Tips for PMR oral boards

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Any one has Tips for PMR oral boards. I know its too early to talk about oral boards but as a Pain fellow I am afraid that I am soon loosing my PMR knowledge. Presently I am confident only in dealing with MSK cases. Are there any good books or CD's for oral boards.
Thanks

The best thing is to find another PM&R and "talk cases through". Use Cuccurullo as a general guide and talk through what elements of history you would focus on, etc. Come up with a "template" of automatic questions so you don't miss anything. (family history especially) We came up with hypothetical cases in TBI, stroke, SCI, etc. You'll be strong at MSK/pain so probably won't need to focus too much on that. concentrate on peds, neuromuscular.

talk through management.

ask if any of the PM&R departments around you host mock orals.

There's no good CD. I studied with one of the other pain fellows and read through cuccurullo again. it's a very different test from the written. more general - looking at your composure and interpersonal skills as much as your clinical knowledge.

need to feel comfortable talking to someone with a poker face.

Before the board police strike this one, know it's all things we were all taught and all fair game for orals. I am talking about techniques of preparation. I am not describing any specific thing anyone has quizzed anyone about during orals. These are some techniques I and others have used:


Describe to someone how you would approach an acute CVA, SCI, TBI etc, from the assessment phase, through rehab and into community re-integration. Describe the meds you might use, their mechanisms of action, and side effects/risks. Discuss preventions and potential complications and how you would watch for them, assess them and treat them (DVT, decub, spasticity, etc.) Describe how you would integrate various members of the rehab team and how you would lead weekly team meetings.

Describe for someone how you assess function in a rehab pt and when they should be admitted and when they should be discharged. Know how you determine whether they can go home or need to go to a facility or with family.

Go to your MRI Dept, and ask a radiologist to quiz you on things such as spine xray and MRI. See if your interpretation agrees with his. Then take the films to another PM&R and describe your treatment approach based on a theoretical pt c/o pain that the MRI would explain.

Describe to someone else how you might write out a prescription for therapy for a given MSK problem. Have them give you various MSK conditions to do this for - lumbar strain, epicondylitis, cervical HNP, plantar fasciitis, etc. Do the same for a neuro problem. Describe other treatment approaches you might use - meds, braces, injections and when you would consider a surgical referral.

Have someone give you an EMG report and then tell them your interpretation. Do the same with lab reports. Correlate it with theoretical conditions.

Have the person you are describing these things to interrupt you periodically to throw you curve balls and request references. Know the risks and pitfalls of every treatment you describe.

The person quizzing you should optimally be someone with more experience than you. They should not give you any feedback into whether your answers are right or wrong until after you are done.

To simulate the anxiety you might have, do all the above after going without sleep for an entire night and then drinking 6 cups of coffee.

https://www.abpmr.org/candidates/partII_video.html

This video from the ABPMR reviews the oral board process, the format, the ACGME core competencies being assessed. A sample vignette starts at 4:38.

As far as high-yield content for the orals, I’d actually recommend the study guides (previously from Archives, now from the purple journal) to start. Review the broad topics: SCI, TBI, stroke, amputee, EMG/neuromuscular, MSK, spine, pain, peds. Become familiar with both acute and long-term management of these conditions.

And, as mentioned above, the examiners won’t provide any feedback during the exam. If you think that you might be drowning, they will not save you.

I heard the same thing, about using the Archives study guides.

By the way, I am scared out of my mind over this oral exam. I haven't taken an oral exam since my MS3 surgery clerkship. And I don't really have anyone around to study with.

Yes, the study guides are all you need really, and confidence that what you learned about taking care patients is sound. Mock interviews with faculty help as well.

Originally Posted by PMR 4 MSK

Before the board police strike this one, know it's all things we were all taught and all fair game for orals. I am talking about techniques of preparation. I am not describing any specific thing anyone has quizzed anyone about during orals. These are some techniques I and others have used:


Describe to someone how you would approach an acute CVA, SCI, TBI etc, from the assessment phase, through rehab and into community re-integration. Describe the meds you might use, their mechanisms of action, and side effects/risks. Discuss preventions and potential complications and how you would watch for them, assess them and treat them (DVT, decub, spasticity, etc.) Describe how you would integrate various members of the rehab team and how you would lead weekly team meetings.

Describe for someone how you assess function in a rehab pt and when they should be admitted and when they should be discharged. Know how you determine whether they can go home or need to go to a facility or with family.

Go to your MRI Dept, and ask a radiologist to quiz you on things such as spine xray and MRI. See if your interpretation agrees with his. Then take the films to another PM&R and describe your treatment approach based on a theoretical pt c/o pain that the MRI would explain.

Describe to someone else how you might write out a prescription for therapy for a given MSK problem. Have them give you various MSK conditions to do this for - lumbar strain, epicondylitis, cervical HNP, plantar fasciitis, etc. Do the same for a neuro problem. Describe other treatment approaches you might use - meds, braces, injections and when you would consider a surgical referral.

Have someone give you an EMG report and then tell them your interpretation. Do the same with lab reports. Correlate it with theoretical conditions.

Have the person you are describing these things to interrupt you periodically to throw you curve balls and request references. Know the risks and pitfalls of every treatment you describe.

The person quizzing you should optimally be someone with more experience than you. They should not give you any feedback into whether your answers are right or wrong until after you are done.

To simulate the anxiety you might have, do all the above after going without sleep for an entire night and then drinking 6 cups of coffee.

I don't know when you took the boards but around 2005 the format changed and it is very different from what it used to be. In fact I would argue it is probably much easier than the old format although the fail rate has gone up somewhat the last couple years.

Originally Posted by Xardas

I don't know when you took the boards but around 2005 the format changed and it is very different from what it used to be. In fact I would argue it is probably much easier than the old format although the fail rate has gone up somewhat the last couple years.

2000

So what is the format now?

Originally Posted by PMR 4 MSK

2000

So what is the format now?

Watch the video.

All the “vignettes” are now standardized. 3 sessions, 40 minutes per session, 3 different examiners, each presenting a different series of cases. No longer the free-for-all, anything goes, format of the past.

Although, if you practice for orals the way you describe, you would probably do fine in the new format.

Well, there are still a lot of fields that require you to pass the oral boards. Like psychiatry, EM, etc. I'm a little less bitter about it since finding out that for neurology, they just tacked on the cost of the oral boards onto the written boards, so those guys now have to pay $3000 for that one exam. Sucks if you fail!

One thing I really wish is that we didn't have to schlep all the way to Minnesota for the boards. I mean, I'm assuming that the people who do the oral exams don't all live in Rochester. Why couldn't we have more local sites for oral exams?

md1217, I think you might want to consider making your signature a little more eyecatching. I almost missed it. :P

Originally Posted by md1217

Neuro has done away with oral boards because it doesn't really test your knowledge, just your "pimpability" under pressure. No patient will ever ask you tons of questions and require you to answer under pressure in a given time. I think any oral boards are ancient testing and should be abolished. Why can't we just have ONE written test to be board certified like most specialties? Why is PM&R always so behind?

Originally Posted by md1217

No patient will ever ask you tons of questions and require you to answer under pressure in a given time.

You don't happen to work in academia do you?

I'd estimate several times a week I have a patient with a list of 10 or questions they want me to answer with my crystal ball while I'm already 20 minutes behind schedule. Or how many come with printouts from the internet on what they have, how it should be treated and questioning why I'm not doing that.

Originally Posted by PMR 4 MSK

You don't happen to work in academia do you?

I'd estimate several times a week I have a patient with a list of 10 or questions they want me to answer with my crystal ball while I'm already 20 minutes behind schedule. Or how many come with printouts from the internet on what they have, how it should be treated and questioning why I'm not doing that.

Oh, we get this in academia too.

Even if it wasn't a realistic situation, I don't know if that's a reason to do away with the exam. I mean, what patient will come into your office and give you choices A through D of what you'd like to do for his care? All testing is artificial.

I'm not sure why I'm defending the oral exam...

OK, then why not get rid of the written exam too. We all know that some people are just good test takers, and some people do poorly with that type of questioning.

I personally like the idea of oral boards. So what if you are scared going into it. Being a doctor is terrifying. But that is why we do it. I'm sorry, but if you can't stand being pimped, you have no business in this field. I am pimped every day by my patients. I am pimped by other doctors! The ability to talk your way through a problem is one of the halmarks of a good physician.

In general (at least in the dark ages when I took the exam), the idea was not if you knew the right answer, because if you did, you just got a harder question. The purpose was to test HOW you thought about the problem.

I'm also scared about oral exams. In fact, I can't remember
the last time I took an oral exam at all, other than those
end-of-rotation little chats with the service director during
residency. Let's see, hmmm ... oral exams ...

Nope. Never. I'm scared. All tips above and below are
greatly appreciated.

By the way, my psychiatry friend says that they are getting
rid of oral boards in psychiatry starting very soon, this year
or next year. He says his class is the last one to take them.

Hey, if anyone else is interested in a remote study partner as the boards approach, let me know.

would also be interested in remote study partner as oral boards approach. seems like a completely different strategy will be needed compared with the written boards.

The knowledge base for PMR is divided into the areas we all know; such as SCI, Stroke, and TBI, as well as P and O, connective tissue disorders, and musculoskeletal rehab as further examples. Of course each of these has sub areas.

In each of these areas, you want to hit three things:

1. The applicable basic science/pathophys
2. The clinical dx and management ( including xray findings for instance if appropriate)
3. Relevant literature. Just popping a couple of articles/sources will do wonders.

Your goal is to steer the examiner into your strengths and where you want to go; their goal is to check an area, so you know it, and move on to something else. That's the tug of war.


Don't forget about burn management!

If anyone wants to buy my study archives from 2000-2010 at a discounted price, let me know!

Thanks!

Now that I have passed the boards, the best advice I can give is be sure to have someone with which to talk the cases through. I was fortunate to have three others I could meet with on a regular basis. And we all did well! For the truly motivated, making up cases is also helpful, it will help you think like the examiner.

If you can't get your spouse or your friends to quiz you, and just sit there with a stone face while you answer, then you guys on this thread who want study partners should setup your computers so you can see each other in real time and ask questions.

If you have too much stage fright for that, write yourself board Q based on topics from study guides, and stand in an empty room of your home and practice giving answers, like you're talking to your examiner. If you stumble, or laugh or blank out, then start over. Keep doing it until you get it the way you want it.

PS I think some programs have mock orals you can sign up for. I did a review course at Baylor that gave mock orals as part of the course, which was very helpful.