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Discussion in 'Pediatrics' started by eligible, 12.19.09.

  1. eligible

    eligible

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    To those frustraed pediatricians as I am, with Board eligibility time running out.

    I am out raged at the low pass rate of 77% for the board exam
    When I called the ABP I got the explanation that "these are the standards that we owe the public".

    Does the public know that there are pediatricians that were "grandfathered in and are still practicing" and never opened a book in over 20 yrs? Who made this policy?

    The ABP can still provide no explanation for the low pass rate and I urge any of you med students : "RETHINK PEDS RESIDENCY"- our leadership provide no explanation nor direction.
    Some of my colleages are facing going back to residency- you don't want that, some of us started families, can you imagine that?

    Meanwhile the jobs that are offered to those who are Board Eligible are with very low compensation- because of the low passing rates the employers are using it against us.
    Any one with same experience is welcome to contact : Ms Linda Althouse
    at the ABP.
    She and the rest of the board members have no idea of the ramification of such policy and the extent of the it. Yet, polocies and standards are being created with out any representation from us the practicing pediatricians, low paying job, low pass rate- HARDLY WORTH IT !!!!
  2. twilightdoc

    twilightdoc Attending

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    The overall ABP pass rates do seem to be lower than those of corresponding "general" boards (medicine, for example). For students applying for Pediatric residencies, inquiring about "Board pass rates" for their trainees is a legitimate question to raise during your interview visit. Individual interviewers or residents you meet may not know this information, but I can assure you that the program director will.
  3. oldbearprofessor

    oldbearprofessor Administrator Administrator SDN Senior Moderator SDN Advisor

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    I addressed the grandfathering issue in this post. As far as the leadership not providing explanation, I would at least note that the pass rate for first time takers of pediatric boards has been unchanged between 75-79% for at least the last 5 years and I think much longer (pretty sure this was the rate for the 1980's and 90's, but don't know for certain), so no one was being deceptive as to the passing rate when current test-takers entered residency. It may be that the pass rate is too low, but one will need to make that case to the ABP to change it's long-standing policy. I can think of reasons this might be reasonable and the ABP might consider it, but, it won't happen overnight or based on a few phone calls to the ABP. Perhaps you can use this forum to list the reasons (benefits to children as well as pediatricians) and develop an argument to be taken to the ABP.

    Oh yes, and according to the ABP website, Ms. Althouse has a PhD, so professionally at least should be addressed as Dr. Althouse.

    Or, you could just look it up as this is public information on the ABP website.

    https://www.abp.org/ABPWebStatic/#m....html&surl=/abpwebsite/stats/wrkstatintro.htm

    and click on the last link about exam pass rates on the far left column.
    Last edited: 12.19.09
  4. Gyric

    Gyric Junior Member

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    That is unfortunate, I had no idea the peds board exam was so rigorous. I should point out that this is not the lowest boards pass rate out there. In pathology (CP) the pass rate has ranged from 59-64% total (72-77% for first timers) in the last two years.
    Last edited: 12.19.09
  5. ahd929

    ahd929 Senior Member

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    maybe i'm missing something, but does that site provide a breakdown by residency program? the link you point to only breaks it down by pediatric subspecialty, and doesn't mention any specific institutions.
  6. oldbearprofessor

    oldbearprofessor Administrator Administrator SDN Senior Moderator SDN Advisor

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    Sorry, try this link
  7. eligible

    eligible

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    With new policies such as board eligibility time line, I definitely feel deceptive and for a good reason.
    Prior to June 2009, a candidate had no time limit on how many times they are eligible to take the boards.
    In fact some pediatricians graduated residencies in 1989 and have been certified in 2002.
    The frustrating part is for those of us who graduated residency after 2005 and before June 2009 who assumed for the past 3-4 years, that we there are no eligibility deadlines to " take the boards".
    Those who applied to peds residency in 2003 had the following statistics:
    low passing rate ( compare to the other GP specialties), but no restriction on eligebility criteria.
    Under what legal category do we fit in?
    So all throughout my residency and upon completing my residency , I was under the assumption that I can take the boards when I feel ready and conducted my life as such, i.e prioritized ( and to each and one of us their reasons). Now we are faced with a dead line, which with all do respect to
    "Oldbearprofessor" by all means I have no intention of bringing up the "grandfathering" which is a done deal never the less comparabale to my issue and demonstrate double standards on behalf of the ABP.
    Yes I was decieved choosing the peds residency, " lower pass rate than the rest, but had no time limit on eligibility".
    It is easy to cut and paste any sentences that you want and reply upon individual words.
    The point is still the same point, "why are they changing the goal post in the middle of the game" ?
    My apologies to Dr. Linda Althouse, she is a respected PhD and has been encouraging our questions and concerns.
    To "Oldbearprofessor", how would you feel if new policy will come into effect after you have finished your long and rigorous training ready to start your life and "oops" you have got a dealine to meet?
    Everything around you has to stand still, including personal matters, medical treatments, everything that life encompass.
    Keep in mind that a year ago, all this was not an issue and things were going according to plan, a plan that was discussed years ago when you chose and started the residency in peds? ( time is running out...)
  8. eligible

    eligible

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    BTW the highest pass rate was reported in 2004 as 78%, since than it has been 76% ( have not seen 80% at least in the past 10 years)
    Anyone?
  9. oldbearprofessor

    oldbearprofessor Administrator Administrator SDN Senior Moderator SDN Advisor

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    Just to clarify, the deadline is 2014, so you have 4 years to study and pass the boards. From the ABP website "Beginning in 2014, the American Board of Pediatrics will require that applicants have completed the training required for initial certification in general pediatrics within the previous 7 years (eg, 2007 or later for examinations administered in 2014). If the required training was not successfully completed within the previous 7 years, the applicant must complete an additional period of accredited training in order to apply for certification."

    You continue to misuse the word grandfathering and putting it in quotes doesn't correct that misuse. There was no grandfathering in general pediatrics (well, not in the last 60 years or so) and as I've repeatedly explained, the situations are not similar in any way even though you believe them to be.

    Sorry, but it is impossible to respond to your stream of conscious posts in any other way. I do not think I've misquoted your ideas and parsing out comments for response is standard on the internet. Your misuse and accusations regarding the word grandfathering were important for me to specifically respond to.

    I agree with the ABP that 7 years after training should be enough to pass boards. I have no problems with it being retroactive. You have 4 years to take the exam, to me that is fair. If you have a major health issue that will prevent you from taking an exam by 2014, then you should appeal to the ABP for an extension.

    Again, running out means 2014, not 2010.

    Sorry you are having a tough time with boards, but I do not agree that the ABPs rules are onerous, unfair or a reason not to do pediatrics. I do agree that ABP should, over time, consider reasoned arguments to raise the pass rate a bit to be more consistent with ABIM and ABFM.
    Last edited: 12.23.09
  10. rotatores

    rotatores Senior Member

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    I think a 4-year warning on taking the boards is more than reasonable and having to take it within 7 years is extremely generous. We all went through residency with the expectations of passing our boards sometime shortly after graduating. Your comments indicate you are surprised that you are expected to pass your boards at some point. I understand that "life" happens and things don't go according to plan and we're not always given the time we feel we need to study, however, isn't that what 3 years of residency is for?
  11. DarthNeurology

    DarthNeurology

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    Just because the Peds boards has a relatively low passing rate does not mean that it is any more "hard" than any other board examination. Rather, the pool of test takers, i.e. pediatric residents, maybe not up to the task, i.e. lower usmle board scores AND many peds residents may be failing the board examinations by a hefty amount, i.e. not even close to passing.

    Three years is a lot of time to pass the Peds boards, also many med/peds residents pass the Peds board when they have had only two years of Peds, sure there is some overlap, but three years should in theory be long enough to learn Peds.

    Peds boards material is "hard" in that you don't get a lot of experience to the stuff in med school and you have to learn more new stuff in residency compared to the IM board, IMHO. Peds residency programs should do more to help with board preparation.
    Last edited: 12.25.09
  12. rotatores

    rotatores Senior Member

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    Easy there Darth! That's a lotta mud slinging...and the second half of your sentence makes absolutely no sense. The overall score has nothing to do with the pass rate!
  13. rotatores

    rotatores Senior Member

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    After reviewing some of your prior posts I'm actually embarrassed that I even responded. :thumbup:
  14. Tone2002

    Tone2002 Senior Member

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    LOL

    Thank you. Clearly that was posted to get a rise out of folks.
  15. DarthNeurology

    DarthNeurology

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    I did not mean to "sling mud" at peds residents, rather noting that the medical education system does not prepare peds residents well for passing the Peds Boards. This is a real issue, sure many peds residents may have lower usmle scores, of course they may become excellent pediatricians, but this should be taken into account when designing peds board review material. Some residency programs, i.e. big academic children hospital programs that have ped residents who did well on the usmle and have possibly a greater fund of general medical knowledge, OR perhaps different more effective study strategies obtain nearly 100% passage rates.

    I would assume that the overall score and percentage correct does have something to do with the passage rate as there is a cut-off somewhere placed for passing. Each year the ABP looks at the cut-off for passing, it is around 410 I believe, the mean of 500 and a standard deviation of 100, . . . if people have a problem with the percentage who fail then the passing score would have to be adjusted below 410 . . . however my point was that many graduate peds resident who fail maybe well below 410 i.e. the bell curve is not a standard bell curve.

    The mean of 500, with 410 being near 1 standard deviation is based on those recently graduate from american medical schools, which means that the passing rate for graduates of american medical schools is near 100-15.8% or approximately 85% passing rate for AMGs, the current passage rate of around 77% reflects that IMGs and DOs pass the Peds Board at a lower rate. . . .

    Anyway, didn't mean to offend . . .
    Last edited: 12.25.09
  16. Monk76

    Monk76

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    Has anyone ever requested a recount for the pediatric board exam? I was one of those that narrowly failed to pass (only by a few points) and have been debating whether or not it makes sense to ask for a recount. Of course if it were a computer based exam (which I think it should be) this wouldn't be much of an issue.

    Does anyone who has asked for a recount and what the results were? I'm really not looking for to studying again for the exam.

    Also as per one of the previous posts. I don't think the pass rate is just secondary to dumb pediatric residents. I trained at a very large academic center with a lot of very smart people that take excellent care of sick pediatric patients and we don't have a 100% pass rate. Unfortunately the board exam is not a reflection of ones ability to care for patients but rather to answer a selection of esoteric questions.


    Just my 2 c
  17. oldbearprofessor

    oldbearprofessor Administrator Administrator SDN Senior Moderator SDN Advisor

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    This thread could use to die and I hate to continue it, but I wanted to correct what I believe are some mistakes in a previous post.

    ABP sets passing score at about 410 each year or at 0.9 SD below mean. This is the 81.59%ile, not the 85%ile. Furthermore the 410 is set on "American Medical Graduates" which are dichotomously distinguished from International Medical Graduates on all references and thus presumably include DOs although I can't immediately find a reference to that.

    Since IMGs represent about 16-18% or so of pedi residents, the difference between the 81.6% and the usual passing score of 76-78% overall for first time takes is at least partially typically related to differences in pass rates between IMGs and AMGs. Someone else can calculate the mean pass rate for IMGs based on these numbers, but a quick calculation would put the IMG rate at about 50% (someone else can correct this exact number).

    None of this suggests that the curve for US AMGs, which controls the pass rate is not bell-shaped or has a double bell or that pediatric residents are unprepared for boards (I've never seen the distribution curve posted). The pass % is almost entirely controlled not by lower scoring IMGs or retakers (whose pass rate is < 40% but are not included in the pass rate published), but by the decision to set the pass score at 410 for US AMGs. One could look it up, but this number has to have been set lower by the ABIM and ABFP.

    Edit: I found it for ABFP. For them, the rate was 390 or 1.1 SDs (86.43 %ile). ABIM is a bit more vague...

    http://www.abim.org/about/examInfo/developed.aspx#standardSetting
    Last edited: 12.27.09
  18. DarthNeurology

    DarthNeurology

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    Thank you for the more indepth statistical analysis OBP, however, ABP hasn't published distributions and the logic behind their decisions, and they may indeed be making valid decisions with regards to passing cut-offs, we just don't know. Board certification has to mean something, i.e. if everybody passed no matter what percentage of questions answered then it wouldn't mean much at all.


    Having a good foundation of clinical knowledge IS important for pediatricians, and a study done in ambulator pediatrics found a significant correlation between Step 1 board score and ABP board passage rate:


    In order to become board certified in their specialty, pediatric residents take the American Board of Pediatrics (ABP) certifying exam, a two day written test with over 700 questions. In medical school and during residency, they also take many other exams that faculty use to monitor trainees' academic progress as well as to assess the likelihood of passing the ABP exam. To determine the power of prior exams to predict a resident's performance on the ABP certifying exam, researchers analyzed the associations between exam results and eventual board scores. The United States Medical Licensing Exam (USMLE) (Steps 1 and 2), annual in training exams (ITE 1, ITE 2, and ITE 3), and the ABP exam were highly correlated with each other. The best predictor of ABP passage was the resident's performance on the USMLE Step 1. A score of 202 on the USMLE Step 1 was associated with about an 80% chance of passing the ABP certifying exam while a score greater or equal to 220 was associated with an almost 95% passage rate on the board exam. Rather than use these findings to screen applicants for pediatric residency programs, program directors should use these test results to guide residents' education in ways to maximize their chances of passing the ABP certifying exam. (Contact Quimby McCaskill, MD, MPH, 904-357-5802.)

    So, . . . if Peds residents had an average of 220 or above on Step 1 then the passage rate would in theory be about 95% (assuming IMGs are excluded), I think 215 is about average for Step 1 anyway. Everybody knows there are a lot of Peds residents who barely scrapped by in medical school and got a 200 or so on Step 1. I think the questions on the ABP are somewhat fair and if a higher percentage of test takers were actually answering more of the questions correctly then the ABP might consider adjusting the number passing. However, they obviously use statistical methods and try to create a fair exam.

    A Step 1 of 220 is average for some IM residency programs, and below average for some surgical specialty fields.

    So, yes, Peds residents may have less of a foundation in basic/clinical sciences as per Step 1 and this is why the Peds Boards appears "harder"

    I do believe there is a double bell curve or something, at any rate it is good that the ABP keeps their standards where they are IMHO.
    Last edited: 12.29.09
  19. rotatores

    rotatores Senior Member

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    Besides the fact that you are making a number of assumptions here...the test is no longer 2 days and it is only about 350 questions.

    Sorry...but I'm gonna have to disagree with you on your opinion that "many" pediatric residents barely scraped by in medical school. That's rather insulting and purely an opinion. Are you always this charming....I feel for your patients. ;)
  20. kickazzz2000

    kickazzz2000 Member

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    With that logic, explain why the ABFM pass rate is close to 87%?
  21. randomdude

    randomdude Junior Member

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    Just curious - anyone know the passrate for repeat test takers?

    also, to the OP: Why can't you just study and take the test? You have 4 attempts left to pass. Just my humble opinion.
  22. oldbearprofessor

    oldbearprofessor Administrator Administrator SDN Senior Moderator SDN Advisor

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    Repeat takers have a pass rate of 30-40% (most recently I saw 34%). They are not part of the curve used to determine the standard deviation and the pass score. The data are not split by first and second retakers.

    The OP, assuming one failure, has two more attempts to pass before doing some form of remediation that might include up to a year of pediatric residency.
  23. shirt

    shirt

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    "noting that the medical education system does not prepare peds residents well for passing the Peds Boards."

    I agree only somewhat. The Peds Boards, unlike other boards exams, requires you to know so much esoteric zebra stuff. It's rediculous!!! My husband is Fam Med and his boards exam was focused more on the practical stuff. He didn't have to study about syndromes that afflict only 1 in a billion. I saw my fair share of weird syndromes in residency but to pass the peds boards, you have to hunker down and learn about all possible rare syndromes out there. I think it's a matter of putting in the effort and learning from the right (high-yield) sources and not necessarily just things you learned from your residency because that is not enough. So yes, in a way, peds residency didn't prepare me at all for passing the peds boards because the questions on the peds boards are about a lot of things I (or for that matter, most old-timer pediatricians) haven't seen but are expected to know.

    And to answer someone's post about having the ABP regrade the exam. It's worth a try, if you failed it by a few points. I had them regrade mine as well because I came very close the first time but of course, I got the "we regret of inform you...you STILL failed" letter. I think in the history of the ABP, no one has ever had a reversal after requesting for a regrade.
  24. shirt

    shirt

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    Oh I forgot to add.

    When I was reading MedStudy, I had to chuckle when I read something to the extent of "...this syndrome is very rare. There are only 4 documented cases in the whole world. Does the ABP want you to know about this syndrome. Yes." :scared:
  25. LadyMD98

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    Hello Everyone! I am new to SDN and I have enjoyed reading the posts so far. I am one the many repeat takers who failed the peds certifying exam in Oct. 2009 and was very disappointed! It was my third time around and I thought the third time would be the charm.

    As I prepare to take the exam this October, I would like some suggestions on how to prepare for the exam. I feel I have tried everything (Board Review course on site, home study with books such as LYW, Med Study, PREP) and I still failed. The cost of the exam is now $2,030 and I'll be damned if I will give anymore money to the ABP.

    Any and all suggestions welcome!
  26. michigangirl

    michigangirl

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    This is one of those exams, that might not be completely practical, but I think it says a lot about someone when they can figure out how to study for an exam through high-yield means. I always did not so well on the in-services-- but I studied my a#$ off for the exam because I knew that I was a good clinician, and that the exam was just a formality. After memorizing Laughing Your way to pediatric boards, First Aid for the Peds Boards and doing 3 years worth of prep, the exam was dare I say, easy. But without all that studying, I would have surely failed. This was just my formula. I understand it's frustrating to fail the boards and to blame it on it all being esoteric stuff. But to be honest, MOST of the stuff is practical. There is a lot of "esoterica" but even that is finite in the amount of information you need to know. If you miss a few questions about the diseases that only 4 people in the world have, it won't make or break failure, as long as you have the practical stuff down pat. It's a TON of memorization. I think learning how to study for an exam is a skill to hone. Have at me. ;)
  27. PMinty44

    PMinty44 Senior Member

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    Anyone out there own the 4th edition of the Med Study core curriculum (not marked or highlighted) that he/she is willing to sell to me? If so, PM me. Thanks! =)
  28. learner1

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    Which book should be the reference? Nelson? Or is it like we need to go through specific books for each sub like Cloherty etc.?
  29. 2011 BOARDS

    2011 BOARDS

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    Hi everyone :),
    I am taking the peds boards oct 2011.
    I was wondering approximately how many questions total will be there on the exam?
  30. pedsresident1

    pedsresident1

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    Hi!

    I just completed residency and don't have a subscription to AAP. Where else can I get 3-5 year worth of Prep questions?

    Thanks!
  31. jwtp

    jwtp

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    no matter how frustrating its been not knowing for 4 years that there will be a restriction coming upon us, still its a fact to face!! In fact still exam being given only once a year unlike other boards, very high failure rate specially for retakers unlike other boards we have no idea whats next?
    since failing the peds boards for few times already and now the timeline approaching close i may sound depress and many people wonder why you cant still study and pass, well i am trying the best but could have been much better if knew about the restrictions and continued once a year exam taking opportunity during the time of residency!
    Anyways no use of crying over all this need some help! how much percentage score individually do we need to pass? I mean the reference group of American grads' first time takers how much do they score to pass? ( percentage not percentile !!).
    Does anybody know if ABP is formatting a plan for those 'successful Pediatricians' who wont pass their boards to go back to the residencies?? who will accept them?? i mean seriously there are lot of folks who have not grandfathered in and running successful peds practices still not planning to take their boards!!
    Anyways coming back, starting very early this year hoping to get right info, read right materials and put enough time to pass this great exam!
    All inputs will be appreciated!!
  32. oldbearprofessor

    oldbearprofessor Administrator Administrator SDN Senior Moderator SDN Advisor

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    ABIM only offers the exam one time a year. They have several dates in that month, but it is still only "once" a year for grading, etc. Family medicine also is once a year. I didn't look up others, but those are the comparison groups for pediatrics and I doubt many offer more than one "time" each year.

    Pass rate is, as noted in many of the posts in this thread, unrelated to how many retakers there are. So, a low pass rate in retakers is not related to any ABP policy that I can tell.

    Questions about the "return to residency" possibility should be addressed to the ABP. My expectation is that a small number of programs will offer a program in which those who needed to remediate residency would have a structured program of increasing responsibility focused on primary care pediatrics. I doubt any programs have established this yet formally though. If anyone knows of such programs, let us know.

    As far as practicing without ever being certified, as you know, there is no requirement legally that one be board certified to practice medicine. The limitation is on the jobs you can get and the hospitals that will approve you. You are correct that not all jobs and situations currently require certification although it is likely that more will with time.
  33. Socrates25

    Socrates25

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    If you're comparing peds to plastic surgery and dermatology then yes I agree that the peds population taking the test is probably inherently weaker at test-taking. However, I sincerely doubt that is the case for most fields like IM, family medicine, psych, etc.

    I think the difference is that peds is much more sheer memorization than IM. IM boards use much more problem-solving type questions where you can sort of reason your way thru the question, develop a differential diagnosis and narrow it down based on the question stem and answer choices. Peds is much more "look at this picture of abnormal facies and tell us what genetic syndrome this kid has."

    I also think that there is a lot of difference in terms of exposure to the material during residency. I cant prove this, but my impression is that peds had more of the "I'm never going to see a case of this in my entire practicing career" whereas IM didnt have as many of those kinds of questions.
  34. Socrates25

    Socrates25

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    I agree. The IM exam has a lot less questions about the "1 in a billion" zebra diagnoses whereas they are scattered all over the peds boards.
  35. Socrates25

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    My suggestions for a surefire way to pass the boards (provided you dont have other issues like test-taking anxiety that will affect your performance):

    1. Start 7 months in advance with HARDCORE STUDYING, at least 2-3 hours a day in the beginning, ramping up to 5-6 hours per day within the last 6 weeks.

    2. Use "Laughing Your Way to the Boards", Zitelli's atlas, MedStudy, and at least 5 years of PREP questions.

    3. Go through Laughing your Way at least 3 times.

    4. Dont read Zitelli's word for word but go thru all the pictures at least 3 times; be able to flip to a random page and identify on the spot what they are trying to tell you without reading the caption.

    5. Go thru MedStudy at least twice.

    6. Go thru 5 years of PREP questions at least twice. Scratch that -- do as many PREP questions as you possibly can -- 5 years is an absolute minimum. I can not emphasize this enough. I remember every single PREP question that I get wrong and I remember why I got it wrong (basically I hate being wrong and seeing the red marker on the PREP questions indicating a wrong answer pisses me off!) My learning yield from getting questions wrong is MUCH higher than what I get from reading a bland text over and over again. Knowing the right answer is not good enough -- you need to know why all the other answers are wrong.

    7. KNOW THE ABP CONTENT SPECIFICATIONS! There are approx 3700 of these content specs, and they are essentially a "cheat sheet" as to what is going to be on the exam. Some of these content specs are incredibly vague; for example one of them is something to the effect of "know common viral syndromes that affect children in various age groups" but others are EXTREMELY specific, in fact they are so specific that you dont need to do any studying on that topic, just knowing the ABP content spec counts as "studying." An example of this one would be "know that Von Willebrand's disease has normal coaguation studies but a prolonged bleeding time." Just by reading that content spec you will remember it for the test. Out of these 3700 topics, a couple of hundred of these cant really be put into question format. For example, one of the content specs is "know that children with chronic diseases require multifactorial social supports." My advice is to read thru all the ABP content specs once before you start studying, and at least twice at the end of your "core" studying a few weeks before the test.

    8. When you read thru the PREP questions, always click on the ABP content spec thats listed at the bottom of the question. This is important because some PREP questions are only partially related to the ABP content spec that its supposed to cover, and reading the ABP content spec they are trying to draw from will enhance your studying. For example, one of the PREP questions will have a question about traveler's diarrhea, asking you to pick the most likely etiology from campylobacter, e coli, giardia, shigella, salmonella, etc ( the answer is e coli). The actual ABP content spec though is different and says something to the effect of "know that e coli enteritis generally does not require antibiotic therapy." You would miss that key point if you just answered the question correctly and moved on without reading the ABP content spec.

    This method is specifically for people who have had difficulty on previous peds boards -- obviously if you are a stud testtaker and an ace resident you dont need to put this much effort into it.
  36. Socrates25

    Socrates25

    Joined:
    08.30.09
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    859
    Status:
    Attending Physician
    SDN 5+ Year Member
    Approx 350.

    The good news is that for the first time ever, its a computerized exam this year and you can take it at prometric. Finally the ABP has seen the light and how absurd it is for people to get on an airplane and travel for hours and stay in a hotel just to take a freaking scantron test with 200 otehr people in an auditorium with people coughing and cell phones/pagers going off for the entire 7 hours.

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