Four members of the ASCO Trainee & Early-Career Advisory Group share a summary of their subspecialty’s board certification process along with personal insights and wisdom based on their individual preparation experiences.

Navigating the Board Certification Process for Hematology and Medical Oncology

By Rahul Banerjee, MD, FACP, and Dionisia Quiroga, DO, PhD

Before we can address the how of studying for the oncology boards, the process of certifying oncology subspecialty medical knowledge following oncology training, we should start at a broader level: who, what, when, where, and why. Of these, perhaps only the who is immediately intuitive: if you’re reading this, who is probably you.

The American Board of Internal Medicine (ABIM) is the most widely used certifying organization for hematologists and medical oncologists in the U.S. There are two board options for hematology/oncology fellows to consider. In terms of what board(s) to take, this is a very personalized decision dependent on your career goals. Should you take the hematology board exam, the medical oncology board exam, or both? Talk to your fellowship and career mentors, and think about your career goals, to help answer this question. Historically, oncologists practicing in community/private practice settings have been board-certified in both fields given that they are often asked to see patients with non-malignant hematologic conditions as well. For oncologists practicing at academic medical centers who specialize in solid tumor oncology, the medical oncology board is probably sufficient. For academic oncologists in malignant hematology or transplantation, many historically have been double-boarded but this is not actually required at most centers to our knowledge.

The when is also tricky. Most of you reading this article will be board-eligible for both hematology and medical oncology through your programs. New Accreditation Council for Graduate Medical Education (ACGME) guidelines allow you to take one set of boards during your third year of fellowship. This provision admittedly didn’t exist for us a few years ago, but we think it’s a great idea to consider; as busy as you think fellowship is, post-fellowship life is almost always harder. Conversely, you technically can take boards up to 7 years after becoming board-eligible. But the longer you delay your exam, the rustier you’ll become on some of the topics you no longer see in practice. It is also important to discuss with potential employers what their policies are in terms of timing to become board-eligible after hiring.

Where to take boards perhaps isn’t so controversial (closer to you is better), but we encourage signing up as soon as you can so you can get a spot at your preferred testing location. If you need any accommodations (e.g., for pregnancy or breastfeeding), be sure to request them early. Ask your future employer if your board exam registration costs, which are typically over $2,300 per exam minus the cost of preparation, can be reimbursed. Finally, why board exams and recertification processes must exist is beyond the scope of this article—we’ll leave it at that.

So now that you’ve decided to take oncology boards and have signed up for an exam, what should you do? Study at a steady pace, but don’t go crazy. All of us have spent the last decade endeavoring to do well on exams, from licensing exams as medical students to in-training exams as fellows. We cannot emphasize enough that the opposite applies after fellowship: as long as you pass boards, nobody cares whether you squeaked by or whether you aced them. Board scores don’t define who you are, and don’t let them define your summer as you graduate from fellowship!

So how should you study for oncology boards? We suggest starting in the spring or early summer (given that board exams typically happen in the fall) and pacing yourself with resources like these:

1. ABIM Certification Exam Blueprints: Prior to committing to a study schedule, make sure to check out the medical oncology and hematology blueprints for a detailed breakdown of topics that will be covered (available at abim.org/certification/exam-information). This can be used as a checklist of topics to review as well as way to structure how much time/effort you allocate to each topic. For example, breast cancer is estimated to be about 13% of the content on the current medical oncology board exam; in contrast, head, neck, thyroid, and central nervous system malignancies only will make up about 4% of the exam.
2. Didactic lectures from fellowship: Assuming you have access to the slides or recordings, these are often an excellent place to start to reorient yourself for each disease group.
3. Specialty society materials: ASCO-SEP or ASH-SAP provide the most extensive board preparation resources. Ask your fellowship program if you don’t already have access to these resources.
4. Question banks and practice exams: Many such banks exist, and we won’t endorse any particular one here. Don’t forget to practice with the ABIM exam tutorials, which also provide some free questions, in the 1 to 2 weeks prior to your exam (available at abim.org/certification/exam-information).
5. Review courses: Both in-person and virtual options for formalized review courses are available from a variety of institutions/companies.

As your exam date approaches, make sure you’re prepared logistically, particularly if you’ve moved since graduating from fellowship: double-check the driving directions, get non-perishable food for snacks, make a general plan for how you want to divvy up breaks, and so forth.

You will do amazingly, and we look forward to being your colleagues! Feel free to reach out to us @RahulBanerjeeMD and @quirogad on X (Twitter) if you’d like any further advice and to keep the conversation on this topic going.

Navigating the Board Certification Process for Radiation Oncology

By Cristina DeCesaris, MD

The field of radiation oncology undergoes board certification through the American Board of Radiology (ABR). The board certification process begins with a series of two written qualifying exams taken during the fourth and fifth years of residency training. Passing qualifying examinations culminates in eligibility for oral board certification in the calendar year following the completion of traditional residency training.

Both written qualifying examinations can be completed remotely at eligible testing centers. The first written qualifying examination is taken during the PGY4 year of residency (historically in July; recently changed to late June) and tests the knowledge of candidates in the fields of radiation biology and physics. This examination consists of 200 questions and is divided into two sections of 100 questions each, with each section dedicated exclusively to biology or physics. Candidates have 1 hour and 49 minutes to complete each section; there is only one subject tested per section. Taking the examination one half at a time (in either biology or physics only) is offered as an option, though the majority of candidates complete both sections at once. Similarly, it is possible to pass the biology section, but not physics, or vice versa; in this case, the candidate would only have to repeat the section which was not passed on the first attempt.

This is unique type of board examination for clinical MDs. For those without a strong basic science background, this can be the most challenging of all radiation oncology written (and oral!) boards to prepare for and to pass. All fully certified residency programs include radiation physics and biology didactic courses given once or twice weekly throughout PGY2 to PGY4. At many programs, a significant portion of the PGY4 is a dedicated research block. I found this tremendously useful for board preparation, which required several hours of dedicated study per week.

I found comprehensive review courses helpful for the biology and physics qualifying exams as well as the oral certifying examinations. My former training program has historically hosted the Dr. Karl Prado Physics & Radiobiology Review Course which provided a comprehensive review of physics and radiobiology topics for senior radiation oncology residents and practitioners over 3 full days of live (and virtual) talks, followed by interactive Q&A. I would also recommend the comprehensive physics review course given by Alan Caggiano, MS, DABR. These review courses are intense and pack a lot of information into a 2- to 3-day period. Plan to complete these courses at least 1 to 3 months prior to your exam date; both provide extensive written materials, and the Caggiano course provides practice questions at the end of each section.

For biology-specific resources, I read Hall and Giaccia’s Radiobiology for the Radiologist textbook cover to cover. I found the material digestible and appreciated the practice questions at the end of each chapter. I also found the American Society for Radiation Oncology (ASTRO) Radiation and Cancer Biology Study Guides helpful and well organized (and free on astro.org!).

For physics-specific resources, many found Basic Radiotherapy Physics and Biology by Chang very helpful. I prepared the most through review courses and completing as many practice questions as I could. RAPHEX examinations were very helpful and come with detailed answer guides (available for purchase at medicalphysics.org). These were also helpful in terms of building exam stamina given their length. The web-based question bank, RadOnc Questions, is very similar in style to UWorld and has a large volume of biology- and physics-based questions with detailed answer keys (available at radoncquestions.com as a 6-month, 1-year, or 5-year subscription). It is also a great resource for the clinical written qualifying examination.

Overall, it is important to give yourself at least 2 to 4 months of preparation. I found it helpful to set small weekly goals (read a certain number of chapters, complete a certain number of questions, etc.), that would ultimately result in covering all materials of interest by exam day. For physics in particular, I would prioritize completing as many practice tests and questions as possible, to cement mathematical concepts.

The Clinical Radiation Oncology Qualifying Examination is a multiple-choice written examination completed remotely testing clinical radiation oncology concepts such as staging, workup, and treatment paradigms and is taken after radiation biology/physics and during the PGY5 (historically, in April or May). It is comprised of two sections of 120 questions, with 2 hours and 45 minutes of testing time allotted per section. I strongly recommend completing the RadOnc Questions Q-bank as test preparation. I initially focused on one to two disease sites at a time, then ultimately completed mixed question sets at or near testing length. Fortunately, this examination focuses on more practical knowledge and concepts that are learned while simply showing up for work every day! I did not find any review courses or textbooks strictly necessary to prepare for this examination.

Once all qualifying examinations have been completed successfully, candidates become eligible for oral board certification. Oral boards are structured so that candidates will be tested in eight separate areas of clinical expertise, with 25- to 30-minute one-on-one sessions conducted by individual expert examiners. The examiner will present a total of three to five cases within their section and test the candidate in a case-presentation format on disease presentations, workup, staging, treatment planning, toxicity management, and follow-up.

The most challenging aspect of oral boards is the format. Successfully completing oral boards requires not only comprehensive knowledge of clinical radiation oncology, but also the skills to respond to questions quickly and efficiently. The candidate is required to complete at least three cases per section, but completing more cases (up to five) is generally favorable. Candidates must pass all eight sections to be board-certified. If a candidate fails one section but passes all others, this is considered a conditional pass and the candidate is asked only to repeat the section of failure. The candidate fails more than one section, the entire oral examination needs to be repeated.

I recommend finding a study group comprised of three to five oral board candidates, ideally with slightly different scopes of clinical practice. Preparation for oral boards requires individual study but also repeated practice of the case-based oral format of the examination. I would recommend 4 to 6 months of preparation for this examination, particularly as study time is often more limited because you are simultaneously balancing life as a first-year attending physician!

My study group met twice weekly (virtually). On Wednesday evenings we reviewed didactic materials and on Saturday mornings we would alternate roles as examiners and examinees, verbally testing each group member to adapt to the oral examination format. Initially, we worked on one disease site per week, but towards the end, as we neared the examination, we would include multiple disease sites per session.

I strongly recommend participating in a mock oral board review course. Most courses consist of two components: high-yield didactics and full-length mock examinations with immediate feedback. This provides critical opportunities to assess your testing stamina, and to have an expert examiner provide you with honest feedback ahead of the final examination. My former training program, the University of Maryland School of Medicine Department of Radiation Oncology, hosts an excellent mock orals course in April every year; I recommend this timing as most candidates will have studied enough to effectively participate, but will have enough time post-mock examinations to correct weaknesses.

Regarding the oral board certification process, two monumental changes have transpired since the COVID-19 pandemic. First, oral board examinations have transitioned from in-person testing to remote testing through secured Zoom meetings. Second, two dates are now offered per year, whereas before there was only a single date. The majority of candidates will undergo the board certification process in May of their first post-residency year.

Although studying for oral boards while establishing a clinic as a first-year faculty member could at times feel stressful and overwhelming, I feel very grateful that I remain close friends with all three members of my study group today, and we continue to discuss tough cases frequently, while supporting and learning from each other’s practice.

Download a list of 2024 resources and dates compiled by Dr. DeCesaris for radiation oncology board preparation.

Navigating the Board Certification Process for Complex General Surgical Oncology

By Neal Bhutiani, MD, PhD

At first blush, the process of becoming a board-certified surgical oncologist can appear long and arduous. Candidates must first complete a residency in general surgery, become board-certified in that discipline, match into and complete an ACGME-accredited complex general surgical oncology (CGSO) fellowship, and then pass both the CGSO Qualifying Exam (QE; written boards) and the CGSO Certifying Exam (CE; oral boards). However, deliberate preparation throughout training and effective utilization of available resources can make the process quite manageable.

As mentioned, the process begins with matching into CGSO fellowship. Case requirements across subspecialties within surgical oncology ensure exposure to the majority of disease processes with which you will be expected to demonstrate familiarity as part of the board certification process. Immerse yourself in each rotation to maximize learning about each pathology and avoid the temptation to only focus on disease processes you find interesting or in which you would like to ultimately focus your practice. In addition to approaching each operative case from the perspective of a junior faculty member, create a reading plan with help from your faculty and senior fellows, prepare for and attend clinic, and actively participate in multidisciplinary tumor boards. Take advantage of your off-service rotations in pathology, medical oncology, and radiation oncology to expand your knowledge about the multidisciplinary elements of cancer care. The totality of these efforts will ensure continued learning and help you work towards proficiency in management of a wide range of malignancies.

Dedicated preparation for the QE and CE varies from individual to individual, but, in general, should begin 4 to 8 weeks prior to each examination. Unlike for the general surgery QE, you will not have an in-training examination during CGSO fellowship to gauge your knowledge and performance against your peers and help identify subject areas where you would benefit from additional preparation. Nonetheless, preparation for the CGSO QE closely mirrors that for the general surgery QE. Emphasis should be placed on National Comprehensive Cancer Network (NCCN) Guideline review and focused content review across malignancy types (e.g., The MD Anderson Surgical Oncology Manual). This should be done in conjunction with high-quality question banks (e.g., Surgical Council on Resident Education [SCORE], StatPearls, Decker Medicine). You should attempt to review approximately 750 to 1,000 questions in their entirety in preparation for the examination. The examination is pass/fail, and the curve is set by the American Board of Surgery each year. The majority of examinees pass the examination on their first attempt. If you pass the QE, you are eligible to register for and take the CE.

Most candidates view the CE as the most stressful part of the CGSO board certification process. You can mitigate that stress through thoughtful, deliberate preparation. In addition to NCCN Guidelines review for each disease site, a virtual review course with sample questions and exam tips is available through the Society of Surgical Oncology (SSO) every January. You should also strongly consider setting up mock oral sessions with your peers who are also preparing for the CE and enlisting some faculty from your fellowship training program to moderate these sessions and provide feedback. Going through the exercise of answering questions in the style of the CE and becoming comfortable with that process remains a critical element of effective preparation. Of note, the CE is administered virtually over a secure platform. Ensure that you are comfortable with your computer setup and have participated in the mandatory equipment check using the same computer and internet connection that you will use for the exam. This will help avoid any unnecessary stressors the day of the exam.

During the examination, keep your answers clear, direct, and concise. Answer confidently. If you do not know the answer to a question, it is better to answer honestly than to make something up. Do not be discouraged by one or two difficult questions. Remember, the goal of the board certification process is to ensure that you are a safe and competent surgical oncologist!

Dr. Banerjee is an assistant professor at the Fred Hutchinson Cancer Center and the University of Washington. His clinical interests are in multiple myeloma and CAR-T therapy. He has authored over 60 peer-reviewed publications with a research emphasis on reducing toxicities and improving the patient experience during treatment for multiple myeloma. Disclosure.

Dr. Quiroga is an assistant professor in the Department of Internal Medicine and a breast medical oncologist at The Ohio State University Comprehensive Cancer Center - James Cancer Hospital & Solove Research Institute. Her research interests focus on the intersection of breast cancer, immunology, and health disparities. She is a member of the ASCO Trainee & Early-Career Advisory Group. Disclosure.

Dr. DeCesaris is an assistant professor of radiation oncology at the Huntsman Cancer Institute at the University of Utah. She specializes in adult and pediatric central nervous system and gynecologic malignancies. Disclosure.

Dr. Bhutiani is currently an advanced colon and rectal surgical oncology fellow at the University of Texas MD Anderson Cancer Center. Following his residency in general surgery and PhD in immunology at the University of Louisville, he completed a fellowship in complex general surgical oncology at MD Anderson in July 2023 and will begin a faculty appointment in fall 2024 as an assistant professor of surgery. Disclosure.