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Format of the Comprehensive Objective Examination in DIAGNOSTIC RADIOLOGY

Comprehensive objective examinations make it possible to obtain a more complete evaluation of the candidate’s strengths and weaknesses. Such examinations are considered as a “whole”. A candidate does not need to “pass” any one component to be eligible to challenge another component. Success or failure is based on consideration of performance on ALL components of the examination. Therefore, if a candidate is unsuccessful on the whole, he or she must repeat all components of the examination within his or her period of candidate eligibility.

  1. Written Component

    The written component consists of one 3-hour paper containing 140–160 multiple choice questions (MCQs). The examination assesses the candidate’s competence to function as a consultant diagnostic radiologist across the CanMEDS domains of Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional.

    This component evaluates the candidate’s knowledge of basic medical science (anatomy, physiology and pathology), the physics of imaging, epidemiology related to diagnostic radiology (head and neck, breast, musculoskeletal, cardiovascular, chest, gastrointestinal and genitourinary radiology), nuclear medicine, and interventional radiology. There may also be questions that test knowledge and understanding of statistical concepts pertaining to radiology and contrast media-related issues. The ability to provide the most probable diagnosis based on clinical scenarios and/or images will also be tested. This component also tests the knowledge of anatomy based on images provided.

    Questions may cover all competencies as described in the Objectives of Training in the Specialty of Diagnostic Radiology.

    The objective of this component is to ensure that candidates have adequate basic knowledge of diagnostic radiology to provide evidence-based and safe patient care.

    Study materials include, but are not limited to, foundational textbooks such as (1) Weissleder R, Wittenberg J, Harisinghani M, and Chen W. Primer of Diagnostic Imaging, 5th ed. St. Louis, MO: Mosby Elsevier; 2011. (ISBN: 978-0323065382); (2) Brant W and Helms C. Fundamentals of Diagnostic Radiology, 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins and Wolters Kluwer; 2012; (3) the Elsevier Case Review series; and (4) the Elsevier The Requisites in Radiology series. Candidates should also be familiar with current, landmark, evidence-based journal articles and clinical practice guidelines in diagnostic radiology.


  2. OSCE Component

    1. Objective of the OSCE component

      The OSCE component consists of sixteen 14-minute stations. The duration of the examination is approximately 4 hours. Questions are based on a blueprint that reflects the Objectives of Training in the Specialty of Diagnostic Radiology.

      Approximately 7 stations are unsupervised and computer-based. These stations are composed of a series of images, and candidates will be provided with an answer sheet to write their responses to questions about the images. The stations evaluate the candidate’s skill in detection and integration of radiologic findings and/or ability to identify the most likely diagnosis based on a variety of imaging findings. Patient management based on imaging findings may also be tested. There may also be stations focused on non-Medical Expert CanMEDS roles such as, but not limited to, Leader, Collaborator, Communicator and Health Advocate.

      There are approximately 9 supervised stations that are also computer-based, but have an examiner present in the examination room. Imaging studies of the chest, breast, and cardiovascular system (2-3 stations), central nervous system, spine, ear, nose and throat (1-2 stations), abdomen and pelvis including obstetrics and gynecology (2-3 stations), and the musculoskeletal system (1-2 stations) are presented. These stations test the candidate’s ability to detect, describe and integrate radiologic findings presented in multiple imaging modalities, as well as to formulate an appropriate differential diagnosis and recommend acceptable patient management in the presence of an examiner. The examiner assesses the candidate’s ability to act as a consultant diagnostic radiologist. The stations also test some of the non-Medical Expert CanMEDS roles. The candidate should approach each station as if he or she were providing a consultation to a referring clinician in a hospital setting; differential diagnoses should be kept brief and pertinent.

    2. Examination Process and Timing

      Candidates are examined either in the morning or afternoon. Each candidate will receive his or her examination schedule at the examination.

      The examination content is identical for both morning and afternoon sessions. For this reason, sequestering may be required following the examination in order to prevent candidates from communicating the content of the examination to others preparing to take the examination. Candidates are requested to respect the registration times on the appointment letter to ensure the sequestering period is as short as possible for all candidates.

      After registration, the official invigilator will direct the candidates to the appropriate waiting areas for the examination. All electronic devices must be surrendered after registration. The devices will be returned at the end of the examination (or sequestering period, if applicable). The format of the OSCE examination allows candidates to be examined by multiple examiners over a variety cases. Candidates will not be examined by an examiner from their own centre. During the scheduling process, all potential conflicts of interest are identified and addressed. Examiners will not be aware of a candidate’s performance on any other part of the examination.

      A Royal College observer may be present during the examination. The observer will not interact with the candidate or the examiners, will not contribute in any way to the candidate’s evaluation, and is there only to observe the conduct of the examination.

      Instructions on entering and exiting examination rooms on completion of each station will be given via a public address (PA) system. Hall monitors will also be available to assist candidates in locating their next station. Candidates may encounter other candidates in the corridor between room changes or during break stations. It is imperative that candidates do not communicate with each other during the rotation.

      Examiners are responsible for monitoring the candidate’s time and ensuring that all the material and questions are covered. Examiners may interrupt the candidate during the scenario to seek further information or to move the scenario forward in a timely fashion. Examiners may take notes during the examination to document performance. They may appear neutral in their reactions to answers and have been instructed not to give any feedback to candidates on their performance. Examiners will answer the candidate’s questions and offer any pertinent study that is available, but only if it is part of the protocol for a given case. If a question or study is not part of the protocol, the examiner will simply tell the candidate that the answer is not available or the study has not been provided. Candidates should not touch the computer monitor screen. Examiners will assist candidates in navigating through the examination material.

    3. Evaluation

      A global rating scale will be used to assess relevant aspects of care demonstrated during the station. Global rating scales will reflect station content, and will focus on the candidate’s ability to systematically work through a case using a focused, rational and efficient approach. Domains assessed include detection and integration of clinical findings (clinical reasoning/judgement, data synthesis), clinical/patient management, and consultancy skills (communication, clarity of expression).

    4. Equipment

      No special equipment is required.

  3. Clarification of Terms Used in the Examination

    Within any of the examination components, when a clinical scenario is presented, the questions posed relate solely to that clinical scenario. The following list clarifies the meaning of the following terms used in the examination:

    most likely: refers to the most likely or probable response for that specific clinical scenario.

    initial: refers to the first step you would take in that specific clinical scenario.

    next: refers to the next step you would take in that specific clinical scenario.

    assessment: refers to the clinical assessment for that specific scenario, and would include history, physical examination, bedside point-of-care testing (but would not include results of laboratory investigations).

    investigations: refers to all investigations for that specific clinical scenario, and may include laboratory tests, diagnostic imaging, ECG, etc.

    treatment: refers to all therapies for that specific clinical scenario, and may include pharmacologic treatments, non-pharmacologic treatments, nutritional therapies, education, counselling, and follow-up.

    management: refers to the steps you would take in the clinical assessment, and may include investigations and/or treatment for that specific clinical scenario.

Revised August 2017