, cardiovascular, IR and MSK. There was a lot of breast MR. The second day, my exam covered GI, GU, and pediatrics.  I had nuclear medicine, physics and quality and safety questions in both days. The quality and safety questions all come from the ABR guideline. There are a lot of questions about quality and safety and the questions are very specific, so the best thing to do is to memorize that booklet. These are easy questions if you review that guide (I made tons of flashcards and did well). There is a Stanford instructor who discusses this booklet in a 12 or so 10-minute YouTube clips. A colleague watched these clips twice (at 2x speed) on YouTube and didn't read the guide at all.

I took the exam in Tucson Arizona. I stayed at the Marriott Inn, which was within walking distance to the ABR headquarters. Overall, the housing, transportation, and food were very accessible and low stress.

My study plan:

I studied for the boards like I studied for other exams (MCAT, USMLE, etc.): practice questions. Since this was MCQ test, I decided I was going to focus on doing MCQs. I did the multiple-choice questions in random tutor mode, and not study by subject because I felt that would mimic the exam more closely.


Qbanks and time intervals:

-7000 questions from RadPrimer (over 3 months)
-Qevlar 2000 questions  (last 3-4wks)
- 500/1200 MCQs from Board Vitals (last 2 wks)
-150 /300 MCQs of Qevlar Nuclear Medicine q-bank (final week)
- 10-15 Face the Core sessions (each session had 75 MCQ) (over 3-4 months).
There is an extra 1200 MCQ from Rock the Boards but I didn't have time to do these. It was probably an overkill to do all of these MCQs but I didn't want to feel like I didn't do everything I could if had I failed.

Time:

My program gave us 3.5 weeks off to study for the exam, so on those days, I spent about 10-12 hours studying every other day.  I think I had about 7 non-working weeks to study (I use my vacation week, conference and research weeks). During the weeks I had off, my study days were more like bursts of studying: I would alternate between studying 12-14 hrs one day doing 200-400 MCQ and then spend 5-6 hrs the following day study and another 3 hrs playing tennis.  I could not study 12 hr days every day...just couldn't stay focus after an exhausting day of studying. So, breaks were critical for me to recover. I went out to dinner once a week with my friends and took one day off a week with my family. I don't think spending this time studying would have changed anything...if anything, these breaks helped me hang on. In fact, I cut back on my "breaks" the last 3 weeks out of anxiety and I think that's why I burnt out.

Resources:

I highly recommend Face the Core sessions which started in February or March. I found about them in April and wished I started from the beginning. These are two-hour webinar sessions with a live instructor and you can ask questions, etc. Before each session, you take a 75 multiple-choice question quiz and then, you review the answers during the webinar. You can see how well you did compare to the average and how high-yield the questions were based on earlier examinee responses. These are great because you get a random smattering of all subjects throughout and you do them twice, all different questions. In total, you complete about 2,000 questions and many of the questions are very high-yield. There are a few sessions that are average, but overall I thought it was a great way to have a broad overview of the subspecialties. The webinars were cheap; it was $20 per webinar. Honestly,  I thought these sessions were more helpful than some of my program's board review because it mimics the boards more closely.

For nuclear medicine, I signed up for the weekend  NuclearMD webinar 100 cases and the radioisotope safety for $200. NuclearMD was a bit expensive but at that point, I didn't care how much I had to spend. I also did the Qevlar NucMed 150/300 multiple-choice question for $30. Of course,  I did the two Face the Core session.  To my surprise, I did well in nuclear medicine, so I guess the sessions must have helped.

I went to Duke review, which was a good review but it was not a make or break for me (concerning the boards). Sitting through 12 hours of lectures is not my forte. If I could do it again, I would've spent the week reviewing UCSF lectures at my convenience and saved myself a lot of money. I reviewed about 75% of the UCSF lectures.

For physics, I completed the 2013 and 2014 RadPhex multiple-choice questions (150 / year) (I know that 2012 is available but I didn't have that at hand) which are great. I also did Huda physics book MCQ, about half of them. There is an iPhone app with 300 multiple choice questions for physics which I completed twice. I did not go to the Huda physics review session. Having returned from 12 hr /day lectures from Duke review, I didn't think I could sit through 8 hour lecture days with Huda. However, I hear from my colleagues (about 80% of my co-residents went) that it was a fantastic review session. The Huda physics book was tremendous, and 3/4 of my physics flashcards came directly from this book. It's a super easy book to read and has most of the useful info you need. I had also completed the RSNA physics modules by March. AAPM also has MCQ questions (~150) which I did. There is a significant emphasis on artifacts and how to fix them. So, make sure you focus on this. Face the Core has two great physics artifacts sessions available (I did both --75 MCQs/session and  $10 /webinar). I hand wrote out all the main learning points for physics into flashcards format and reviewed those flashcards 4-5 times. I don't remember from reading materials and needed to hammer home facts that I knew I wasn't going to recall (like how many mGy per minute of Fluoro, mGy for a CT abdomen, fetal radiation dose, NRC regulations, factors that affect SNR and spatial resolution, etc.).



Flashcards: I started making hand-written flashcards about two months before the exam and I think these flashcards were a turning point; I hadn't made handwritten flashcards since high school. Before that, I would do the MCQs and check the answers and took notes on Google doc. I had electronic flashcards (Anki and FlashcardDeluxe) but there was something nice about writing out the facts and drawing the anatomy. About two months before the exam, I made flashcards for everything: ABR quality and safety pamphlet, physics (based on Huda physics book and RadPhex) and random radiology facts. I would review the flashcards every other day. On the board, most of the questions you either knew or you didn't. You couldn't rationalize the answer. The MCQ review was the source for my Flashcards. Doing MCQs was not enough for me because I would forget the minutia. 

ABR Test Questions:

The ABR has 150 multiple-choice practice questions on the website. I hear that to pass the boards, you need to answer at least 65% of the questions correctly. I think that using the practice multiple-choice questions on ABR website is an effective way to measure how well you would do and where you are. I did the questions 3 weeks before the exam and then 1 day before to see where I was. I scored 15% points higher on my 2nd exam without checking the correct answers to make sure I wasn't cheating myself (I used an excel file to record the provided answers and checked my answers without looking at the questions).   I had also heard from other residents that in earlier years that most people who conditioned on the boards usually conditioned in physics. Per the ABR website, the pass rate is about 90%.



Books: Core Radiology is fantastic. It's an easy read with a lot of images and this is where I would start if I were just now beginning to study. The Core is the closest resource that comes close to First Aid for USMLE. I made a lot of flashcards directly from this book. My co-resident said that she read this book 3 times and that meant a lot to me because she is a ridiculously smart resident. I also heard Crack the Core was good too but I didn't know about it till after the boards.

Taking Multiple Choice Questions:

I should make a note that another benefit for me using this MCQ approach was the ability to develop a strategy for answer the MCQ questions. After completing three-quarters of the multiple choice questions, I realized I was looking at the images first before reading the explanations. Previously, I would read the question, look at the image and then look for the correct answer.  I changed my strategy and decided to read the question, read the answers, formulate key image findings I should see and then look at the image.  When I started doing this, my scores improved by 5-10% consistently on RadPrimer. Understanding this test taking strategy was an important discovery during the process.

Dealing with the Stress:

Studying for the boards was one of the most stressful things I've done. So, keeping the stress at bay was important for me. I went running at least two times a week, played tennis once a week.  About four weeks before the boards,  I finished reading a book called the Art of Learning by Josh Waitskin.  I bought into the author's view of learning and did whatever he did... He is an advocate for mediation, so I started to meditate right before going to sleep every day.  I started at 5 minutes and slowly made my way up to about half an hour every day.  It doesn't feel like I am accomplishing anything when I am meditation but in retrospect,  I think it was a critical change for me and I continue to meditate every day.   You can look up all the benefits of meditation. But I think it helped me be more perceptive of myself,  what works and don't work and how to adjust as needed.  It's like constructing a cognitive thermometer. Another good book that I read to help me with boards was Make it Stick... outstanding resource for understanding effective strategies for learning.  I listened to both books on Audiobooks while driving  (I use the Audible app by Amazon). 

 I took one day off a week to spend with my family. During the weeks that I had off to study, I studied about 4-5 days and played lots of tennis. Despite that, I think I still burnt out, because the last week leading up the exam I could not study very much at all and was ready to be done with it, whether pass or fail. My advice to you: take brakes, pace yourself, do something relaxing at regular intervals. In the last weeks leading up the exam, the stress level was through the roof for me and I cheated myself from taking breaks which was the wrong thing to do.

This is the summary of the strategy that I took:

-Interleave the subjects so that I wasn't  over-focusing on one section. I did MCQs in random order so I couldn't over-emphasize. (Before I started doing MCQ in random order, I did most of the neuro and breast MCQ onRadPrimer before December, so in retrospect, these two subjects were the two weakest sections for me in the boards because I didn't review them closer to the boards. So, be cautious and re-review all the subspecialties.) A good rule of thumb I had heard was to start studying four months before the exam (review everything in 3 months, re-review everything in 3 wks; and review high yield facts in 3 days).

-Making flashcards so that I could consolidate my learning and recall all the facts.

-Constantly test my knowledge. Passively reviewing my notes was ineffective compared to testing myself either with flashcards or MCQs.

-Get into a rhythm. I hadn't studied for 8-10 hrs at a time since college and medical school and I had lost my stamina. But once the routine became regular, I got into the habit of it.  Studying became much easier. In this race, the slow and steady wins the race.

-Take breaks at regular intervals.

Last points:

With a 90% pass rate, the odds are in our favor.  It certainly felt like a rite of passage (painful but glad I'm beyond it now). I wouldn't have studied radiology as much as I did without the motivation of the boards and now as a fourth year, I feel smarter, faster and more confident.


If you have any questions, feel free to contact me. Best wishes to you!  Here is a LINK to a powerpoint that one of my colleagues (among the smartest in my class) presented to the current 3rd-year class shortly after our boards regarding her perspective. LINK to review of question banks I used. Check out additional ABR Core Resources.

Eighteen months after later when you're studying for part 2, check out my blog on the Certifying Exam.

I've gotten several questions about how I make my flashcards. I made a YouTube video showing my technique.


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