Editors note: The CRA fall exam window opens for applications on July 29 and the application deadline is September 16. Testing will take place November 1-30.

When preparing for the CRA exam, we often focus on the leaders who passed. For this article, I wanted to take a different approach and speak with two imaging leaders who recently took the exam and did not pass. Their feedback was honest, practical, and possibly more helpful than a perfect success story.

Both leaders were honest about feeling embarrassed and disappointed. That reaction is understandable. No one prepares for a professional certification exam hoping to fall short.

Real-World Leadership Isn’t Enough

Both leaders were clear that the CRA exam is not something you can casually prepare for, even if you already work in radiology leadership. The exam is directly tied to the work imaging administrators do every day, including operations, human resources, fiscal management, asset management, and communication. But both leaders agreed that knowing the work and preparing for the exam are not the same thing.

One leader shared that their exam preparation was interrupted by a hospital strike. As anyone in healthcare leadership knows, when something like that happens, everything else moves to the side. Staffing, coverage in critical areas, patient safety, communication, and daily operational needs become the priority. They were still studying, but it became inconsistent and fragmented.

Their reflection was simple: “I don’t think I failed because I didn’t know how to lead. I think I didn’t have the protected study time I needed.”

That stood out to me.

The second leader shared a similar concern. They felt comfortable with many parts of the exam because the content felt familiar. Operations, staffing, department workflows, and leadership communication are all part of their daily work. But once they took the exam, they realized some areas needed a deeper level of preparation, especially finance, asset management, and regulatory topics.

Study Smarter, Not Just Harder

One of the strongest themes from both conversations was the importance of starting with the CRA exam content outline. Both leaders felt that future candidates should use the exam domains as the study guide instead of just opening the books and reading from page one. The content outline helps identify where you are strong, where you are weaker, and where you need to spend more time.

They also recommended taking the practice tests early. Not at the end of studying, but at the beginning. The practice test gives you a better sense of how the questions are written and where you may be guessing. One leader said they wished they had used the practice test more like a diagnostic tool instead of waiting until closer to the exam.

Another point they both emphasized was building a study plan that fits the reality of healthcare leadership. Most imaging leaders are not studying under ideal conditions. They are studying around staffing issues, budget meetings, physician requests, patient safety concerns, and responsibilities at home. Waiting for the perfect quiet block of time may not be realistic.

One leader said shorter, focused study sessions would have helped more than trying to study only when they had a large amount of free time. Even 30 to 45 minutes several times a week can make a difference if the time is protected and intentional.

Tie the Material Into Your Day-to-Day Work

Both leaders also felt that connecting the material to real leadership examples from your own experience and your organization makes the content easier to retain. When studying human resources, think about hiring, coaching, corrective action, retention, and staff development. When studying fiscal management, think about overtime, productivity, capital requests, supply costs, and volume. When studying asset management, think about equipment replacement, service contracts, downtime, lifecycle planning, and room utilization.

Their feedback was not discouraging. In fact, it was the opposite. Neither leader viewed the exam as impossible or unfair. They both felt the CRA is worth pursuing and that it reflects the complexity of radiology administration. Their main message was that the exam deserves focused preparation.

They also encouraged future candidates to use the available AHRA and CRA resources, including the study references, practice exams, workshops, and the CRA community. They felt it would have helped to talk with others earlier in the process and not study completely alone.

The biggest takeaway from these conversations is that not passing the CRA exam does not mean someone is not a strong leader. It means the exam requires time, structure, and honest preparation. Healthcare leaders are used to putting the department first. The challenge is learning to protect study time with the same seriousness that we protect meetings, staffing coverage, and patient care.

For anyone preparing for the CRA exam, the advice from these two leaders was clear: Start with the exam domains, take the practice test early, be honest about your weaker areas, and give yourself enough time. The CRA reflects the real work of imaging leadership, and it is worth preparing for in a way that respects both the exam and the role.