I'll say one thing about the oral boards in that it isn't testing your knowledge base. From the time you take the writtens, if you keep reviewing the material until the time you are scheduled to take the orals in a reasonable fashion (few hours a week), you will likely have all the knowledge base you need for the orals.
This is a test of reaction and adjustment, not knowledge. It is a test to see if you can LOGICALLY and CLEARLY present an anesthetic plan and truly function as a consultant. In that sense, you will need to be able to know when you should defer to subspecialists and when you should be able to comfortably state the safety of bringing a patient to the OR.
Understand that your oral board cases are likely to be the most difficult cases you have ever seen in an academic center or as straightforward a case as you commonly see in private practice. There will always be flexibility built into each case to allow the examiners some wiggle room to push the limits of your adaptability (29 y/o female, G1PO, 29 weeks gestation, s/p MVC with traumatic descending thoracic aortic dissection and CT positive subdural hematoma; followed by 36 y/o male, 5'11" 165, with severe PCN and latex allergies, otherwise healthy, coming in for lap chole, 2/6 systolic murmur noted on preop exam).
Ho, Jensen, Board Stiff Too, etc. all present similar philosophies about how to attack the boards: Read the question, outline the pertinent issues in a framework of preop, intraop, and postop time frames, and never let the patient go back to the OR without having addressed the major issues and questions. If the examiner puts you in the OR, it should be only after you stated your completion of the preop preparatory phase.
Preop issues typically include the general stability of the patient, vital signs, preop tests (EKG, CXR, lab work, etc.). Do what is necessary in a focused fashion. Take the shotgun approach and you will open up a can of worms for the examiners to feed on (why did you order the expensive thallium dipyridamole examination when a simple stress test would have sufficed? Did you really mean to order a contrast CT in this diabetic, hypertensive patient with chronic renal insufficiency? While waiting for your emergent MRI of the spine for bilateral lower extremity radiculopathy, your patient exsanguinates in the radiology holding area, etc.).
Intraop issues are obviously where the topics can vary greatly. Staying up to date on your review material after the writtens will save you a great deal of time in preparing for this phase of your oral board question. Always know what plan B, C, D, E, etc. would be in every scenario. Don't fret over drug dosages, drug limits, and subspecialty issues that only subspecialists should take care of (i.e. delivering a baby). Provide the anesthetic, protect the patient, and put the subspecialist in the scenario when they should be there (see first example case above - once you go to the OR to fix the highest priority problem - exsanguination via ruptured thoracic aorta, bring in the obstetrician to monitor the baby with you keeping mom stable, mom in left uterine tilt, etc. ready for a C section should it be necessary and not affect mom, or if mom is a lost cause and baby is salvageable).
Postop issues commonly include vent management, ICU sedation, PONV, rebleeding, a return to the OR and when to go, appropriate use of consultants and tests, and a variety of medicolegal issues. You may do everything right and the patient still dies. It is up to the examiner to determine if you did everything logically, in the proper sequence, and with the proper priority and urgency.
Lastly, don't argue with the examiners, but likewise, reaffirm your position if you feel that you are being led down a path toward mass destruction. They will get you there regardless of what you say, but if you have noted your objection previously, you have already shown that you would not purposefully put a patient at risk and the examiner will have had to change the examination scenario to put you at that position (in other words, you have scored points with examiner for not falling into a trap). Don't "force" the examiner to give you a test result or lab value after they have previously stated that you have been given all that is available, or if they have stated that something is stable ("Are you absolutely certain my patient doesn't have hemoglobinuria?").
This is my primer for the oral boards. While my classmates took Ho, Jensen, or both, I read Board Stiff Too, found and read an old Jensen review course manual once, reread Morgan & Mikhail, and did one mock oral with a Southwestern attending and one with a classmate. I started a little late because of the echocardiography boards, but with a reasonable amount of time to review enough information as well as practice. I was able to pass without taking any time off from work, though I was a little stressed given how busy we were this past summer.
Be honest in your personal assessment: Are you a good speaker? Is your fund of knowledge adequate? Are you adaptable in pressure situations or do you tend to go into a shell? The answers to these questions will help you determine how best to prepare (information review, mock orals, both, etc.). For myself, I believe that I am comfortable in public speaking situations as well as adaptable in those situations, therefore I spent most of my time reviewing information while framing it in the context of an oral examination in my mind. For some of my colleagues, multiple practice examinations was the way to go to keep on top of their biggest hurdles (nervousness, tendencies to stutter, etc.).
Edit: For the younger residents in training, use your everyday cases as an opportunity to start thinking like a consultant and practice framing one case each day into the oral board situation. Ask your attendings to be your examiners and use a case each day to discuss what issues could be brought up during an oral examination (assuming your attendings have taken and passed the orals).
