Radiation Oncology Certifying (Oral) Exam Updates

Brian Davis, MD, PhD; Steven Frank, MD, FASTRO; Andrea Ng, MD, MPH, FASTRO; Kenneth Rosenzweig, MD, FASTRO; John Suh, MD, FASTRO; Catheryn Yashar, MD, FASTRO; and Michael Yunes, MD

Board certification is an essential component in building trust between the public and physicians.¹ There are 24 American Board of Medical Specialty (ABMS) boards in 38 specialties that each have a unique approach to certification, tailored to the clinical discipline.² Each board is entrusted with developing relevant standards and ensuring that all aspects of certification continually evolve to improve the assessment of candidates.

The American Board of Radiology is one of 14 specialty boards that require oral exams, or a verbal assessment, prior to granting certification.³ Radiation oncology, interventional radiology and medical physics have continually required the oral exam, while diagnostic radiology is returning to this critical assessment in 2028 after transitioning away from the oral exam for over a decade. The legacy oral exam was offered in person in Louisville, Kentucky, and briefly in Tucson, Arizona, for diplomates certified prior to 2021. This exam was administered once a year, typically in May. In 2020, no oral exams occurred due to the pandemic, which subsequently led to a rapid transition to a successful remote oral exam model. The ABR determined that delivering the oral exam remotely was safe, reliable and equally effective, without the challenges associated with a face-to-face exam.

The development of a dedicated remote oral exam system has reduced the need for examiner and examinee travel and the associated stress. In addition to the spring exam, a fall exam was reinstituted to accommodate candidates with life events that make taking the Spring exam impractical. This enables candidates who have conditioned one or two sections of the exam an opportunity to obtain certification more rapidly. An additional benefit of the remote software is that it gives the ABR the ability to continually improve oral exam content and delivery. The goal is to standardize as much as possible, ensuring that each examinee is provided the same opportunities regardless of the examiner, category, location or date of the exam.

Given our commitment to continually improve the exam, we collect feedback from examinees and examiners after each remote exam, leveraging their insights alongside input from ABR psychometric and information technology specialists to drive continuous improvements, leading to incremental enhancements in the overall experience. Additionally, we refined our examiner training, further advancing the goal of minimizing assessment variability. Our aim is to improve standardization of exam processes to reduce unintended risk.⁴

The ABR Radiation Oncology Oral Certifying Exam was most recently remotely administered April 6-8, 2025. Following each exam, the radiation oncology trustees meet together and discuss potential themes to share with training programs, residents and recent graduates. Over the past several years, the following points have been identified as warranting additional attention:

1. Candidates who conditionally pass one or two sections of an exam will successfully obtain certification at the next exam opportunity at a very high rate (>93% over the past five years).
2. The ABR offers a single radiation oncology certification that includes all treatment modalities including external beam (photons, electrons, protons, heavy particles), brachytherapy (permanent interstitial, high dose rate, low dose rate, etc.) and radiopharmaceuticals (unsealed sources). The ABR does not customize its qualifying or certifying exams to specific practice patterns.
3. The exam questions represent a small sample of very large domains. It is impossible for each exam to cover every topic; therefore, each exam administration will be unique.
4. Each candidate who struggled in a particular category is discussed with all examiners in that category. This ensures scoring consistency and helps determine the gravity of potential errors. Following these category meetings, the full panel of examiners reviews the final scores of each candidate. During this meeting, a marginal failure in one category may be raised if the examinee performed well in other categories. Each examiner for that candidate has an opportunity to present strengths and weaknesses for the other examiners to consider in this crucial decision. A candidate’s final score is not determined by a single examiner, but rather by many examiners through a careful and collaborative deliberation process at both the category and panel levels.
5. Brachytherapy is an essential element of board certification. Examinees should be able to discuss the role of brachytherapy as well as dosimetry, physics and the guidelines for the use in all disease sites that utilize it.
6. Candidates are reminded that organ at risk constraints and treatment parameters should be understood and are appropriate questions in the certification exam. Deferring these questions to a dosimetrist or physicist is not an acceptable response during the oral exam.