ABR Core Exam preparation
The ABR Core Exam is the first step in board examinations for radiology residents, taken at the end of the R3 or PGY-4 year of radiology. This exam covers a variety of topic, including non-interpretive skills, physics, and then each subsection of radiology separately. There are a ton of study resources out there, and a lot of people suggesting how you might prepare.
As of now, the exam has been moved to online only because of the pandemic. Residents are now allowed to take the exam remotely over a 2 day period from their home sites. While not explicitly divided into sections, questions do seem to be clustered by category or at least all on a single day. That is, all the neuroradiology questions are probably all going to be clustered on one day of the exam.
There are 2 online study guides for the ABR core exam, both of which are a joke for separate reasons. The main ABR core study guide is pointless because it’s 135 pages long and simply a list of all topics in radiology. Each subsection then has a “Core Exam Blueprint”, which gives the division of questions by percentage. For example, see the version for neuroradiology. Somewhat more helpful, but so generic as to be useless.
The scoring of the exam has been controversial, with complaints about the arbitrary nature of the exam, high variability in failure rates, and black box approach to scoring.
The scoring of the exam has been controversial, with complaints about the arbitrary nature of the exam, high variability in failure rates, and black box approach to scoring. Moreover, the failure rate continues to increase, with a brutal 16% failure rate in 2019. The ABR maintains that it is scored according to a criterion based standard, which means that it isn’t on a curve, but I think the biggest problem is no one knows who decides what a 3rd year resident should know (and it’s most likely faculty overestimating what a resident should have known based on what they think they can remember from 10-20 years ago). You cannot condition individual sections except physics. So there are only 3 possible outcomes:
- Overall pass
- Condition exam based on physics, retake physics
- Overall fail
The remainder of this page is devoted to the neuroradiology portion of the exam only.
There are likely to be something like 60 neuroradiology questions on the exam. As described in the neuroradiology blueprint, the exam is divided into 5 sections with relative contributions as follows
- Brain (25-30%)
- Spine (20-25%)
- Head & Neck/Skull base (20-25%)
- Physics (15-20%)
- Quality and Safety (5-10%)
Those questions from physics and quality/safety are probably overlapping questions like artifact reduction, radiation dose, etc. I think there is probably a broad definition of head/neck, with not that much coverage of rare temporal deformities, etc.
The bread and butter of this exam is the multipart image based question, where an initial question is shown with a series of images. This initial question may be about the findings or the most likely diagnosis.
Subsequent questions may continue to be about that case. Sometimes, it may lock your first answer before allowing you to progress. The follow-up may give you the answer to the first question, or simply throw you off. It’s hard to tell but you should be prepared for minor frustrations.
Image quality has overall been poor. Images are known to be too small, not scrollable when they should be, and often widowed inappropriately.
Further quick tips are found in the introduction to board review videos, such as Intro to Board Review 1.
There are number of online question banks which address the radiology core exam. It is not my intent to review them all here. You will find a better reviews of the sites, their pros and cons, and their cost elsewhere. Some of the options include
There is a nice review of these resources at Benwhite.com.
Ask your senior residents which of these have been most valuable, useful, and cost effective in recent years. It probably varies over time. Many residents get Radprimer through their residency, which almost certainly makes it worthwhile. However, it is probably too long and detail oriented for structured review.
There are a number of great neuroradiology books to use throughout your residency. My personal favorite as a study tool to recommend while on rotations is Neuroradiology: The Requisites. It has enough detail when you want it, or you can just skip through relevant sections and look at the captions when you don’t have time. Other books I have found very readable and useful are Problem Solving in Neuroradiology and Neuroradiology Companion.
For general board review, people generally love Crack the Core Exam by Prometheus Lionheart. It comes as a Volume 1 and Volume 2, and has been updated for 2022. There is also a Crack the Core Case Review and a dedicated Core Physics review called Radiology Physics – War Machine (amazing title, right?). I hear great things, but beware that some people have warned that the ABR is deliberately trying to avoid topics in this book. Go figure… the ABR trying to avoid general topics.
Case based books are also a useful supplement as you study, including:
- Case Review Series: Brain Imaging
- Case Review Series: Spine Imaging
- Case Review Series: H&N Imaging
- Neuroradiology: A Core Review
A full description of these books (as well as others) is found below:
The only way to succeed on this test is to study consistently throughout your residency. For most people, there is a lot of time between daily obligations and call to read too much. I find that the easiest way is to spend a few minutes each day reviewing a topic that you see at the view station. If you see a brain tumor for instance, but then read a short article or a section of a book, or watch a video on brain tumors to solidify that day’s knowledge.
Use your downtime appropriately to read websites, including Radiopaedia and StatDx.
Most residencies also offer series of board review lectures. Make the most of these, as most high-level residencies have excellent review series and offer dedicated study time for residents.
UCSF board review DVDs, if you have access to them, are high quality and comprehensive, although the versions circulating can be somewhat dated. They are highly relevant to this exam.
From this website, I recommend first getting familiar with some of the more high yield topic general reviews, including:
Then proceed to the board review case style videos
I then suggest finishing up with the high speed review (one minute per case). If you are limited on time, then start here.
The ABR core exam is a bit of an uncertainty. The pass/fail rate has varied considerably over the years, and the level of detail expected has been highly variable depending on the year. Based on how they prepared, similar quality residents can leave the exam feeling positive or demoralized. The inclusion of physics and on interpretive skills make it even more of a wildcard. At least now they have made it so that you can take it without traveling to Chicago or Tuscon (for the time being).
Good luck though and let me know if you have any feedback after taking the exam.
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