Resolution on Board Frenzy

Association of Program Directors in Radiology
To: Members Association of Program Directors in Radiology
and Chiefs of Departments

From: Subcommittee on “Board frenzy” (Boarditis)
Subject: Guidelines
May 8, 2003

A major problem identified by the Association of Program Directors has been called “board frenzy’ or “boarditis”. Accordingly, a resolution sent to the membership stating:

Be it resolved that Department Chiefs and Program Directors insure that, in the presence of pending examinations, all of their residents participate fully in the educational and service aspects of their departments. This resolution was approved by a vote of 135-13.

Given the enthusiastic support of the membership, other involved organizations were contacted with the following unofficial responses:

ABR: In their discussion for changing the timing of the Boards, “Board frenzy” has been a major consideration; the Board will make a decision this year. They also plan to emphasize their long-standing position that the purpose of the examination is to establish competency and that the cases shown are quite typical of those seen in everyday practice.

RRC: Promulgated a statement:

“Full-time participation in educational conferences, clinical services, and call responsibilities is expected at all levels of training, including the final year of residency.”

The RRC said it plans on having their inspectors ask specific questions about adherence to this statement at the time of site visits.

Residents: Both A³CR² and the resident section of the ACR have expressed their disapproval of residents not participating fully in the described full training program of their institutions and the resident section of the ACR has a statement on their web site so stating.

APDR: The next step was to appoint a subcommittee consisting of Janower, Casola, and Herring to develop some guidelines for Program Directors which should be helpful in forming a base from which to combat this problem.

 APDR ad hoc Sub-Committee on the  Program Director’s Role in Alleviating “Board Frenzy”

The justification mentioned most often for considering changing the timing of the oral examination of the American Board of Radiology has been the perception by some that residents develop a “Board frenzy” for a major part of their senior year and become less than conscientious in attending to their clinical and research duties during this time. Some Program Directors feel powerless to effect any change in this behavior.

Since each resident’s education is the ultimate responsibility of the Residency Program Director, the Program Director has the right, the authority and the obligation to require each resident’s complete participation in all four years of the residency training program.

This statement by the sub-committee of the APDR is designed to help empower Program Directors to exercise that authority.

Some guidelines for Program Directors:

	Program Directors should repeatedly emphasize that preparation for the Boards is a four-year process that begins at the start of the residency program.
	The Program Director is responsible for formulating clinical rotation schedules and conference schedules suitable and equitable for residents at all levels of training in the Program. Resident teaching conferences should not be altered in such a way so as to place undo emphasis on Board preparation at the expense of all other residents in the Program.
	Residents should be required to carry-out all assigned clinical and research obligations and provide appropriate patient care throughout the program.
	Section chiefs, faculty and the residents should be explicitly told what is expected of the senior residents on their clinical rotations and should be discouraged from relying on “word of mouth” from previous classes as to what is and isn’t appropriate at Boards time.
	The Program Director should repeatedly counsel faculty and residents that the oral Boards are designed to be a measure of minimal competency and are not designed to test minutiae or esoteria.
	All Board preparation exercises (mock boards, Board review sessions, etc) should be conducted before or after, but not during, normal working hours.
	Call schedules may be altered to allow for increased study time before the Boards but should avoid placing an onerous call burden on more junior residents so as to allow the senior residents “time-off” for the Boards.
	Consideration should be given for a “de-briefing” session immediately following the completion of the oral Boards which involves all of the residents including those who have just taken the oral Boards as well as the Program Director so that information about the examination can be disseminated to all junior residents at the same time in the presence of the Program Director. In this way, any “unusual” experiences of one candidate can be balanced by the experiences of the others.

“Board frenzy” tends to be self-perpetuating. If residents look at those ahead of them and see that they are able to spend much of the latter part of their training program studying rather than participating fully in the activities of the Department, they come to expect that such time will be similarly available for them and pace themselves accordingly.

“Board frenzy” has been with us for a long time and time for action is now. These guidelines, should serve as a basis for concerted action by all concerned. It is suggested that they be shared with the faculty and the residents.

THE TIME IS NOW! YOU HAVE THE POWER!

APDR Subcommittee on “Board Frenzy”
M.L.Janower,chairman
Giovanna Casola
Bill Herring