Osler Review Course - Public or private sessions?

[Citrace]

Anyone here do the osler board review course for the orals?
Id like to do it... but was wondering what's better... the public or private sessions...
or should I do both?

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[Winged Scapula]

Anyone here do the osler board review course for the orals?
Id like to do it... but was wondering what's better... the public or private sessions...
or should I do both?

Didn't take the course but IIRC the course is public with a couple of private sessions. If you wanted more private sessions, I think you can buy more private sessions if you wanted.

 

[ESU_MD]

Its been awhile... But some of those osler examiners really seemed washed up. However, the same basic concepts get tested over and over.

 

[ajimd]

What about the "Pass Machine" videos? I have all but finished them and I can't believe these people they are testing during the mock examination are actually going to sit for the oral boards. Are these PGY3/4? residents or are they truly physicians awaiting certification? I'm not sure they are high yield - any input is appreciated

 

[Winged Scapula]

What about the "Pass Machine" videos? I have all but finished them and I can't believe these people they are testing during the mock examination are actually going to sit for the oral boards. Are these PGY3/4? residents or are they truly physicians awaiting certification? I'm not sure they are high yield - any input is appreciated

I haven't seen the videos but one of my residents had the reading material. I can tell you it was repetitive (ie, same scenarios over and over) and not all of it was High Yield (ie, a lot of thoracic stuff it looked like to me)

 

[ajimd]

Agreed, not high yield at all - I trust brushing up on common pediatric/thoracic/OBGYN/Uro issues should suffice for this exam? I mean, other than the infamous "you perform an appendectomy on a patient and the right ovary is torsed/ruptured cyst/ectopic pregnancy....what do you want to do now". I have not heard much when it comes to these topics. I will be attending Osler and I'm told its much better and comprehensive than these "pass" videos, material has been. I have read Neff's book, finished "How to win" and am starting to go over these topics for a second time. Other than some good prayer time, any other advice? 1/30/13 right around the corner

 

[Winged Scapula]

Agreed, not high yield at all - I trust brushing up on common pediatric/thoracic/OBGYN/Uro issues should suffice for this exam?

That was my experience and from what I've heard from others as well. I did get a testicular CA scenario, but don't know anyone who got any unusual Peds or much thoracic at all (other than chest trauma).

I mean, other than the infamous "you perform an appendectomy on a patient and the right ovary is torsed/ruptured cyst/ectopic pregnancy....what do you want to do now". I have not heard much when it comes to these topics.

Yep.

I will be attending Osler and I'm told its much better and comprehensive than these "pass" videos, material has been. I have read Neff's book, finished "How to win" and am starting to go over these topics for a second time. Other than some good prayer time, any other advice? 1/30/13 right around the corner

There is a lengthy, useful thread (IMHO) in this forum about the Oral Boards. My advice would be "expect the unexpected". I was unlucky in residency that we didn't have too many complications (at least that I saw) so you need to know how to manage things when they go wrong. Your anastomoses will always leak, your patient will have a post op MI, etc. They know you know what to do with cholecystitis - but do you know what to do when the patient has an EF of 15%, or when they come back and you find a clip across the CBD?

As I noted in the other thread:

- pharmaceuticals can be your friend: a BB if you need one, some Imodium or Gas-X the night before
- put a lemon drop or mint in your pocket to suck on between rooms; your throat will be very dry
- a tissue in your pocket to wipe your hands dry if you are a sweater
- stay at the exam hotel if you can; usually an expensive one but its worth it to be close and familiar with your surroundings. You can also go to the restaurant the night before the exam starts and stare down everyone.
- if you are working, take the rest of the week off; you'll either want to celebrate or you won't want to go back to work and face everyone just yet
- the junior guys are very inexperienced and sometimes they are almost as nervous as you, and don't ask questions in a very succinct manner; ask them to repeat if necessary (just not too often)
- don't back down if faced with, "are you sure doctor? You'd really do that?"
- out loud practice is really key; its a whole different way of studying

 

[SLUser11]

Agreed, not high yield at all - I trust brushing up on common pediatric/thoracic/OBGYN/Uro issues should suffice for this exam? I mean, other than the infamous "you perform an appendectomy on a patient and the right ovary is torsed/ruptured cyst/ectopic pregnancy....what do you want to do now". I have not heard much when it comes to these topics. I will be attending Osler and I'm told its much better and comprehensive than these "pass" videos, material has been. I have read Neff's book, finished "How to win" and am starting to go over these topics for a second time. Other than some good prayer time, any other advice? 1/30/13 right around the corner

It sounds like you've prepared well. Try not to get too nervous about it, as I believe it's counterproductive.

You may find Osler to be low-yield, so bring some study material with you in case you want a break from the course to do your own reading.

Here's a very lengthy thread on the topic which I started a year ago. It may put your mind at ease.

 

[ajimd]

Thanks SLUser - I realize that most of the exam is hype, as there is only so much general surgery they can expect "safe" general surgeons to know, but trying to get my hands on all the possible stuff I can so I can say I did everything I could... It's going to come down to how I present and discuss these topics. I hope the mock sessions help

 

[ajimd]

I was curious how I should approach answering a question with a procedure I don't perform often, or at all. I know we need to know how to describe open AAA, Whipple...etc, but what about TAH with BSO if you find a 5 cm ovarian mass on a right hemi, or a Peustow for chronic pancreatitis, or etc. I mean, I have read about these procedures, but not sure I can go into detail as to how to perform them if asked. I know they need to be done, but how do I answer without sounding like I want to punt it off to someone else (as I'm not supposed to do)

 

[Smurfette]

I was curious how I should approach answering a question with a procedure I don't perform often, or at all. I know we need to know how to describe open AAA, Whipple...etc, but what about TAH with BSO if you find a 5 cm ovarian mass on a right hemi, or a Peustow for chronic pancreatitis, or etc. I mean, I have read about these procedures, but not sure I can go into detail as to how to perform them if asked. I know they need to be done, but how do I answer without sounding like I want to punt it off to someone else (as I'm not supposed to do)

You can say something along the lines of "I've never personally performed this procedure, but the main steps are....". Then just describe the basics of the procedure so they know you grasp the concept(s). They know everybody has different experiences with the rarer procedures. The purpose is to make sure you are a safe surgeon and make safe decisions, not to harp on every step of a rare procedure typically only done by a small minority of surgeons.

OTOH, if you tell them you've never done a right hemi, chole or hernia, you're in trouble.

 

[ajimd]

OTOH, if you tell them you've never done a right hemi, chole or hernia, you're in trouble.[/QUOTE]

Haha! I think I would have to cancel my travel plans if I could not describe these. Agreed

 

[SLUser11]

You can say something along the lines of "I've never personally performed this procedure, but the main steps are....". Then just describe the basics of the procedure so they know you grasp the concept(s). They know everybody has different experiences with the rarer procedures. The purpose is to make sure you are a safe surgeon and make safe decisions, not to harp on every step of a rare procedure typically only done by a small minority of surgeons.

OTOH, if you tell them you've never done a right hemi, chole or hernia, you're in trouble.

I like this answer. "I've never personally performed this procedure, but it is what I recommend for the patient." I wouldn't volunteer the steps, though. I'd wait until they ask you to walk them through it, then give them the steps.

 

[ajimd]

Good answer, but again, if they press on how to perform a Hyster, or a Radical neck dissection....or something else, I'm afraid to flail through it and i certainly dont want to feel like im making up an operation as I go along (instant fail). I mean, open AAA, LAR, hemicolectomies, gallbladder and bile duct procedures, Mastectomy....etc. I'm ok with, but am I really gonna say: " I would perform a salpingotomy and evacuate the ruptured ectopic" if thats what I found when I went in for an apply? I can just hear them say : "have you done that before?" I mean, part of me says i'm not gonna allow myself to get trapped into that situation, but in a fast paced, high stress environment...

 

[Winged Scapula]

Good answer, but again, if they press on how to perform a Hyster, or a Radical neck dissection....or something else, I'm afraid to flail through it and i certainly dont want to feel like im making up an operation as I go along (instant fail). I mean, open AAA, LAR, hemicolectomies, gallbladder and bile duct procedures, Mastectomy....etc. I'm ok with, but am I really gonna say: " I would perform a salpingotomy and evacuate the ruptured ectopic" if thats what I found when I went in for an apply? I can just hear them say : "have you done that before?" I mean, part of me says i'm not gonna allow myself to get trapped into that situation, but in a fast paced, high stress environment...

1) they are not going to ask you anything that most surgical residents haven't done; since Gyn is not a required rotation for a GS residency, they aren't likely to ask you how to do a salpingectomy or hysterectomy;

2) if you haven't done a procedure before, either SLUser or Smurfette's options are fine. DO not make up an operation or simply say, "I don't know".

3) if you get down into the details of a procedure which is not a common one done by most US surgery residents, you most likely have passed the room;

4) usually they only want basics (ie, not step by step); I was asked about a MRNeck - I got about 3 steps in and they stopped and moved on to the next question

 

[Buzz Me]

1) they are not going to ask you anything that most surgical residents haven't done; since Gyn is not a required rotation for a GS residency, they aren't likely to ask you how to do a salpingectomy or hysterectomy;

It was when I was an intern!

 

[Winged Scapula]

It was when I was an intern!

Required by YOUR program. It is not required by ABS.

 

[Buzz Me]

Required by YOUR program. It is not required by ABS.

No longer. That, along with Ortho and ER...all gone!

 

[Winged Scapula]

No longer. That, along with Ortho and ER...all gone!

I would have enjoyed an Ortho rotation; ER and OB-Gyn not so much.

Gyne was not required by ABS when I was a resident (a few years before you), so I suspect your residency just let the rotation linger a little longer on the rolls than mine did. Good for me.

 

[Smurfette]

We had to rotate on two randomly assigned subspecialty services as an intern (ortho, plastics, ENT, GU, or if really unlucky, neurosurg; Gyn was NOT a rotation).

Ortho may sound like a good rotation to some, but my ortho rotation consisted of me being a discharge monkey who dosed coumadin ad nauseum. Our rounds consisted of the ortho residents asking me "when does PT say they can go?" and "what's the INR?" on every patient, and me doing an average of 10-15 dc summaries a day with rehab/outpatient PT/whatever paperwork to go with it. There was zero teaching. I wasn't even supposed to go to any of their conferences.

GU would have been the most useful rotation for me.

 

[Winged Scapula]

We had to rotate on two randomly assigned subspecialty services as an intern (ortho, plastics, ENT, GU, or if really unlucky, neurosurg; Gyn was NOT a rotation).

Ortho may sound like a good rotation to some, but my ortho rotation consisted of me being a discharge monkey who dosed coumadin ad nauseum. Our rounds consisted of the ortho residents asking me "when does PT say they can go?" and "what's the INR?" on every patient, and me doing an average of 10-15 dc summaries a day with rehab/outpatient PT/whatever paperwork to go with it. There was zero teaching. I wasn't even supposed to go to any of their conferences.

GU would have been the most useful rotation for me.

That does sound unpleasant.

In hindsight, as an off service resident with an Ortho program, I'm sure I wouldn't have been hammerin' in any IM rods or drilling any dynamic hip screws but doing the same DC **** as you did.

I did a Hand rotation 3rd year but it was in the community and loads of fun; o/w my electives were ENT and PRS both of which I loved. Uro was popular as well.

 

[ajimd]

So the course is ok - no major revelations.
The only thing I have found myself doing up there is that I hear all the scenarios, but it would help me if I could summarize (just for a second) to the examiners what is going on....for example, "So as I understand it, this is a 20 y/o with long standing steroid use secondary to ulcerative colitis, now with diffuse abdominal pain, likely secondary to toxic megacolon - therefore I would proceed with..." Is this acceptable? or do they view this as a stall tactic?

 

[Winged Scapula]

So the course is ok - no major revelations.
The only thing I have found myself doing up there is that I hear all the scenarios, but it would help me if I could summarize (just for a second) to the examiners what is going on....for example, "So as I understand it, this is a 20 y/o with long standing steroid use secondary to ulcerative colitis, now with diffuse abdominal pain, likely secondary to toxic megacolon - therefore I would proceed with..." Is this acceptable? or do they view this as a stall tactic?

I understand because that's how I like to do it in real life. The conventional wisdom however is that you have a very limited amount of time and that summarizing back to the examiners is perceived as either stalling or wasting time.

 

[Pir8DeacDoc]

Smurfette your program sounds like mine. I was lucky enough not to get the Ortho rotation.

 

[SLUser11]

, "So as I understand it, this is a 20 y/o with long standing steroid use secondary to ulcerative colitis, now with diffuse abdominal pain, likely secondary to toxic megacolon - therefore I would proceed with..." Is this acceptable? or do they view this as a stall tactic?

I think it's okay if it helps you organize your thoughts, but I wouldn't do it routinely with every scenario, because it will possibly annoy the examiners, and then they'll make things harder for you.

If you already understand the scenario, don't recite it back to them. However, sometimes, they don't do a great job of painting the clinical picture, and a clarification may be warranted.

Good luck.

 

[Winged Scapula]

I think it's okay if it helps you organize your thoughts, but I wouldn't do it routinely with every scenario, because it will possibly annoy the examiners, and then they'll make things harder for you.

If you already understand the scenario, don't recite it back to them. However, sometimes, they don't do a great job of painting the clinical picture, and a clarification may be warranted.

Good luck.

I found that especially to be true with the junior examiners.

 

[ajimd]

Yea, I'm worried about those guys. All I wanna do is take the darn thing... 2 days and counting.

 

[ajimd]

There has to be a better way than cram people into hotel rooms, have them spend tons of money, and then get asked some complex questions that we don't deal with on a daily basis, and use that to say whether or not a surgeon should be certified based on the "safe" answers they provided in that pressure-cooker if an environment. No matter how extreme the situation may become in real life, there is ALWAYS time to think. I can't believe that was what all the fuss was about. I'm actually quite surprised they use that as a means to actually promote/certify people in their respective fields. Seems a bit random and vague