The ABR Online Testing Experience

When I finally got around to taking the Neuroradiology CAQ Exam this fall, I finally had the pleasure of partaking in the ABR’s remote testing platform. I put a lot of work into my posts about the Core and Certifying Exams back in the day, but they do hail from the pre-pandemic era.

Here are some thoughts on taking an ABR exam from the comfort of not Chicago or Tucson:

Big Brother

ABR relies on a third-party company called Proctorio for monitoring. Update: As of 2022, the ABR is now handling remote monitoring in-house instead of relying on a third-party vendor.

Everything–including the real-time video monitoring, capturing a photo of your picture ID during the start-up process, and the “room scan”–rely on the webcam. This feature was clearly intended to be used on a laptop, which you could easily pick up and spin around the room. The ABR now requires a separate dedicated side-view webcam, which makes the acrobatics a bit more complicated.

Instead of buying a separate webcam, I used a super old DSLR with a $15 HDMI to USB video capture card (the knockoff of the better Cam Link). This works fine (and it’s what I use for Zoom calls to have that beautiful bokeh so that people like me more), but it’s worth noting that if you don’t have good autofocus (and mine is so old that it does not), that it may take a few tries to get the screengrab of your photo ID good enough to satisfy Proctorio’s artificially intelligent needs. Depending on your desk set up, a relatively short cable connecting the camera to the computer or a tripod to have the camera high enough to actually see anything if you don’t have a dresser or something suitable nearby can make the room scan awkward and a bit tenuous. A longer USB cord helps. After around 5 minutes of finagling, eventually, I was allowed to take the test.

You could also use your phone as a webcam by using one of many inexpensive apps like Camo or EpocCam, which is probably the best option, especially if you already have some sort of suitable stand or one of the infinite variety of cheapo phone tripods.

Anyway, what I’m trying to say is I don’t think most people need to buy a dedicated external webcam just for the purpose of taking one of these ABR tests. Especially since most webcams are terrible.

I will say that Proctorio didn’t make me install any apps on my phone, and the Chrome Extension is easy to uninstall. I don’t think anyone is going to have their identity stolen or be harassed by call center employees. While I am admittedly not very experienced with the myriad options for education spyware, it seems like the ABR picked one of the better players.

Computer Set-up

I really wanted to use my home workstation. It has direct fiber internet and a system I use every day for radiology-type stuff. However, Proctorio and the ABR have a 1 monitor rule, and I–in my radiologist glory–have 4 monitors. To satisfy Proctorio, any extra monitors in the space have to be missing from your system entirely, so simply turning them off isn’t good enough. They need to be totally unplugged from your computer so that they don’t show up. I use a dual PC system set-up to read simultaneously for the hospital and our outpatient PACS by swapping monitors and peripherals between two different PCs using a KVM switch. It’s awesome. But the nest of monitor cords is no joke, and the settings are just how I like them, and there was no way I was going spend the time unplugging stuff and jeopardize any of that in order to take a 3-hour exam with a bunch of low-quality JPGs.

Instead, I took it on my 2017 iMac over WiFi, which is across the house from the router, and it was fine. The biggest problem was getting Proctorio happy with the backlighting from the adjacent window overexposing the camera and making me look too dim.

Yes, I did roll over my attending chair, the Herman Miller Embody, from across the house for the experience, and it was worth it.

The Practice Test

The practice test is a 98 question process, but really it’s just designed to get you to make sure you can pass Proctorio’s welcome barriers and familiarize yourself with the software. The content is a random hodgepodge of questions, but there is no performance feedback or answer key, limiting usefulness as an actual practice exam experience.

The content parallels the Core Exam, which is to say I found it more difficult now as a super high-performing experienced attending radiologist than I would have as a resident. Go figure.

The Online Platform

I would show you some screenshots, but, you know, I can’t.

The software is totally fine. It works. You have a bunch of tools to manipulate the images, but since most images are just static screen grabs of middling quality, you usually don’t need to do anything. In fact, the image sizes are small enough and the questions themselves short enough that you really don’t need or even want a large monitor or anything fancy to take the exam. Your average laptop screen has plenty of real estate.

The ABR locks your past performance every 30 questions to prevent you from altering your responses to prior questions after you’ve left the surveillance zone for breaks (aka cheating). Locking so frequently is a touch annoying, and I’m sure the policy frustrates the people who want to blaze through the whole test and then agonize for hours on all the questions they flagged at the end. Psychologically, this is probably healthier, though it does make flagging a question basically useless.

I wish they just locked questions at breaks and not after so short a period, but given intermittent connectivity issues, the shorter batch size probably helps substantially reduce their tech support demands. It’s a worthwhile price to pay for the convenience.

Another irritating feature is that the ABR really wants you to move forward through the exam and not backward to revisit old questions, so much so that if you try to visit the previous question, the software prompts you with a pop-up saying (paraphrasing) “forward is so much better, are you sure you want to go back?”…which is annoying. I think the idea here is that they especially don’t want you to see a question, not answer, go backward, lose access in some way, and then have to unlock the question for you and/or question your integrity. 

On exam day, I got a brief “connection lost” warning twice, lasting for a few seconds before being reestablished automatically, otherwise no interruptions. I know people personally and online who had less good luck, sometimes being completely kicked out and needing to call to have questions unlocked. To their credit, I’ve only heard good things about ABR customer service when it comes to helping with exam connectivity issues.

Overall

Overall these inconveniences are a small price for being able to wear pajamas and take a break literally whenever you want, which is wonderful. The ability to use a bathroom mere feet away or get drinks and snacks on a whim creates a completely different ambiance than a typical testing experience.

Not having to pay for flights and hotels, waste days on both ends for travel, and leave your family is also almost priceless.

In some ways, it’s a little harder to get in the normal high-stakes exam headspace without the suffering, but it’s a breath of fresh air that I enjoyed nonetheless. I bought a twelve-pack of Diet Mountain Dew just for the occasion, and I made myself a nice fresh ice coffee as well (see above, hat tip double-walled insulated glasses) to sip while answering ludicrous questions about differentiating spinal cord tumors. 

If that’s not the dream, I don’t know what is.