Appendix 10 — Focus Groups

In January 2020, two focus groups were facilitated by an outside consultant. Participants in the focus groups were selected to represent a broad base of membership. They included general and academic radiologists, residents, a fellow, a radiation oncologist, and medical physicists. The focus groups covered all four components of MOC, but this summary will primarily discuss Part 3: Assessment of Knowledge, Judgement and Skills.

Positive perceptions of the ABR certification included:

  • Most (defined as >75% of participants) recognized the need for well-respected certification.
  • Most believed that certification adds credibility in the public’s eye for those currently in practice, although there was general agreement that the public is unaware of the level of competency required for radiologists beyond being “board certified.”
  • Some (defined as <50%) felt MOC is important to keep the radiology community up to date and ensures a standard level of competence over time.
  • Some believed that the change to OLA is much better than the prior 10-year examination, especially being educational because answers and explanations are provided. The physicists preferred OLA, indicating that the questions were perceived as practical.
  • One participant also noted that the ABR appeared to have navigated many changes as well as or better than other specialties.

Concerns about the ABR and MOC included:

  • Regarding examination quality:
    • Some participants believed that questions may be too general for their subspecialty or focus in practice and have not increased their knowledge in radiology or their specific subspecialty, making this more of a burden than benefit.
    • Radiologists have access to computers, so the tests don’t accurately reflect how radiologists work in today’s environment. The one-minute time limit to answer some OLA questions seemed arbitrary.

      Quotes included:
      “OLA tests knowledge in your brain, but it doesn’t test how clinical radiology … is done today.”
      “…test writers are … honing in on zebra cases.”

  • Regarding value to the public and radiology community:
    • Most felt that MOC has had little impact on the radiology community, seeing no change in the quality of the work of radiologists since MOC was implemented.
    • The majority wanted scientific evidence that MOC is beneficial and effective in increasing competence.
    • The primary target of MOC is the radiology community since the public is unaware of the role of radiologists.
    • The vast majority agreed that the public is unaware of the role/level of competency required for radiologists beyond being board certified.

      “In 20 plus years, I have never had a patient ask me … if I was board certified … what’s my license, how many CMEs … they don’t care.”
      “Their (the public’s) idea of what we (radiologists) do is so rudimentary, they really do not understand what we do for a living.”
      “I think the public thinks that once you are certified by passing your boards and maintaining your annual state license … that satisfies the public.”

  • Professional implications:
    • Medical physicists noted that the background requirements (e.g., PhD) for certification may create stagnation in the future for their field by excluding some qualified candidates.
    • Some noted that MOC is burdensome and redundant with their state certification and facility requirements.
    • Residents noted that it is an elusive big organization that doesn’t really touch base with residents and seems like a “bit of an old guys’ network,” outdated and looking for a purpose.

      “It is just one more demand corporations place on people.”
      “Just one more list of questions and things I need to do on my time.”

  • Cost
    • Many indicated that it is expensive, especially for residents, and they wanted more financial transparency on how fees are being used.