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2018 ABFAS Study Tips

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OhEmGee

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Found some old threads. They were mildly helpful.

  • We all have to read mclglamry cover to cover
  • Goldfarb seems to be a wash.
  • Sounds like Hershey Manual is okay.
  • All the expensive board question sites are too easy

Anyone who took this last year have an more recent insight?

Thanks in advance.
 

air bud

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BQ? dont bother its a waste of time. You are a resident, you better already be reading and know this stuff. I studied 2 days and I wasted 2 days.
 
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DYK343

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I studied pretty hard for it. At least a month 3-5 hours a day. It didn't help at all. Other than the computer simulator you really can't study for it. Its not a factual exam. Its an exam you have to work through problems in your own mind and find the best solution. There are multiple right answers and you have to pick out the best right answer. I thought foot was much harder than RRA but others felt the exact opposite opposite.

It is a graduated exam. The better you do the harder the questions. Maybe I just bombed RRA and barely passed? I dunno. I felt like I got most of the right answers on RRA. It seemed more straight forward. Foot was pretty difficult. In the end I felt terrible about it but i passed all sections.

Best way to study for the exam is to have a broad understanding of the literature for foot/ankle. You can't cram for it.
 

Madura

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I found a post on a different ABFAS thread, but this one is more updated so I'll continue the conversation/question here:

The post was about how nobody knows how the clinical portion is graded. Does anyone have updated knowledge/tips on how to succeed here besides obviously knowing the long list of options to choose from? The biggest thing I want to know is if you get marked down for choosing a treatment that could "harm the patient" because I always thought you only get marked down for NOT including things, but never for including too much.
 

air bud

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I found a post on a different ABFAS thread, but this one is more updated so I'll continue the conversation/question here:

The post was about how nobody knows how the clinical portion is graded. Does anyone have updated knowledge/tips on how to succeed here besides obviously knowing the long list of options to choose from? The biggest thing I want to know is if you get marked down for choosing a treatment that could "harm the patient" because I always thought you only get marked down for NOT including things, but never for including too much.
Do what makes sense. Treat the patient. If you have a perfectly healthy patient there for an Achilles tendon rupture, don't check pulses. It's a waste of a diagnostic selection. Stuff like that. Don't select things for Completeness sake, that's not what you are being tested on. Think of it as a progress note not an initial exam. Focused to the problem.
 
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pacpod

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What helped me for the case portion was to do the ABFAS practice test not really for the case but to continue to familiarize myself with the structure/options/etc. And then to read over the CBPS answer key also noted at the bottom of this page Documents | ABFAS The help came from it explaining what they were looking for in the case and what they awarded points to etc.

I feel like a lot of the didactic was you know it or you don't. Everyone's experience was different. I didn't think the foot didactic/cases and the RRA cases were bad but i felt like the RRA didactic was tough but passed them all. I agree, hershey/goldfarb wasn't worth it for me.
 
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dtrack22

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The post from @Adam Smasher in the stickied ABFAS Scores thread is all you need to read...

I passed all sections as well. I have a few thoughts on preparation as well as test-taking strategy.

Preparing for Multiple Choice: The single best preparation you can do is pay attention during surgery and show up for cases prepared. This will have you actively thinking and the subject becomes more than an academic exercise for you. The more you do this over 3 years, the less important it is to do practice questions.

I used boards by numbers for practice questions. I found the study notes unhelpful. It's good as a question bank in terms of directing you to subject areas where you are weak, but BBN is also outdated (too many questions about arthrograms) and overemphasizes eponyms and classification schemes. In any case, I found the multiple choice questions much harder on the exam (especially the RRA questions) then on BBN or the ABFAS practice exam or in-training exams. A colleague of mine used board vitals and I saw a few of their practice questions which were also pretty dumb.

Which Brings me to the Simulation Exam: This exam attempts but ultimately falls short of being a realistic patient scenario. While it's understandable why we would limit the examination to 10 maneuvers, certain presentations may have a broad differential dx and certain diagnoses require a thorough PE workup (e.g. Flatfoot recon). Personally, I think 15-20 maneuvers is a better allowance. My biggest issue is that in a real world scenario, you have the ability to ask the patient to point with one finger where it hurts, but we can't here (there's a way around this, see below under imaging). So clearly, the objective here is not to do what's best for your simulated patient but to optimize your score. The good news is that the test can be outwitted.

Imaging: This was the first tab I would go to when I was taking the test. In many cases, pinpointing the symptoms is unavailable from the history, but an MRI will automatically give the 2-3 slices with all the diagnostic information you need. I have to respectfully disagree with @Ankle Breaker about the shotgun strategy, because not only has ABFAS explicitly stated they will not penalize you for unnecessary studies, but shotgunning your imaging often ensures you maximize your diagnostic information and therefore your exam score. While I was sitting for the exam, I remember thinking on one case, "Sure I'll get a CT scan, even though I don't think it's necessary." Turned out CT images were available, though I'm not sure this equates to the scan being a graded point. While ridiculous, this "MRI first and ask questions later" strategy ensures you can proceed efficiently through the case. The best part is that you're allowed 10 imaging studies, so it's hard to imagine a scenario where you would hit that limit.

PE: Here's where you trade your shotgun for a sniper rifle. From the grading rubric for the ABFAS practice exam, it would seem that checking pedal pulses and sensation [syntax: "light touch"] are not graded points. Still, I think it's appropriate to do. Most of the time asking for "vitals" gets you all the vital statistics you need on an infected pt, though sometimes you'll get the dreaded "be more specific" which in my opinion should not deduct from your 10 maneuver allowance. Remember, use your imaging findings to direct your exam, which we obviously do not do in real life but remember, this is about maximizing points, and if they didn't want us to use this approach they wouldn't allow is to switch freely between the imaging and PE tabs. I almost always used 8-10 maneuvers, even though only 3 of them are graded for points.

Other PE pearls:
1) check for crepitus and lymph nodes on infection cases
2) ALWAYS range the ankle joint and follow it with a Silfverskiold exam if necessary. The equinus workup/dx/management can lead to massive point loss if you forget it.
3) Flatfoot: there are a lot of specific maneuvers here that add up to big points. Heel raise, hubscher maneuver, RCSP, palpating the sinus tarsi.

Labs: I shotgunned labs too. While I'm 90% sure this is not necessary, I would get routine preoperative labs on everyone. CBC, PT/INR. Vitamin D levels are also a nice touch, but I doubt a graded point. For some idiotic reason, BMP/CMP are not on the menu. Type "serum" and then pick off the individual electrolytes. Obtaining serum creatinine would theoretically have ramifications on the use of IV contrast in your imaging, but ABFAS kindly glosses over this issue within the confines of the simulation. All diabetic patients get fingersticks and HbA1c, all RA pts get ESR/CRP, ditto for infections plus blood cx and wound cx, alcoholics gets AST/ALT, and anyone where we have gout in the differential gets a UA. For the ladies, hCG. You have up to 20 choices, so the world is your oyster under this tab. Practice the simulation online and you can get your whole lab panel clicked off in under a minute.

Diagnostic Procedures: Careful here, because some of these procedures are more invasive and the potential to lose points exists. Wounds need to be probed [syntax "wound probe"]. Smokers and others with lousy pulses should get Dopplers, though that's never been a graded point on the practice test. Diagnostic blocks are easy points to add in any case involving nerve entrapment or arthritis. EMG for tarsal tunnel cases. For serious trauma cases, check compartment pressures. Soft tissue masses should be transilluminated, aspiration bx, and followed by incisional/needle bx.

Diagnosis: Self-explanatory, but don't forget equinus! Half the patients will have it!

Management: See the ABFAS practice exam to get an idea what they're looking for. I think this was pretty straight-forward, if you were thorough in your workup and diagnosis, the treatment plan follows logically. Make sure you know proper syntax, for instance you don't "consult" vascular, you "refer" to vascular. Finally, when in doubt, fuse the joint.
 
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Madura

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All 3 responses were incredibly helpful. Thanks.
 
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