Firstly, it should almost go without saying, but: you can do this.
I’d also like to acknowledge that nothing below is particularly noteworthy or novel advice. The Core Exam is like the other high-stakes multiple choice exams you’ve taken except for the fact that it has more pictures.
And, of course, the question of how to pass the Core Exam after a failure is mostly the same as asking how to pass it in the first place. Before we get further, I published a series of articles grouped here as a “Guide to the Core Exam” that lays out a lot of helpful information. There are some out-of-date passages about failing because physics and in-person details, but the core information is unchanged.
Acknowledge Luck
As you no doubt noticed during your first attempt(s), the questions on the ABR exams are somewhat arbitrary in what they include, so part of your performance is luck of the draw. While the difficulty is curated, the specific content breakdown is not a perfect cross section of possible topics. You can have the same diagnosis multiple times but then zero questions on broad swaths of important material. How your knowledge gaps line up can make a big difference.
Your performance on a given day is a product of your variable skill (energy, focus, attention, etc) and the exact exam you get. All things being equal, that means that a borderline failure is also truly a near pass.
Dissect Your Performance
Look at the two breakdowns: organ (breast, cardiovascular, GI, GU, MSK, neuro, peds, and thoracic) and modality (CT, IR, MR, Nucs, radiography, US, NIS, and Physics). Find if you have outliers, and plan to shore up those shortfalls with extra dedicated targeted review.
At the same time, do not neglect your strengths entirely. Backsliding is counterproductive.
The nature of spaced repetition is that you need more reps more frequently for new knowledge and problem areas and fewer reps spaced further apart for your strengths—but you still need reps across the board.
Further Reading: Learning & The Transfer Problem
Review Your Study Methods
What exactly was your study method and plan for your initial attempt(s)?
There are a couple of maladaptive tendencies common amongst medical students that can persist into residency:
- The tendency to graze across too many resources. Focus on fewer things and learn them deeply.
- The tendency to spend too much time passively reading (and especially re-reading) books like Crack the Core at the expense of doing lots of high-quality questions. We are radiologists, and the majority of the exam is image identification: you need to look at lots and lots of pictures.
When it comes to doing practice questions, you also need zoom out and look for trends:
More than just stronger/weaker subspecialty performance, are there any themes to why you get questions wrong? Is there a time component? Is it that you often don’t see the finding in the picture? That you simply don’t know the diagnosis? Or that you’re being fooled by differential considerations and need to focus on key features that distinguish between plausible alternatives? Is it a confidence issue and you’re overthinking it, getting spooked by questions that seem too easy? If you change answers, are you more likely to change from wrong to right or right to wrong? (I think most people overthink it and change for the worse).
If there’s a pattern, it can be the key to unlocking performance.
Further Reading: Dealing with Test Anxiety and Demoralization
Questions/Cases > Reading >> Re-reading
First: Horses > Zebras.
In general, the biggest bang for your buck is still going to be common diagnoses (including weird looks of common things) and normal variants over esoterica. Rare things arise most when they are absolute Aunt Minnies that you can tell at a glance (hence the need for lots of image-based questions).
On a related note, if you never saw them, the ancient free official ABR practice test from 2014 is available on the Wayback machine here.
Also worth mentioning: NIS is a bunch of random material. Many people can read the manual a copy of times and get the job done here, but the reality is that these need to mostly be easy points. If you don’t retain pseudoscientific business jargon naturally, then don’t shirk the review here. The NIS App, for example, is well-reviewed, but there is also an Anki deck as well.
Spaced Repetition
You can use the ACR DXIT/in-service Anki deck for a large number of good free questions. You could also use one of the massive Core Radiology decks. But for the second round of studying after a failure, making quick cards of every question you guess or get wrong from whatever source you’re using with your phone’s camera or with screenshots and incorporating that into repeated longitudinal review may be the highest yield.
In Windows, for example, Windows+Shift+S opens up a quick adjustable screenshot reticle that will copy that portion of your screen to the clipboard.
On Mac, the adjustable screenshot shortcut is Shift+Command+4, which automatically saves to desktop. To save to your clipboard, add Control, so Ctrl+Shift+Command+4.
The Reality
Passing is almost certainly a matter of doing more, high-quality reps while not over-focusing on weaknesses such that you backslide on your relative strengths. The Core Exam is arbitrary enough that some of your high and low-performance areas may not be as meaningful as you think, so you need to continue broad reps in addition to the extra targeted review.
Once you can emotionally recover from the setback and just get back to it, it’s going to work out.
Further Reading: Focused Nonchalance