clinical medical physics

Preparing for the ABR Medical Physics Exams

Every August and May/June, Medical Physicists seeking board-certification flock to testing centers and oral exam testing rooms to sit for parts of the ABR exam.  Parts 1 and 2 are offered in August as computerized tests, while Part 3 is an oral exam administered in late May to early June.  In order to sit for the ABR exam, you must apply the year before and meet the requirement for each exam.  Full information on the exam parts can be found on the ABR website here

Anatomy of the exams

Part 1 is the general medical physics knowledge and clinical exam, which is the same for all medical physics specialties. The deadline for applying to take this exam is October 31 of the year before you sit. This year, 2017, the exam is offered August 7th and costs $505.  In order to be eligible for this exam, the applicant “must be enrolled in and in good standing with, or have graduated from, a CAMPEP-accredited program (graduate program, doctorate in medical physics [DMP] program, certificate program, or medical physics residency).”  The general portion of the exam covers the knowledge expected to be covered in core graduate program classes, such as dosimetry, medical imaging, nuclear medicine, radiation safety, and radiotherapy treatment process. The clinical portion focuses on introductory anatomy, physiology, and terminology.   A content guide and sample questions from ABR can be accessed here.  Please note this year begins the new question types (more below) and the ABR Part 1 page has been updated to reflect these new question types.  Once you have applied for Part 1, you have 5 calendar years to pass Part 1.  Once you have passed Part 1, you have 10 calendar years become board eligible. ABR says: “Board eligibility for medical physicists begins once a candidate has been approved for the Part 2 Examination, or has completed a CAMPEP-accredited residency, whichever occurs first.”

Part 2 is the specialty exam.  There are three different exam specialties: diagnostic, therapeutic, and nuclear medical physics.  When applying for this exam, you will have to pick which exam subspecialty you are going to take; you cannot pursue two different specialties at the same time.  However, after finishing one specialty (though Part 3), you can pursue a second. This year the Part 2 exam (computerized) is administered on August 8th and costs $650.  In order to be eligible for this exam, you must pass Part 1 and complete a CAMPEP approved residency or be approved for Part 2 though application, whichever occurs first. International applicants who do not hold US or Canadian degrees can complete a structured mentorship; more information here.  The material covered on this exam is at the level of that expected to be covered in your residency program. A content guide and sample questions from ABR can be accessed for diagnostic, therapeutic, and nuclear subspecialties.  Note these pages have not been updated to show the new question types (more information below).  Examples of new question types can be found under Part 1 information here. Once you are considered board eligible, you have six calendar years to become fully certified by passing all three parts of the ABR exam.

Part 3 is the oral exam.  This is the only in-person exam and consists of five questions, one from each of five categories, asked by five different examiners.  Part 3 is currently held in a hotel in Louisville, Kentucky.  This year, the exam was held between May 21st and 24th and cost $765.  This exam is designed to test “your knowledge and fitness to practice applied medical physics in your specified specialty.”  An invitation is sent approximately five months in advance, and if you accept the invitation, you will be scheduled and need to pay the fee.  A list of the categories for each of the specialties can be found here.  This exam can only be taken after a candidate has passed Part 1 and Part 2.  

New question types

Beginning with the 2017 tests, the ABR is introducing new questions types.  Prior to 2017, questions on Part 1 and Part 2 were multiple choice and divided into simple and complex, where complex questions required more involved computations.  The Part 1 and Part 2 exams will now have:

  • case based questions:  multiple part questions without the ability to go back a change a previous part that are designed to replace a complex question
  • multiple-select questions:  participant will need to select the indicated number of correct answers from all choices
  • fill-in-the-blank questions: the correct answer is entered into the blank with no choices presented
  • point-and-click questions: the answer is selected by using the mouse to click on the require object in an image  

Examples and more details on the new question types can be found in the Part 1 content guide.

Preparing for the exam

Special thanks to Dr. Josh Evans (Therapy) , Dr. Frank Corwin (Diagnostic), and Dr. John “Chet” Ford (Therapy) for taking the time to discuss their advice on preparing for the exam with me.  A session from AAPM last year given by Dr. Josh Evans, Dr. Laura Padilla, Dr. Matthew Studenski, and Dr. Todd McNutt on preparing for the ABR Part 2 and Part 3 can be found here.

For all three parts, here are some general pieces of advice.   

1)  Everyone, including myself (I’ve passed Part 1), advise beginning preparations at least 2–3 months in advance (I know… not helpful to those taking the exam this August).  This is recommended to have time to cover all the material in small manageable sections.  

2) Begin with the information about topics on the ABR website to determine what information to include in the study plan you create.  This plan could be an outline of topics to cover with a proposed timeline, which can keep you on track and prevent the amount of information from feeling overwhelming.  

3) Go over everything even if you know it, and spend more time with the material you do not see “every day.”  If you are in a therapy-focused program, this could mean putting extra time in studying imaging (MR, CT, PET, SPECT, etc…) for Part 1.  

4) Don’t forget to take breaks.  Your mind can only handle so much information before you get diminishing returns on what you can recall. One advisor suggested no more than 2–3 hours a day.  

5) Test-taking tip for Parts 1 and 2: if you can’t answer a question in about one minute, flag it and come back. (An exception is the new case-based questions: you have to answer the parts in order and cannot go back. The system should give you a warning before starting one of these questions.)

For Part 1, your class notes and lectures are a good starting point.  I personally created a study guide for each of my graduate core classes from my notes and lectures beginning in February to study for my comprehensive exams in April. I then continued to use these study guides to prepare for the ABR Part 1.  In addition to your notes, there are several online resources that are available.  Sites like WePassed.com (recommended by all individuals I asked),  physicsabr, Quizlet, and the Yahoo Med Phys Bard Prep group have practice questions you can do (not all are free).  You can even find additional suggestions from sites like Reddit.  Just a word of caution: you sign an agreement before taking the ABR exam that you will not share ANY questions from the exam (they are under copyright), including “recalled” questions.  Some online resources you find may include questions that are in violation of that policy.  I personally do not know if the sites listed above include any “recalled” questions and urge you to use your judgement even with resources suggested here.  For a more hard copy approach, going over chapter questions in textbooks such as Kahn (The Physics of Radiation Therapy), Attix  (Introduction to Radiological Physics and Radiation Dosimetry), Johns and Cunningham (The Physics of Radiology), Cember (Introduction to Health Physics), and Bushberg (The Essential Physics of Medical Imaging) may be helpful.  Alternatively, or in addition, going through RAPHEX and Huda (Review of Radiological Physics) can provide hundreds of practice questions.  For the clinical exam, it may also be useful to review an anatomy textbook that shows medical images for help with identifying organs in an image, such as Tortora (Principle of Anatomy and Physiology).  It is a good idea to become familiar with identifying organs in a variety of imaging modalities not just CT.   In addition, reviewing dose limits to organs and Greek/Latin roots related to medicine for help with unfamiliar terminology.

For Part 2, the advice is similar to Part 1.  Focus on the TG reports, review the important tables and comments from NCRP 116 and 147 and ICRP 103 on radiation safety and dose limits, and material from your residency to form study guides.  A lot of the online and hardcopy resources listed under Part 1 also include material useful for Part 2 or include focused Part 2 questions.  Khan was a favorite suggestion of the Therapy physicists I spoke with, while Bushberg was recommended for Diagnostic as well as “know[ing] some basic circuit analysis, like Kirchhoff’s Law, and basic reactive circuits.”  Another suggestion for speed is to memorize the values of common constants that are multiplied together, and to practice more questions from areas you are less exposed to during residency, like shielding calculations.

For Part 3, take even more time to prepare for each category.  All of the material for Parts 1 and 2 are useful for Part 3. The exam questions can come from anything in the topic.  Since this part is typically taken after you are employed, talk to your employer about the possibility of scheduling time off to study and potentially pay for exam preparation material (the worst they can say is no).  Try to observe procedures in the clinic that you are not responsible in your job; for example, this could be high dose rate brachytherapy or stereotactic radiotherapy in therapy, or MR in diagnostic imaging (or CT/Fluoroscopy for the MR physics).  In addition to the material, it is important to practice presentation.  Unlike the other parts of the ABR exam, which are computerized, Part 3 is taken in front of an examiner and it is beneficial to practice answering questions under pressure.  The AAPM 2017 interview workshop in Denver would be a good place to practice articulating the answers to questions while thinking on your feet (sign up here).  Other ways to practice include recording yourself answering a question and playing it back, or Skyping with a friend who can give you feedback.  The AAPM also holds mock oral exams, so keep an eye out or ask your local chapter if they have one scheduled (or better yet, volunteer to organize one for your chapter). Practice staying calm, providing engaging and positive body language, avoid using “um” and “like” to fill spaces, and breathing while answering questions. Remember to answer the question that you are asked, and only the question that is asked!  You are scored on your answer to the exam question.  The examiner is instructed to not give anything away in regards to the correctness of your answer, so practice giving direct answers to a question without superfluous information.  This can help prevent what I tend to do when nervous: giving everything I know on a topic to fill the awkward silence.  The examiner has the opportunity to ask follow-up or clarification questions.  The more information you include in your original answer the more you open yourself up to additional questions even if they are off topic for the exam question.  If you are unsure of an answer, say how you would find the answer.  One of the areas the examiners are testing you on is fitness to be a medical physicist; therefore, knowing the limits of your knowledge is essential to prevent harm to patients.

While no one wants to fail any of the parts, if you do, you can take them again in whole or in part where applicable until your eligibility period runs out: 5 years from initial approval for Part 1, and 6 years from completion of residency or approval of Part 2 (whichever is first) for passing Parts 2 and 3.  For information on becoming eligible to take Part 1 beyond 5-years from initial approval see the ABR policy here.  For information on re-establishing board eligibility (Part 2 and 3) see here.

Your favorite way to prepare for any of the ABR medical physics exams not here?  Please add any suggestions and advice you have in the comments below.  Those of us yet to take the exams thank you!

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