There’s always a tension between giving specific advice (that doesn’t generalize well across different programs) and broad advice (that can sometimes be almost meaningless), but with that caveat, here are some thoughts about starting radiology training:

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I’ve given the ABR a lot of flak over the past few years at pretty much every opportunity, from their expensive, non-portable, and occasionally questionably-written examination to their fumbling of a technical mishap during last year‘s June examination in Chicago. Today, I wanted to highlight something I think the ABR does well, which is something that other medical boards should strive to do better: support nursing mothers.

I also wanted to give additional props on customer service, because unlike my experiences in the past, when I emailed the ABR recently to confirm their nursing mother’s policy, they responded within an hour with a detailed and thorough response.

These are the ABR accommodations for nursing mothers:

* Your pump must be kept in your locker until needed.
* A private room is available where you can go to pump.
* If you do not have a battery-operated pump, an electrical outlet will be available.
* You will need to provide your own method to store / refrigerate the milk.
* Your break time clock will be updated to reflect a total of 60 minutes of break time. While on break, your exam time will pause and break timer will count down. Once break time has expired, your exam time will begin counting down.
* Any extra time you need beyond the additional time will cut into your regular exam time.
These accommodations are standard at both Tucson and Chicago locations.

So, the ABR provides a private space with an electrical outlet and a bit of extra time (30 min) to accommodate nursing mothers. They do ask that you submit an official-looking ADA form at least three months in advance, but this is only a mild inconvenience because they clarified that they do not require a signed doctor’s note as would be necessary in the case of actual disability.

In years past, the ABR has told candidates that no electrical outlet was available, forcing several budding radiologists to purchase a new battery-operated or rechargeable breast pump, a special pump battery pack, a more expensive multipurpose plug-enabled battery pack, or a hand pump. As of this year, they now guarantee access to an outlet if needed, which means that no one will need to spend any extra money to pump during the exam assuming they have insulated storage and ice packs etc (which they would need for traveling anyway). At this point, the last thing that they could do to improve would be to provide access to a staff refrigerator for storage during the exam.

There is a dearth of women in radiology, and this type of support—while free and requiring only a nominal effort—is nonetheless rare and very meaningful, and I want to give credit where it’s due and applaud the ABR’s improving efforts for inclusivity. One of the perks of the ABR’s choice to administer all examinations at their own locations is that they completely control the experience and the rules.

So while I and others have criticized the ABR for imposing additional travel costs and inconvenience on examinees to fly to one of two testing locations in order to take a computerized exam that should theoretically be distributable, I don’t want to discount the overall good job the ABR does with the exam experience. It’s undeniably substantially better than that of your typical commercial testing center with their prison-like ambiance, inefficiencies, and unpleasant TSA-style pat downs. Accommodations for nursing mothers at most commercial testing centers like Prometric and PearsonVue are typically permission to pump in a filthy public restroom or perhaps your car.

Now, as a comparison: feel free to read how this story of a pediatrician’s experience a couple years back. Or this ACLU post about how the NBME handles nursing. Long story short, even though Prometric locations are required by federal law to have a private room to pump available for their employees, they would never deign to share it with an examinee. Instead, it was:

It is still up to you to find a place suitable to you to nurse; whether it is your car, a restroom, or any other public space accessible to you as an exam candidate

Additionally, many accommodations from boards like the ABIM still require a doctor’s note:

Documentation from a medical provider demonstrating the need for an accommodation – ordinarily, a physician’s letter stating the candidate’s delivery date and the anticipated frequency/duration of sessions to express breast milk will suffice.

That’s just silly.

We’re physicians. The purpose of a board exam is to ensure that trainees and recent graduates are ready for safe independent practice, not an opportunity to play at being a poorly-organized police state.

It’s trivial to give women a quiet room to pump in and the respect that they deserve. It’s not even an accommodation—it’s just the decent thing to do. And I don’t think it’s acceptable in 2018 for most major medical organizations to cede the responsibility for all testing policy implementations to large testing corporations that clearly do not care about service.

While the federal law for nursing mothers was designed to protect hourly employees and doesn’t apply to customers or salaried employees (like residents, sadly), I think a law that was written to prevent the extortion of employees earning minimum-wage is probably a good starting point for the standards we should also expect for physicians and just about everyone else in the country. Good job, ABR.

After years of pretending that people could actually fail (“condition”) individual exam sections other than physics in its convoluted two-stage exam scoring process, the ABR has decided to simplify things going starting this year in 2018.

From now on, there are three scoring outcomes:

• PASS if you get a score of 350 or higher when averaging all sections together (and specifically pass physics)
• CONDITION if you pass the overall exam but score less than 350 on physics
• FAIL if your overall score is less than 350 when averaging all sections together

Conditioning physics means re-taking just physics. Failing means re-taking the whole thing.

This means that your performance on any individual section (except physics) is irrelevant so long as the average score across all sections meets the passing threshold of 350. No surprise there. For followers of last year’s mammography kerfluffle, you’ll remember that the ABR acknowledged that the results of the mammography section in isolation literally had no bearing on a single examinee’s passage result. Whether or not it was really technically possible to condition a non-physics section, no has ever conditioned a section other than physics since the Core Exam’s inception.

Scoring is still cloudy, however, because the passing threshold of 350 is a meaningless number without any measure of the preparation required or the percentage of questions you must answer correctly in order to achieve that score. It’s purportedly derived from the sum of the Angoff method scores for each section based on what the expert panel believes a “minimally competent” radiologist should know. So, whatever. This does mean, however, that strong sections can make up for weak sections. Consider this is your license to ignore GI and GU fluoroscopy.

While this sounds like a big positive development, I believe this is basically just a paper change. The ABR is just acknowledging outright the reality on the ground for the past several years: The large gap between overall passing performance and the true failure threshold for all non-physics sections is so large that in practice no one could actually fail an individual section.

Frankly, I wouldn’t be surprised if the one person per year who should have conditioned a non-physics section was just given a score of 200 on the offending set in order to pass via an informal secretive score floor. Who knows.

But at least it’s simpler and more straightforward now.