Any advice for the oral boards?

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JonJonStick

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Any last minute advice for the big test day from some of our elders on this forum? or any funny stories?
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1. Not a bad idea to memorize some basic chemo doses + administration schedules - especially RCHOP, ABVD, oral 5FU, oral TMZ. You will certainly not fail for not knowing them but answering this question may impress your tester enough to overlook something else.

2. Remember, first do no harm. Respect max doses to organs at risk, no matter the circumstance. In real life if a patient has an aggressive cancer near a critical structure you sometimes roll the dice after informed consent. Don't say that on oral boards.

3. It's very important to have a clear written, memorized script for all forms of brachytherapy.

4. A bit late advice now, but you really should not answer using techniques that you don't routinely use. You will invariable get follow-up questions which you will have a hard time answering otherwise.

5. Don't quote specific publications, ever, unless explicitly asked. You don't want to deal with the follow-up questions.

GOOD LUCK!
 
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1) Answer the question; don't elaborate in an attempt to impress the examiner.

2) Agree GFunk re chemo schedules (especially concurrent). Likely will not fail if you miss the dose/regimen (since that is not your job) but if you nail it then the examiner will give you bonus points (since most don't get this correct)

3) Be deliberate; not so slow to be annoying but tell yourself to slow down. Run out the clock.

3) See item #1

Good Luck
 
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You don't fail the section you thought you failed--you fail the one after. Don't think about what happened in the last room. Even if you think you bombed it, you might still pass. Just move on and don't let it ruin the next section or the rest of your day.
 
Anectdotally, I've heard conditioning one section won't be enough for a return trip to repeat if you've been strong everywhere else. Keeping that in mind, you have to stay focused, even after you think you may have bombed a section.

The modern lymphoma guidelines weren't published when I took boards, so despite getting reamed by the examiner for using the older mskcc ifrt paper, I still passed.
 
After hearing the case presentation, figure out where it leads in your head and stick to the script. E.g. intermediate risk endometrial cancer case is there just to make sure you know what is the vaginal cylinder.
 
Everyone I studied with (hi, all!) thought they failed immediately after boards, but we all passed. Very common sentiment, so don't dwell on it too much.
 
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seper said:
After hearing the case presentation, figure out where it leads in your head and stick to the script. E.g. intermediate risk endometrial cancer case is there just to make sure you know what is the vaginal cylinder.
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To echo what seper said, many cases on oral boards will be borderline cases where you have choice in observation, limited treatment or aggressive treatment. We were all trained differently and we all have different styles. In these cases don't perseverate on the "correct" answer but instead tell them what you will do. In borderline cases, examiners want to ensure that you employ sound, evidence-based logic and don't do anything that would harm the patient.
 
Gfunk6 said:
To echo what seper said, many cases on oral boards will be borderline cases where you have choice in observation, limited treatment or aggressive treatment. We were all trained differently and we all have different styles. In these cases don't perseverate on the "correct" answer but instead tell them what you will do. In borderline cases, examiners want to ensure that you employ sound, evidence-based logic and don't do anything that would harm the patient.
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First, do no harm.
 
This is all well and good. I would additionally benefit from some sage advice regarding the best places in Louisville to consume bourbon after the exam. Preferably in large quantities and away from any examiners. Much appreciated.
 
thaddeus said:
This is all well and good. I would additionally benefit from some sage advice regarding the best places in Louisville to consume bourbon after the exam. Preferably in large quantities and away from any examiners. Much appreciated.
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I am an examiner this year but promise not to speak with you. This is my favorite.

Home
 
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thaddeus said:
This is all well and good. I would additionally benefit from some sage advice regarding the best places in Louisville to consume bourbon after the exam. Preferably in large quantities and away from any examiners. Much appreciated.
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Sorry forgot to say Good Luck! You will do just fine.

Cheers!
 
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Go for broke! Challenge your examiner...even if he did write the paper. 72 on every section or bust!

Joking aside, I would reiterate what others have said--don't let one bad section keep you down. You'll be nervous as F during your first section and it's unlikely to be your best. I think the examiners understand that, though. Just be safe and explain what YOU do. Don't tell them what you think they want to hear.
 
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Doctorer said:
Anyone else ready to throw up?
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No. I’m just over the process. I think it’s been good to do deep dives on everything, but I am ready to start spending time with my wife and family after work again and to get back into the lab more.

Just remember that the pass rate is really high. They want you to pass. If you prepared you should be fine.
 
I knew an examiner who liked to present a case of a kid with Ewing's in his c-spine; the examiner wanted you to give like a ~50 Gy dose. And then when you would, examiner would be like "I thought cord tolerance was 45 Gy?" And get you all confused. He wanted you to give the 50.4 Gy or whatever... the cord "tolerance" was (a bit of) a secondary concern. Of course if you get a question like that you're already passing probably...
 
scarbrtj said:
I knew an examiner who liked to present a case of a kid with Ewing's in his c-spine; the examiner wanted you to give like a ~50 Gy dose. And then when you would, examiner would be like "I thought cord tolerance was 45 Gy?" And get you all confused. He wanted you to give the 50.4 Gy or whatever... the cord "tolerance" was (a bit of) a secondary concern. Of course if you get a question like that you're already passing probably...
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Some of it may just be testing one's knowledge of current protocols. AEWS1031 actually has a spinal cord tolerance of 50.4 Gy and by protocol they do go to 50.4 Gy for those.

upload_2018-5-18_18-3-28.png
 
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emt409 said:
Heard about a case this year where one person got all 72's and 71's, except for a 68 in one section, and that was it --> fail.
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I wonder if they in fact will condition for something really egregious in one section.....like giving 70 to the brainstem or something like that.
 
emt409 said:
Heard about a case this year where one person got all 72's and 71's, except for a 68 in one section, and that was it --> fail.
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If true, that candidate would be conditioned. Only need to take that section next year. I doubt that anyone would get all 72s and 71s. More likely a few weak 70s.
 
We are taught that cervical spinal cord can handle 50.4. Is anyone really not comfortable treating to that? Obviously 45 is better, but would you actually sacrifice target coverage to get c-spine under 45?

Also, how the heck do you get 72 in every section except one that you fail completely. I don't see how that's possible unless someone flat out forgot to prepare for a section. Seems like baloney.
 
KHE88 said:
We are taught that cervical spinal cord can handle 50.4. Is anyone really not comfortable treating to that? Obviously 45 is better, but would you actually sacrifice target coverage to get c-spine under 45?

Also, how the heck do you get 72 in every section except one that you fail completely. I don't see how that's possible unless someone flat out forgot to prepare for a section. Seems like baloney.
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On the boards yes. Often in real life too. Don’t go down the slippery slope of no respecting tolerances. People find themselves down some serious rabbit holes before they know it by trying to explain these things away. That leads to lawsuits so be careful and think long and hard about what you’re doing
 
Haybrant said:
On the boards yes. Often in real life too. Don’t go down the slippery slope of no respecting tolerances. People find themselves down some serious rabbit holes before they know it by trying to explain these things away. That leads to lawsuits so be careful and think long and hard about what you’re doing
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Just to clarify, you would not be comfortable going above 45 on the boards or in real life? QUANTEC and most RTOG protocols says 50.
 
radmonckey said:
Just to clarify, you would not be comfortable going above 45 on the boards or in real life? QUANTEC and most RTOG protocols says 50.
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This was my question. If somebody were to ask me, "what is the tolerance dose of the c-spine," I would say "max 5040."
Is this wrong?
 
KHE88 said:
We are taught that cervical spinal cord can handle 50.4. Is anyone really not comfortable treating to that? Obviously 45 is better, but would you actually sacrifice target coverage to get c-spine under 45?

Also, how the heck do you get 72 in every section except one that you fail completely. I don't see how that's possible unless someone flat out forgot to prepare for a section. Seems like baloney.
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According to my attending who was in the meeting, the person was brought up for discussion and everyone was in disbelief that he could get a 68 with 71s and 72s, and they asked the section leader, and the paraphrase was, "They killed a person, 68 not up for discussion." And taht was it.

My suspicious was it was their first section, and they were nervous and said something silly. Or they tried to get fancy. Or they didn't study peds enough and screwed up a peds tolerance question.
 
emt409 said:
According to my attending who was in the meeting, the person was brought up for discussion and everyone was in disbelief that he could get a 68 with 71s and 72s, and they asked the section leader, and the paraphrase was, "They killed a person, 68 not up for discussion." And taht was it.

My suspicious was it was their first section, and they were nervous and said something silly. Or they tried to get fancy. Or they didn't study peds enough and screwed up a peds tolerance question.
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Exactly what I thought... I imagine something basic like tolerances will probably get you conditioned even if you ace every other section. Gotta know the basics
 
medgator said:
Exactly what I thought... I imagine something basic like tolerances will probably get you conditioned even if you ace every other section. Gotta know the basics
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If this is true (again), this individual returns for one section. A setback to be sure but with 3 decades of a career not the end of the world.
 
Chartreuse Wombat said:
If this is true (again), this individual returns for one section. A setback to be sure but with 3 decades of a career not the end of the world.
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That is true. I've heard you can condition up to 2 sections and not have to retake the whole thing, but I'm sure you know better than me
 
medgator said:
That is true. I've heard you can condition up to 2 sections and not have to retake the whole thing, but I'm sure you know better than me
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Correct. Two sections <70 is condition; return to take just sections <70.
 
emt409 said:
According to my attending who was in the meeting, the person was brought up for discussion and everyone was in disbelief that he could get a 68 with 71s and 72s, and they asked the section leader, and the paraphrase was, "They killed a person, 68 not up for discussion." And taht was it.

My suspicious was it was their first section, and they were nervous and said something silly. Or they tried to get fancy. Or they didn't study peds enough and screwed up a peds tolerance question.
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Why is your attending disclosing this? Its either a violation of ABR confidentiality or you’re trolling. Either way, not helpful.
 
cuedot said:
Why is your attending disclosing this? Its either a violation of ABR confidentiality or you’re trolling. Either way, not helpful.
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How is it a violation of confidentiality? Neither you nor I have any more information than that a person conditionally failed, which has been true for at least one person every year. And I disagree that it is not helpful information. It solidifies that respecting dose tolerances and treating safely is THE MOST IMPORTANT aspect of taking oral boards.
 
emt409 said:
How is it a violation of confidentiality? Neither you nor I have any more information than that a person conditionally failed, which has been true for at least one person every year. And I disagree that it is not helpful information. It solidifies that respecting dose tolerances and treating safely is THE MOST IMPORTANT aspect of taking oral boards.
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This is speculative. There are a lot of ways you can "kill a patient" besides violating a dose constraint including underdosing a lethal cancer. There are also many OARs that you can overdose without risking mortality. For example, would you overdose the cochlea in order to give a nasopharynx 70 Gy? I would in practice and I would on the boards (with patient's informed consent). Could you fail if it was the brainstem you were treating to 70 Gy? Maybe so. The important thing is to know the constraints and illustrate you can think critically about them. They aren't black and white.
 
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cuedot said:
This is speculative.
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It is. People should stop feeding this. It might be true and it might not. Assuming its accurate it sounds like a really smart person (you have to be very good to get any, let alone multiple, 72s) made a really dumb mistake. Or maybe they rubbed the examiner the wrong way. Or they had an unreasonable examiner. Or its fake news. At worst, this is a hiccup for them. Embarrassing, but not likely to affect their career or livelihood.

Results will be out soon.
 
I heard that if someone fails (<70 on 3 or more sections), they have to repeat the whole exam and they aren't even told which sections they failed. This seems counterproductive. Why not tell the examinee which sections to study harder?
 
could be fake news - and I've forgotten exactly how the scoring works.

CW- I thought that a 68 (even in 1 section) resulted in a fail (whereas 69 in 1 or 2 sections was a condition).

I remember being told that there were 2 levels of discussion - the disease site group and the overall group - for all scores of 69 (not sure about 68) ? So an initial 69 can be over-ridden by a unreasonable examiner.

Also - why not 1, 2, 3, 4 and 5 scoring ?????
 
PointA said:
I heard that if someone fails (<70 on 3 or more sections), they have to repeat the whole exam and they aren't even told which sections they failed. This seems counterproductive. Why not tell the examinee which sections to study harder?
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Its one thing to whiff on a single section. Its stressful and even really smart people can get flustered and miss something they wouldn't otherwise miss in practice. If you fail more than 2 sections it probably means one of two things:
1) You are genuinely unsafe to practice after 4 years of training and at least 1 year of practice or
2) You are really bad at the oral format for one reason or another

In either case, focused studying is unlikely the solution.
 
radiaterMike said:
could be fake news - and I've forgotten exactly how the scoring works.

CW- I thought that a 68 (even in 1 section) resulted in a fail (whereas 69 in 1 or 2 sections was a condition).

I remember being told that there were 2 levels of discussion - the disease site group and the overall group - for all scores of 69 (not sure about 68) ? So an initial 69 can be over-ridden by a unreasonable examiner.

Also - why not 1, 2, 3, 4 and 5 scoring ?????
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A lot of people think that. I don't know if it used to be that way or not. The ABR site is pretty clear and as Wombat has told us, he is a current examiner so I am pretty sure he knows what is up.

If they dish out a 68 it means that they are very sure the applicant should fail that section. A 69 is an on the fence grade that they can consider moving up or down based on how the applicant did in other sections. They don't want to fail people that they think are safe to practice. The examiners that I am friends with insist they try to give you every benefit of the doubt that they can. Thats what makes this particular anecdote sound a little dubious. Not impossible, but dubious.
 
Anyone have an inside line on when these might be out?
 
Doctorer said:
Anyone have an inside line on when these might be out?
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At the exam they said that hoped to have them out by yesterday. The ABR website says two weeks after the last day of the exam, so presumably by next week.
 
emt409 said:
According to my attending who was in the meeting, the person was brought up for discussion and everyone was in disbelief that he could get a 68 with 71s and 72s, and they asked the section leader, and the paraphrase was, "They killed a person, 68 not up for discussion." And taht was it.

My suspicious was it was their first section, and they were nervous and said something silly. Or they tried to get fancy. Or they didn't study peds enough and screwed up a peds tolerance question.
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Lol I could see this happening, in fact could be me. I thought I did pretty well on every section. But I embarrassingly bombed head and neck.
 
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