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acidbase1

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+1. Unfortunately, if the knowledge is not far from a CRNA's, what's the difference? What does "doctor" stand for? What does one build the clinical expertise on?

For the record, I also hated my own written exam. I remember a number of Step 1 level questions and details that were completely irrelevant to the practice of anesthesia. I couldn't care less whether an adrenergic receptor subtype increases or decreases cAMP or whatever in the cell. I used to know that, but I cannot imagine a clinical scenario where that would matter.

See, what you guys don't understand is I would have died to have had some questions like that yesterday. In fact, I prepared for that level of detail. These weee Richter scale absurd
 
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deleted171991

Btw, in case an ultrasound catches on fire when we're doing the ABA Applied OSCEs later this year, I'd love to know what extinguisher to use! (From what I read out of curiosity afterwards, two of the options are routinely used for electrical fires.)

[ABA, instead of being angry that this question got mentioned online afterwards, just get rid of it. It's really, really stupid. Let me emphasize, really stupid. In fact, fire that question writer from your staff.]
CO2 and/or sand, I think. (I will look it up now.)

P.S. Correct answers: CO2 and dry chemical-based or powder.
 
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complainaboutaba

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CO2 and/or sand, I think. (I will look it up now.)

P.S. Correct answers: CO2 and dry chemical-based or powder.

Yeah they had both CO2 and dry agent on there. Oh well. Maybe they were being nice and giving us a 2/4 chance. :)
 

pgg

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Maybe. But in this specialty common sense, quick thinking, and lack of stupidity go a long way in avoiding bad outcomes. The esoteric stuff, not so much. FWIW the guy in my residency program who scored in the top 10 percent on the basic and crushes the ITE, I wouldn't let him anesthetise my dog ...

The residency program director and the oral board examiners are the weed-out points for clinically incompetent people. Not the written exams.
 
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pgg

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I think FFP sees people complaining about an exam and thinks we're exaggerating the amount of dumb questions and whining because it was hard, since that happens all the time.

I agree, this exam felt different - lazier, stupider, etc than other exams I've taken before. If he had taken it, I really think he would've been disgusted how little critical thinking and detailed knowledge of anesthetic practice was useful in answering the questions

I believe you guys. After every exam, this board sees a thread where people gripe about some esoteric BS WTF questions. But it really does sound like it was different this year.

I graduated and passed my boards before the Basic / Advanced split. In a way I'm glad to hear the Advanced exam isn't a rehash of "basic" topics like volatile agents and difficult airways. But it sounds like they may have missed the mark in making the Advanced exam difficult but relevant, and possibly produced an unfair exam.

In the late 2000s when I was a resident, I think the exam really was too easy ... just look at the published by-year norm tables and look at how many CA1s were getting passing scores on the ITE. This was a time when the ITE and the real exam were the same test ... you'd be sitting in a classroom as a resident filling in bubbles with a #2 pencil next to a new graduate filling in the same bubbles on the same test, but for actual board credit. Something like 1/5th of CA1s could pass the thing; it was too easy.


@FFP -

If an anesthesiologist can't pass the board exams in the UK or New Zealand ... can they still practice the specialty?

I totally agree that the exams should be difficult. I readily believe that other countries have more difficult anesthesia boards ... or maybe they'd just be more difficult to us since they get a lot more CCM training than US residents do?

The problem is that hospitals and insurance companies in this country have made board certification a near de-facto requirement to practice at all.

After completing medical school, internship, and residency, the bar to practice at all shouldn't be set by the ABA.

It used to be that board certification in the USA was an extra badge of honor, and optional. Now that it's essentially a requirement, I can't really agree that the ABA should be making the test so difficult that more than 10-15% fail each year.
 
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pgg

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I'll add that I'm presently waiting for the results of the Advanced PTEeXAM (Examination of Special Competence in Advanced Perioperative Transesophageal Echocardiography), which I took about two weeks ago.

I thought that exam had some fairly difficult questions. A handful were kind of out of left field, and the emphasis of some topics (e.g. knobology) over other topics (e.g. the mitral valve) was puzzling. But I left thinking it was fair. I feel pretty confident I passed, but if I didn't I'll be angry with myself, not the NBE.

I can empathize with those of you who are angry and anxious because this ABA exam struck you as unfair.
 

acidbase1

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I feel as if at this point I'm kind of a professional test taker/student. We understand this process, we have been taking exams for over a decade. I don't think some of the older gentleman understand how competitive things have gotten. USLME scores keep going up. It once was easy to get a spot in anesthesia with a 200 on step 1. Now most of the applicants we interviewed last year had 230 and above. Heck, since the institution of the basic exam my ITE percentile went down 20% based on the same raw score from the previous year. The bar keeps getting higher and higher and it's getting to a point of absurdity.

It is what it is, and yes, we all more than likely passed. However, I hope the ABA takes a long hard look of where this deal is headed. Yesterday was the biggest joke in my academic career, one that spans 17 years.
 
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deleted171991

@FFP -

If an anesthesiologist can't pass the board exams in the UK or New Zealand ... can they still practice the specialty?
As far as I know, they can, just still at resident (registrar) level. Maybe that's not such a bad idea. That's actually more strict than in the US, where one can work for 2-5 years (depending on the hospital), without being board-certified. @bashwell, @dhb, please correct me if I'm wrong.

They don't get more hours of training than us, just more years. And, while critical care is part of their specialty, that shouldn't make them more of a doctor or consultant. Or do you think I am a better anesthesiologist than you (probably not true), because I am also critical care-trained? :)

And not that I am accusing you of this, but it's always easier to choose the populist position. Populist doesn't always mean right; quite the opposite, usually. Excellence usually requires hard work and sacrifice, and those two can be pretty unpopular. Heck, a lot of those people get accused of being just good test-takers, and we all have legends about the guy who looked great on paper and sucked clinically. There, now I truly live up to my pompous ass title.
 
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deleted171991

I want to be just like you FFP
No, you don't. You're smarter than that.

But after having worked a few years, especially in PP, you will have met a lot of these "great" anesthesiologists who haven't read a serious piece of literature in many years, who laugh in your face when you suggest that something can be done better than their 1-2 decade-old ways, who cut corners every day to keep the surgeons happy, who just shrug their shoulders when they see/have a near miss and keep doing what they are doing, who don't even realize when they deliver subpar care, who don't put much soul in their daily work, who just love the status quo, who let CRNAs and even SRNAs do more every day (if it means they have to do less), who care mostly about the money. And then you will have to decide if you can still respect yourself while being one of them, especially if you become their partner. Because that's the popular position/attitude that has brought us all the good stuff in anesthesiology: the CRNAs, the management companies etc. Passion and perfectionism are rarely appreciated, because they usually bring in less money.
 
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complainaboutaba

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I'm going to attempt to make this my last post re: this exam, because why beat a dead horse, but...

I was just talking to another resident re: his experience, and I like what he said about what bothered him so much about this exam. "I feel like a below average SRNA would have done very similarly to me on this exam. I cannot even claim that our written certification exams require a much better understanding of medicine and physiology than theirs anymore."

This exam was basically 67 reps of the following (not necessarily exact questions, but somewhat close, for illustrative purposes):
Q1 - what should you give for Mg toxicity - calcium, duh
Q2 - which LA passes to fetus the least - chloroprocaine, duh
Q3 - which chemical warfare agent causes the most pulm edema - huh?

I think many of the SRNA students at my institution would have known the same 2/3 of the answers that I did, and guessed similarly on the other 1/3. This is how we're deciding who to say is a board certified anesthesiologist nowadays? Embarrassing. Do better ABA.
 
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deleted171991

If the exam was not hard, but as stupid as you describe it, then (between the ABA and the ASA) we are doomed.
 
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sigrhoillusion

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I'm going to attempt to make this my last post re: this exam, because why beat a dead horse, but...

I was just talking to another resident re: his experience, and I like what he said about what bothered him so much about this exam. "I feel like a below average SRNA would have done very similarly to me on this exam. I cannot even claim that our written certification exams require a much better understanding of medicine and physiology than theirs anymore."

This exam was basically 67 reps of the following (not necessarily exact questions, but somewhat close, for illustrative purposes):
Q1 - what should you give for Mg toxicity - calcium, duh
Q2 - which LA passes to fetus the least - chloroprocaine, duh
Q3 - which chemical warfare agent causes the most pulm edema - huh?

I think many of the SRNA students at my institution would have known the same 2/3 of the answers that I did, and guessed similarly on the other 1/3. This is how we're deciding who to say is a board certified anesthesiologist nowadays? Embarrassing. Do better ABA.

So you DON'T know what agent causes the most pulm edema!?!?! just messing.

BTW... is it phosgene?

Then again, with Trump we all might need to brush up on our warfare anesthesia knowledge... :rolleyes:
 

complainaboutaba

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So you DON'T know what agent causes the most pulm edema!?!?! just messing.

BTW... is it phosgene?

For anyone, like me, that remembers the four potential answers to that question - all have pulm edema as a significant part of their pathology - per my brief search afterwards. I think the writer of this question was trying to be even nicer to us than the guy who wrote a fire extinguisher question with two correct answers. He decided to give us a question where all answers would be considered correct.

In addition to the above mentioned possible answers, I'm going to limit the amount of castor beans in my diet moving forward. Because their associated (but unnamed) poison also leads to pulm edema - like every other f-ing answer to that question.
 
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AdmiralChz

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I took the test yesterday, and to be completely honest I didn't find it as ridiculous as others are. I seem to remember being MUCH more frustrated with the Basic and all the IT questions that went along with it.

Were there headscratchingly random questions? Of course, but USMLE Steps 1-3 and Basic all had them. I was pleasantly surprised at the lack of rehash of basic questions - much more focus on neurophysiology, cardiac physiology with medications and pregnancy changes. The interface was clunky for sure, but that may be more of a reflection on Pearson than the ABA itself?

I agree with many of the others - I'm not so sure the written boards are made to examine "critical thinking skills" as some have suggested, the orals seem much more geared towards this and thinkin on your toes as a consultant. Plus you should have been doing some of that doctor-ish stuff during residency and subject to regular evaluations, at least I hope.

In any case I'm glad it's (hopefully) over. Congratulations to everyone on making t through another hurdle!
 

bashwell

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As far as I know, they can, just still at resident (registrar) level. Maybe that's not such a bad idea. That's actually more strict than in the US, where one can work for 2-5 years (depending on the hospital), without being board-certified. @bashwell, @dhb, please correct me if I'm wrong.
Apologies as I haven't read the rest of the comments in this post. Probably best to ask @JobsFan this question though since he's already a staff specialist (consultant/attending), and he can correct me if I'm wrong. From what I know, anaesthetic registrars in Australia have to sit two exams (each composed of multiple parts MCQs, SAQs, vivas, etc) -- primary and final/exit exam. Both have low pass rates relative to board exams in the US. I don't know the exact per cent, and it varies year by year, though it's probably easy to find by Googling, but I've been told as "low" (by US standards) as a 30%-40% pass rate. I've also been told the primary exam is a lot more difficult than the exit exam.

If you fail your primary exam, it's possible to lose your spot. I was told this by a Supervisor of Training (approximately like a PD in the US) in anaesthestics. If you fail your final, then I think you can still work. At least I've met a few anaesthetics registrars who have failed their exit exam but are still working as anaesthetists/anesthesiologists. I don't know if there's limit to how many times one can sit the exam however but I'm sure JobsFan would know. Sorry as that's all I really know, but hope that helps a little bit.
 

acidbase1

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I took the test yesterday, and to be completely honest I didn't find it as ridiculous as others are. I seem to remember being MUCH more frustrated with the Basic and all the IT questions that went along with it.

Were there headscratchingly random questions? Of course, but USMLE Steps 1-3 and Basic all had them. I was pleasantly surprised at the lack of rehash of basic questions - much more focus on neurophysiology, cardiac physiology with medications and pregnancy changes. The interface was clunky for sure, but that may be more of a reflection on Pearson than the ABA itself?

I agree with many of the others - I'm not so sure the written boards are made to examine "critical thinking skills" as some have suggested, the orals seem much more geared towards this and thinkin on your toes as a consultant. Plus you should have been doing some of that doctor-ish stuff during residency and subject to regular evaluations, at least I hope.

In any case I'm glad it's (hopefully) over. Congratulations to everyone on making t through another hurdle!

First person I've heard say this out of three programs... you must've not been prepared for the basic bc they weren't even remotely close.
 

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Giant WTF test.

If I failed I seriously don't have a clue what/how to study.
 
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pgg

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As far as I know, they can, just still at resident (registrar) level. Maybe that's not such a bad idea. That's actually more strict than in the US, where one can work for 2-5 years (depending on the hospital), without being board-certified.

They can work as registrars indefinitely, can't they? The sorta-comparable state in the US (board-eligible attending) has a clock.


They don't get more hours of training than us, just more years. And, while critical care is part of their specialty, that shouldn't make them more of a doctor or consultant. Or do you think I am a better anesthesiologist than you (probably not true), because I am also critical care-trained? :)

I suspect you are a more well rounded physician than I am - certainly in the intensivist direction. But probably general medicine too. You spent a year doing medicine. I last cracked a critical care book (a condensed one at that) during a pair of 2-week CTICU blocks last year ... at a time when I was much more preoccupied with echo books.


And not that I am accusing you of this, but it's always easier to choose the populist position. Populist doesn't always mean right; quite the opposite, usually. Excellence usually requires hard work and sacrifice, and those two can be pretty unpopular. Heck, a lot of those people get accused of being just good test-takers, and we all have legends about the guy who looked great on paper and sucked clinically. There, now I truly live up to my pompous ass title.

I'm just saying I think there's more broken here than the board certification system. And were the ABA to take a harder line on the threshold for board certification, that there would be some unintended (perhaps undesirable) consequences.

They failed about 50% of the field back in the 90s when the specialty was in crisis and half-empty programs were desperately accepting truly awful candidates. The fact that they did fail half the field is a great credit to the ABA. But I suspect they failed the right people, and that those people were failing because of halothane questions, not fire extinguisher questions. It'd be a shame if the ABA chose "esoteric" rather than "difficult but clinically important" questions to move the cut line.
 

AdmiralChz

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First person I've heard say this out of three programs... you must've not been prepared for the basic bc they weren't even remotely close.

Well my pass is the same as your pass... even got one of those useless 10% letters. Maybe you weren't so ready this time and taking your anger out on everyone else?

You need to chill out, I wasn't attacking you at all. Deep breaths.
 
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acidbase1

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Funny, I got one of those 10% letters as well.

I've never been ill-prepared for an exam in my life. Clearly you're the black sheep, just stating the obvious. That or you're one of those tools who comes onto SDN to gloat about scoring in the 99th percentile. Either way, the test was garbage. Comparing that abomination to USMLE or the basic is a joke
 
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pgg

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Deep breaths indeed.

No enemies here. Let's keep it civil.

85-90% of you passed. Soon this will all be a happy memory and we can reunite for round 2 of "WTF was the ABA thinking" when your orals come around. :)
 
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anbuitachi

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I'm going to attempt to make this my last post re: this exam, because why beat a dead horse, but...

I was just talking to another resident re: his experience, and I like what he said about what bothered him so much about this exam. "I feel like a below average SRNA would have done very similarly to me on this exam. I cannot even claim that our written certification exams require a much better understanding of medicine and physiology than theirs anymore."

This exam was basically 67 reps of the following (not necessarily exact questions, but somewhat close, for illustrative purposes):
Q1 - what should you give for Mg toxicity - calcium, duh
Q2 - which LA passes to fetus the least - chloroprocaine, duh
Q3 - which chemical warfare agent causes the most pulm edema - huh?

I think many of the SRNA students at my institution would have known the same 2/3 of the answers that I did, and guessed similarly on the other 1/3. This is how we're deciding who to say is a board certified anesthesiologist nowadays? Embarrassing. Do better ABA.

Not true I highly doubt Srna student can get those two. Not as easy as you think
 

WashMe

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'Twas on this day last year (day after Labor Day) that results were released. We'll see if the trend continues. Good luck to all!
 

acidbase1

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They're probably trying to figure out what to do since they had to throw out half of the questions
 
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Twiggidy

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Board certification is pretty much a requirement to maintain credentialing at a hospital. Therefore the ABA needs pretty much everyone to be board certified. If board certification became so difficult that a sizable portion of anesthesiologists were not able to be certified there would be a huge shortage of docs leading hospitals to do away with board certification as necessary for credentialing leading to markedly less revenue for the ABA

I disagree. Hospitals would still require certification. Only the strong would survive and board certified anesthesiologist would be seen as VALUABLE
 
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Twiggidy

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And that's where the problem is with board-certification in this country. Quantity, not quality. That has never been the way to excellence.

That's why I applaud when they at least try to make people sweat for that title. There is an increasing tech-type mentality in the specialty, if not the entire profession; people only want to learn what they use in their everyday routine practice. Guess what? That's not what being a doctor is about, in most of the world. The term "doctor" comes from expert, authority on a subject, teacher, adviser. The routine stuff? That's something even a "DNP" should/will be able to do.

Exactly. As I've said on this board before, we graduate way too many residents.

As a matter of fact, I think the oral board should be heavily weighted. I think it shows better "does this person actually know what they're doing" versus the written exam and the Part 4 simulator should be required every year. The cost doesn't even matter because if you have financial sense you'll just write it off or get reimbursed for it.
 

Pharmado

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Exactly. As I've said on this board before, we graduate way too many residents.

As a matter of fact, I think the oral board should be heavily weighted. I think it shows better "does this person actually know what they're doing" versus the written exam and the Part 4 simulator should be required every year. The cost doesn't even matter because if you have financial sense you'll just write it off or get reimbursed for it.

Simulator every year? If you ever get on the ABA board I think they'll love you. Every other anesthesiologist in the country will hate your guts, but hey, that's life.
 

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The cost doesn't even matter because if you have financial sense you'll just write it off or get reimbursed for it.

A tax write off is not equivalent to keeping my money in my pocket rather than wasting it on jumping through the latest hoop in physician training and waiting to claw my own money back on tax day.

Of course, I will pay because I am already so far gone down this path that there is really no turning back now. If I get reimbursed for this, that money has to come from somewhere. Education fund money only goes so far. There are plenty of better uses for this money than forking it over to a pack of admins and paper pushers. This is just an overpriced, increasingly complex and expensive rubber stamp.

Beefing up our exams would be a great strategy if physicians weren't already the best group of test takers in medicine. This is not the area where we need to strengthen our specialty. Taking a bigger, stronger test doesn't separate us from the pack any more than going to medical school and getting into residency already has. When is the last time a patient asked you about your test scores?
 
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futuredoc10

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Advanced exam results must be back today, correct?

One would think so, but Ive thought that all week!

They are probably having a hard time trying to curve an exam with 7 questions after all the ones they had to throw out. ;)
 
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propforall

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Haha! Today and tomorrow marks exactly 6 weeks, is it possible they'll be late?
 

futuredoc10

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Haha! Today and tomorrow marks exactly 6 weeks, is it possible they'll be late?

I wonder if the hurricanes and the rescheduling of exams for the unfortunate people down there has consumed their time the past week or so causing the delay in results???
 

Pharmado

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There weren't hurricanes at the time everyone took the exam. The results should be out, but the ABA never was one to do things in a way that is convenient for us. I'd guess Monday, but that's me.
 

futuredoc10

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There weren't hurricanes at the time everyone took the exam. The results should be out, but the ABA never was one to do things in a way that is convenient for us. I'd guess Monday, but that's me.

I realize there weren't hurricanes when we took the exam but there are other exams being effected by the hurricanes. From the ABA website:

Message to All Impacted by the Hurricane
We express our deepest concern for everyone impacted by the hurricane. We know that some of you in the affected areas are scheduled to take an exam at a Pearson VUE testing center or at our Assessment Center in Raleigh, N.C. If you testing center is closed or you are unable to travel to your scheduled exam, we will work with you to reschedule your exam.

Its just a possible theory on why results are so delayed. But who know for sure...
 

Pharmado

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Word on the street from a colleague of mine said they are planning to release scores next week. Take that for what it is worth since it comes 3rd hand.
 

acidbase1

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I'm sorry but this is the biggest joke I've been a part of in my 17 year academic career. Not only do they give us a disaster of an exam, they make us sweat it out for >6 weeks

ABA should be ashamed of themselves
 
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AdmiralChz

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I'm sorry but this is the biggest joke I've been a part of in my 17 year academic career. Not only do they give us a disaster of an exam, they make us sweat it out for >6 weeks

ABA should be ashamed of themselves

*shrug* What's another few days? I doubt the ABA is losing any sleep over it, like others have said I am sure they are dealing with rescheduling people (not just examinees but likely examiners as well). As time has passed, my opinion on the exam has softened a little bit - time to move on (well, hopefully) and put it back in the depths with the other standardized test memories.

Also since this coming Spring when the 2017 cohort takes oral boards it will be the start of the infamous "Applied" exam with OSCEs so they may still be figuring out how to schedule people in during that time as there will be much more to do. Just an idea.
 

acidbase1

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Yeah one of my classmates called the ABA and they'll be out today
 
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deleted171991

The certification status directory is up, as far as I can see.
 

Scylin

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Program directors know the results (ours texted our results to us this morning).
 
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