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Discussion in 'Podiatric Residents & Physicians' started by I post PRN, Apr 18, 2017.
word on the street is scores should come out this Friday, anyone hear anything different?
Thanks for the HTN
They did say 6-8 weeks, 10 days from now would be 7 weeks. Man.
According to ABFAS, "later this week"
A classmate of mine called yesterday, their response... "there is a lot of statistical analysis that is done, so probably 6-8 weeks from the day if the test."
Thanks for nothing.
(Insert old man voice) Back in my day - 2 years ago - I waited 12 weeks for my scores to come back.
That's awful man
That was back when y'all took it in May too? How did that work not getting scores until August?
Posted on ABFAS. Scores are up under exam history
Yep, took boards in May. Got scores back July/August I think. Had to be the first podiatrist to request ankle privileges at one of my hospitals and didn't have board-qualification to back me up. I think that this new schedule is much better
Well. I passed all 4 parts but can't honestly say that the money spent on prep was all THAT beneficial. In retrospect, I might have just studied McG & really analyzed the format of the few online scenario exams. I'm sure luck was a factor. I'm relieved though. I would recommend anyone who didn't get a complete pass to follow up in October even though it's not something you want to think about right now. I do think that the way hospital & insurance is trending that the ABFAS credential will be a limiting factor in the future.
What did everyone use to study? I am taking it in October. Heres what ive heard:
1. Mcglamery (old or new version?)
2. Boards by numbers
5. Pocket Podiatry
If you guys had to pick two from that list what would they be? Also old Mcglamery or the new green one?
Did you study specific sections in mcglamery or just went through the entire textbook? I find it a little hard to do that since its sooooo wordy. I dont know of anyone who went through entire textbook
I had a second hand version of the video's I watched. The most beneficial part may have been the video that talked about test taking strategy. I printed the entire hand out but did not study it at all.
2)* McGlamry 2nd edition. I studied the entire 2 volumes but not word for word. Mostly like a chapter summary review. This basically covered everything in the world of podiatric surgery. Worth the time in my opinion.
3)* Boards by numbers. I loved the hundreds of M/C questions with quick reference to electronic notes they provided. Although I dont think I had any specific questions on the actual exam this gave me. I liked the the pediatric prep this gave me but my test unfortunately had little to no ped's questions. The access to this material lasts a long while after purchasing & I would recommend to at least go through 20 questions a night, look up the reason you got the question wrong, scratch it off your list of topics & repeat the next night with a new topic.
4) Board Master's. I purchased 2 packages for a total of 4 scenario questions. This was somewhat helpful but not an exact match to what the ABFAS practice test's had. (the ABFAS practice tests were more similar to the real deal)
5) Residency manuals. I studied these mainly for a quick refresher of the procedural selection / workup (flatfoot...etc). I admittedly spent too much time on classifications as well.
Overall, much like boards 1,2,3. The majority of the questions I was just able to deduct down to 2 answers based on the information I have gathered over the years by paying attention in class & keeping my eyes and ears open during clinic & in the OR. Luckily, my residency rarely ever has a double resident scrub case. But...... I've never been too proud to come in as a 2nd assist if it was an interesting case & actually feel that it is easier (less stressful) to learn about whats going on & why during the case if your just the guy holding the rakes and not the one holding the #15 blade with the attending breathing on the back of your neck.
I don't think this test has a magic source to prep from but McG is a good one to start with along with BBTN.
This is all just my opinion.
I used the new McGlamry's for the "big topics", read through Goldfarb, some PI, boards by the numbers, and ABFAS practice cases.
I only had the book for Goldfarb but didn't care too much for it. There were a number of errors I came across but in the end was a decent review text that helped point out where I needed to study more. I don't think it did a thing for prep for the RRA didactic portion. I don't know what material I could have used to allow for good prep of my RRA didactic portion though lol. I just felt that section was out of left field for me and even had some legitimate opinion questions presented as fact. I felt like the RRA patient simulation portion was much easier than didactic for me.
I agree with @Carbon13 that for the most part if I didn't know the answer I could break it down to a couple and go from there.
I could have seen that test go either direction for me, but I was fortunate.
I went through McGlamrys word for word during PGY2-3. I don't know that it was worth all the time it took, especially some of the wordier chapters like the tumor chapters. But, hey, I passed so maybe it helped
@Carbon13, I assume you mean 4th (most recent) edition of McGlamrys? I think the 2nd edition was published mid-90s.
Thank the Lord I passed. I was certain one of the CBPS sections would get me.
For studying I did boards by the numbers, board vitals (foot and rra), read the PI, did the abfas practice cases, and bought 3 cases from board masters.
Boards by the numbers and board vitals was definitely the most helpful imo. With a couple of thousand questions between them you're going to cover every topic at least once.
Board Masters cpbs questions were expensive ($150 for 3) and a huge waste of money. They were very easy, and the set up is not the same as on the actual test.
With roughly 8 weeks up studying from solely those sources I felt very well prepared for the written portions. The CPBS is just a crap shoot, honestly.
I know this was discussed in a venting thread after the test, but I'd like to reiterate how flawed our qualification/certification process is.
For a profession who throws around "parity" like it's going out of style it's comical how poor the exam process is compared to our MD/DO peers.
I think this problem is exacerbated by the fact that so many institutions now are requiring qualification/certification regardless of residency training. Someone from a top tier program could be denied surgical privileges because of not passing 1 part of the test. Or what is someone passes the RRA but not the foot? Then they're not qualified for either. That is just stupid.
All this does is add fuel to the fire of patients, doctors, and institutions having no earthly idea what exactly we can/do do, and what our training is like.
Meanwhile, folks at the ABFAS are sitting back, laughing as they count their $1,800 per applicant.
Okay, I'm done ranting. Luckily I'm done with the process until certification when I have to face that idiotic CBPS again...
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.
Great post @adamsmasher So much of it is understanding the test and how to take it. I put together a similar CBPS strategy and followed it for each patient. The "freebie" x-rays at that start often helped guide treatment for a vague patient stem and terrible clinical picture.
I agree, my kingdom for "point to where it hurts".
@ Adam Smasher. Excellent Post as state above.
Luckily I got through this exam as well. But as others have pointed out, mostly luck is the word. Sad to think, but true. I agree with studying as you start residency during your PGY1, PGY2 years. As much as I want to think that all the questions come from McGlamry's textbook, they don't. I have some (maybe around 10-15 questions from the Didactic portions come straight from the textbook word for word.
I studied also 2 months prior. Used Boards by the Numbers and reading McGlamry's. I can honestly say that BBN did not help very much even though other colleagues in the past told me it did help them. I feel like every year they focus on certain topics. I was told to know bone tumors inside out. Didn't get 1 single questions on bone tumors. More questions on STJ arthroscopy than bunions etc.
Didactic is somewhat of a crap shoot as everyone tends to say the same thing year after year. The CPBS can be passed but looking over the examples they list on the website. Infections you need to palpate lymph nodes, vitals, labs, etc. In Peds, back and neck exam, etc. That entire part takes practice and understanding which words are available to you. The answers aren't always practical of course as they want you to get a MRI if a patient has gas gangrene because you want to rule out OM.
But others pointed out, it's a exam. It's not a exam that shows standard or guideline of practice.
For future test takers, I would READ and take notes of McGlamry chapters and start memorizing your notes. Complications, specific techniques, X-rays etc. Especially in the RRA didactic this was big. I would focus on Tibia CORA, arthroscopy, etc. Boards by Numbers did not help me, maybe it helped others. Other colleagues did say that Goldfarb helped. Stryker course power points were a waste of time. I would try to avoid reading Mann's, not because it's a bad textbook but the questions won't come from there.
Do certain hospitals require ABFAS qualification prior to obtaining surgical privileges? I understand that after a certain amount of years (usually 3-5) you're expected to be board certified but do they require this out of the gate as a new grad?
@Ankle Breaker had a good suggestion to sticky this. This would have been helpful to me pre-ABFAS and hopefully the discussion can continue to help those in future rounds of the exam.
I have also heard that ABFAS BQ can be a requirement of some fellowships. Not mine, but a good friend's program.
Just for fun, here's the price for several other medical specialty board certification exams:
American Board of Orthopedic Surgery: 2 part exam, part I is $1040, part II is $2325 including a $975 (!) application and credentialing fee
American Board of Internal Medicine: 1 part, $1365, no application fee
American Board of Dermatology: 1 part, $2500, no application fee
American Board of Surgery: 2 parts, Qualifying exam is $1200 + $400 application fee, Certifying exam is $1300 + travel expenses (oral exam)
American Board of Family Medicine: 1 part, $1300, no application fee
American Board of Ophthalmology: 2 parts, qaulifying exam is $1650, certifying exam is $1650 + travel expenses (oral exam)
American Board of Otolaryngology: 2 parts, $3,580 (!) for both, plus travel expenses for the oral exam
American Board of Psychiatry and Neurology: 1 part each (psych or neuro) $1685 + $700 application fee apiece
Interesting to see that ABFAS has these guys beat for the most part. However, I thought the ABFAS $200 application fee was absurd. Why does it cost so much money to process applications? Shouldn't it be less expensive then in the era of paper applications?
Wow that must have been tough, especially if you are practicing in a smaller suburb city in Tx right?
Well, it made sitting in front of the credentialing committee a bit awkward when that question came up. And I guess it would be tough in suburban TX, just like it was for me not in suburbia and not in Texas...
Case submission results were released yesterday May 31, date of submission was April 8.
I noticed your rant about the certification process with ABFAS. I've been in practice 14 years and just decided to become board certified with them recently. I'm currently certified with ABLES but due to many job opportunities, most of them require ABFAS, which is unfortunate. I totally agree with you about the process being a mess. Wait until you do the case submissions. They are so subjective and picky. There is no scores and its basically pass or fail. They also don't allow you to discuss your results with them thus not allowing you to learn from your mistakes. Also, they do not disclose their pass/failure rates. This could mean that they possibly have an agenda with each candidate. You have 7 years to pass your part II and they have 7 years to soak up your money!