That exam was painful, and that was the consensus of everyone there who took it.
Firstly, the format. If you are doing AP/CP or AP or CP only, you get 3.5 hours and the exam is 150 questions. If you are doing a combined primary and subspecialty, its 200 questions and you get 4.5 hours. You dont need nearly that much time to finish the exam.
If you are AP/CP, whether or not you are also doing a subspecialty, you start with a 50 question general AP/CP module. You can only answer questions in that module and once you finish it, you can't go back to it. You can't start any other module until you finish this general module. If you are AP or CP only, Im not sure if you start with a 25 or 50 question general module.
Once you finish the general module, if you are subspecialty (as I am), you go into a 150 question subspecialty module. Once you finish that, the exam is over. As I said before, once you start the subspecialty module, you can't go back to the general module.
If you are just AP/CP, then once you finish the general module, you can choose the next module you want to do. They apparently differ in the number of questions (some nodules have more questions, some have fewer). Once you finish a module, you again choose the next one you want to do until you've done a total of 150 questions. One you finish a module and move onto the next one, you can't go back to any of the modules you have completed.
As for what they ask, if you havent done CP (as I havent), then there is a lot of probably basic stuff that you wont remember anymore, so better study for real. But more importantly, there are a lot of what I call "look up knowledge" questions, stuff you don't need to have in your memory banks for day to day practice as long as you have a book/internet nearby to figure out. I wont go any more specific than that, but it was really frustrating, especially since I probably knew that stuff better for the primary exam. Some stuff that they asked I knew I should have memorized but didn't. Some of it I think was fair to ask so I only have myself to blame. Other stuff again is "look up" knowledge that I dont think should have been tested.
However, I have 2 real complaints about this exam.
1) Virtual microscopy. They need to junk this and just use glass slides like real pathologists. We're in Tampa anyway and there is staff there who I am sure can handle the slide boxes. Too many questions I was asked to evaluate a virtual microscopy image of a large lesion that needed a complete evaluation (looking at epidermis and dermis) which is torture when trying to use virtual microscopy. Its pick a spot, zoom in, wait for image to reload, move to another spot, wait for image to reload, etc. etc. Its like trying to piece together the plot of a 2 hour movie by examining random frames from a film reel. There is a reason why we still have microscopes and will have them for a long time.
2) Images of a small focus of a lesion and asking for a diagnosis when multiple choices in the differential diagnosis are possible. That's bad enough, but then add doing it with absolutely no clinical history which would normally narrow down the differential diagnosis, which was the case in some of the images. So many of those images I said to myself "if I had the glass slide from which this image was taken, I could give the answer, but please don't ask me to guess based on the one focus which you think is diagnostic (clue: its not, and a good pathologist knows not to make a diagnosis based on one high power field).
Anyway, I think I passed, maybe, but I am not at all confident. Of course I felt that way about all the other exams (except CP where I actually was confident I passed but thats because I spent a lot more time studying for that than AP or dermpath. A lot more. I had been carrying around Clinical Laboratory Pearls and reading it for over 2 years just to prepare for that exam).
A final note. There was a day session of people doing only primary, only subspecialty, or combined exams in the morning. In the afternoon, there were more people doing primary exams (no subspecialty). After that, no one else signed up for the spring session. They only needed one day to get everyone in. I expect that will change for the next session they have (which hopefully I wont have to deal with)
