In July 1, 2004, the class of new residents in Radiology are the first group of trainees subject to the revision of the series of examinations leading to initial certification in your specialty. As you may know, the changes involve modification of the timing, content and context of these tests [1].

First of all, why were they changed? Many of you remember the challenge of the oral board examination which took place in late May or early June of the fourth year of residency. For those graybeards among us, you may remember that up until the early 1980s that momentous experience occurred as now 4 years after beginning residency, but which then lasted only 3 years.

You recall the positive and negative aspects of the test very well, I presume. At least everyone I have met has a store of stories about their preparation for it, about the test itself and about the anxious waiting for the results. Many of you also have not forgotten that the intensive studying for it was an excellent review of the entirety of diagnostic radiology. But at the same time you will acknowledge that to a greater or lesser degree you were infected with the virus causing “board psychosis”. You were compelled by the worry over it, whether permitted or not, to neglect clinical duties during that fretful interval. Your previously assigned work was shunted to more junior residents so as not to bother you as you pursued your heroic journey leading to its climax in Louisville. And for this extended period of abject studying, you were paid in full or at least were able to maintain your resident’s meager salary, no questions asked.

Also you might remember the dread of having to discuss cases in front of an examiner you could not see and could not charm. He or she expected you to be quick, glib and correct in every case set before you. The oral boards did not replicate normal viewing and interpreting in which a difficult case may be set aside for later deliberation. Rather the oral board was a performance, requiring extemporaneous and learned discussion of unknown images. No wonder it was scary in contemplation and stressful in realization.

Furthermore, the oral board exam tested one on nearly everything in diagnostic imaging. Since 1970 with the advent of multiple modalities Radiology has grown geometrically in both range of tests and in its corpus of knowledge. In the 1980s, to accommodate its broadening curriculum, Radiology residencies expanded to 4 years. In contrast our colleagues in Internal Medicine dealt with the problem of an ever expanding knowledge base by changing the term of the core residency to 3 years and by establishing and encouraging fellowships of 2–3 years in the 12 branches of Internal Medicine thereby engendering the establishment of subspecialists across the wide spectrum of the specialty. In Internal Medicine, then, subspecialization became early on a fact of life and the schedule of board examinations in the basic principles of internal medicine and in the various subspecialties were codified and subscribed to by their trainees.