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Best oral board course for repeaters?

Discussion in 'Anesthesiology' started by timgasman, Sep 26, 2016.

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  1. timgasman

    timgasman

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    So if the orals didn't work out the first time around, which oral board course is best for repeaters?

    Just Oral Boards vs. Ultimate board prep vs. ho? thoughts?
     
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  3. Twiggidy

    Twiggidy ASA Member 2+ Year Member

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  4. loveumms

    loveumms Senior Member 10+ Year Member

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    Honestly just practice. Call people from your residency and ask them to give you exams (hopefully you have a few board examiners on staff there). It's all about repetition - doing it over and over and over.
     
    ZzzPlz likes this.
  5. ZzzPlz

    ZzzPlz ASA Member 5+ Year Member

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    Yes. More/different practice partners. I improved like 300% in confidence and overall preparation after getting sodomized for a weekend by a board examiner faculty member

    Don't know about courses except they are expensive and haven't heard of any that are overwhelmingly good.

    Did pass machine for written a and they will pay 110% back to you if you fail. Costed like $1200 and I think they have an oral version maybe? Get your department to pay for it or write it off if possible.
     
    wickedskillz likes this.
  6. timgasman

    timgasman

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    I have heard from many people Ho is not in the running for repeaters. People say justoralboards.com is popular and also the ultimate board prep course but need unbiased posts here about these and any others. heard jensen and ho not really useful.
     
    kaioukenx likes this.
  7. Twiggidy

    Twiggidy ASA Member 2+ Year Member

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    Honestly OP, this is the internet and you'll get about 1000 different opinions. In my experience (ie at my residency), the "practice practice practice" people had a high failure rate, while the Ho course group had a high pass rate. Not saying that someone who just practices can't pass or that Ho guarantees you'll pass. I found Ho helped me organize my answers and give concise pertinent answers. I even had the flu during the course so I was "out of it" but if I didn't do Ho I would've failed. But I'm only one opinion.....
     
  8. skypilot

    skypilot 2K Member 10+ Year Member

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    If you truly worship Dr Ho as a deity you will pass easily. I took three of his courses including one the week of the boards with forty practice exams!
     
  9. confusingleaf

    confusingleaf ASA Member

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    agreed with all of the above posters. i did ho and felt very confident and prepared. FWIW i did one of his "ultimate" packages that included a LOT of online recorded lectures and also the 4 day intensive. honestly? if i was to do it again i think i got way more benefit from all of the online materials and the practice exams i did over skype. the 4 day crash course was way too much information too quickly. that being said, i invested multiple months (about 4 of very intensive study every weekend/some during the week). the online lectures helped me go more at my speed.

    plus, ho teaches you how to answer the questions and how to verbalize things that you KNOW but don't SAY.
     
  10. sigrhoillusion

    sigrhoillusion ASA Member 2+ Year Member

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    Save your money. Practice with other residents, colleagues and board examiners. Try to do phone or skype exams if not in same area.

    Honestly, there are only so many things they can throw at you. Just don't get lead down the path of death... there will be a difficult airway, there will be a pregnant woman, there will be a general vs. Regional decision, there will be a pre-op where they're gonna have SOB or CP or both and they'll ask you what to order...

    Practice, practice, practice...
     
  11. Twiggidy

    Twiggidy ASA Member 2+ Year Member

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    and with oral boards that's what it's all about. Passing
     
  12. Twiggidy

    Twiggidy ASA Member 2+ Year Member

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    yep. and that's what it is. An investment for your future that pays off huge with a Pass.

    And you're right, most 3rd years know how to go out and do a mediocre to ok anesthetic upon graduation. the course (and orals for that matter) emphasize that we as anesthesiologists are consultants and have to be able to communicate things to the services that consult with us. it's what separates us from "you know who". i hate orals, but the concept makes perfect sense.
     
  13. inflamesdjk02

    inflamesdjk02 Senior Member 10+ Year Member

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    My own experience.

    I failed my first oral board exam in 2015. It was a combination of poor preparation, overconfidence, working long hours, having an infant at home at the time, and having bad luck on test day in the form of my first stem coming on my weakest topic with two aggressive examiners.

    I decided that I would not fail a 2nd time, no matter the cost. I signed up for one of the Ho guaranteed plans. I attended a 4-day course about 6 months before my exam, to get some practice and to realize how much information I needed to master. After that, for about 2 months, I strictly spent time watching the online videos. Starting about 4 months out, I began going through practice ABA exams with a study partner and some of the Ho practice exams. About 2 months out, I tried to take as many online exams with Ho examiners as I could, and I ended up taking about 30. At the same time I went through all of the online videos a 2nd time. I took notes every time watching a video, and compiled everything into a single document, which I reviewed several times the week before the test. I passed the 2nd time.

    I really liked the Ho course because he is very regimented and organized things to my liking. The online study materials are vast and comprehensive. He also sends a textbook which is about 700 pages which I found to be slightly helpful to browse through, but not completely necessary. Ho also contacted me personally throughout the process to monitor my progress and ask if there was anything he could do to help. I really appreciated that.
     
  14. timgasman

    timgasman

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    To be honest with you guys, I dont know how anyone can learn how to take this exam froma big lecture hall of 70 people. I went to chicago for ho and just tuned out most of the time. Things didn't work out for me on the real test. I need more intensive one-on-one.

    Now, I know justoralboards.com is the gold standard for repeaters, but what about the other courses? Any botique courses that are useful? I tried shopping at walmart (ho). As of now, I'm thinking justoralboards. Thoughts?
     
  15. skypilot

    skypilot 2K Member 10+ Year Member

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    Whatever method you choose, you will have to do practice exams until you want to throw up. If you don't want to do Ho, then just get a study partner who is more intelligent and more motivated than you, and do practice exams every day for 90 days. If you do the Ho course, do the one which is composed of many practice exams. Participate in the internet discussions in the Ho course. You will pass!
     
    Last edited: Oct 3, 2016
  16. Twiggidy

    Twiggidy ASA Member 2+ Year Member

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    As we all know, you have to know the information, but I feel like with orals, they want to make sure you're thinking and not just a robot.

    For example, 70 yo patient getting an AVR and upon induction his BP drops to 70/50 and the HR goes to 110, what do you do next doctor?

    A failing answer is, give some neo to get the BP up. (Even if you explain why you're giving Neo over something else and why, it's still not a "consultant" answer.

    This is just an brief example but they want to make sure you're not a robot.

    A better answer, first I'd ensure adequate oxygenation and ventilation, then I'd check his rhythm, then I'd ...etc etc. etc...... That's more like a consultant answer. You're going through the entire process and that is basically what Ho teaches. To get that most out of Ho, you should already have the background knowledge and they just teach how to answer questions. Yes, there will be questions that you have no clue how to answer. "I'm not sure" and move on, to goal is to get more questions to show what you DO know.

    You really have to explain your thinking in a organized and reasonable way. You can't "just intubate" or "just give some neo". If they want the drug they'll say, "What drug doctor?" and then just tell them the drug and move on...don't explain how the drug works because that's not what they asked you.

    Also, be careful quoting studies because you can dig a hole if you don't know the details. We all know PA catheters have shown no benefit in non-cardiac surgery. If they ask, "do you want a PA?" I would simply say NO and explain why other monitors are adequate.

    The orals are tricky but can be done with, as everyone else is saying.......

    [​IMG]
     
    vector2 likes this.
  17. skypilot

    skypilot 2K Member 10+ Year Member

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    The most important thing I learned from Dr. Ho was to recognize an ambiguous situation and be able to say "there is a differential for that, and here is the differential diagnosis." And for each diagnosis here is the treatment. After I have examined the most basic causes for that differential, I will proceed to the more estoteric causes. For instance, low blood pressure is ambiguous. There is a wide differential that includes hypovolemia, arrythmia, hypoxia, shock, etc. When an examiner asks you about hypotension recognize that differential and run through the causes out loud. Don't skip right to the Phenylephrine, maybe the cause is a pulmonary embolus. It is ok to be uncertain as long as you can list the differential and explain the treatments.
     
    Last edited: Oct 3, 2016
    Twiggidy likes this.
  18. sigrhoillusion

    sigrhoillusion ASA Member 2+ Year Member

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    While I agree with you to some point, I don't think going to a course makes you any better at stating the obvious. Pretty much any book or oral examiner will tell you to always "assess the patient" before you do any treatment. Like for your example, giving neo is probably the best thing to do, giving ephedrine or epi, probably not so much. That being said, from my experience taking the orals both practicing and the real thing, as soon as I say "I would assess the patient, check their vitals, check ventilation and oxygenation, blah blah blah..." the examiner would cut me off and be like "OK... whatever... you do all that... but what would you do?!"

    Honestly, the more I practiced the more I felt like a robot, cause every answer seemed so canned. Assess the patient, check vitals, do THIS because of THAT. If you know the info (passed Part 1) then knowing the cues to answering different scenarios is the key to passing Part 2, and I don't feel that spedning a ton of money sitting in a lecture hall is the best way to do that. But everyone has their own ways, so whater works for the OP. Remember P = MD...

    Love the Iverson picture by the way.
     
  19. timgasman

    timgasman

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    I am all about practice, practice, practice, but the problem with the ho course was that with the exception of 3 short exams with mock examiners, the bulk of the practice was with other "blind students" like myself. I think this is what hurt me the most.

    On the flip side, course like justoralboards.com allow practicing with board certified anesthesiologist but this comes at a premium in the form of higher fees. So which is it, lower fees and roll the dice or higher fees and get more attention? Still confused...maybe I should change my name to stillconfused.
     
  20. skypilot

    skypilot 2K Member 10+ Year Member

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    .
     
    Last edited: Oct 5, 2016
  21. skypilot

    skypilot 2K Member 10+ Year Member

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    Last edited: Oct 5, 2016
  22. skypilot

    skypilot 2K Member 10+ Year Member

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    There is some luck involved. You may have gotten a bad examiner the first time. Just keep doing practice exams. Get a senior staff member from your group to do some. Take the week of exams off to really practice and polish your presentation and enthusiasm. Have a canned response for when you have no idea where the examiner is leading you.

    By the way the answer to the low blood pressure question is not phenylephrine, or epi, or ephedrine. The answer is: "If I discover an arrythmia I may need to cardiovert the patient, if I discover hypoxia, I may need to adjust the endotracheal tube position, if the patient seems to be having an allergic reaction to rocuronium I may need to administer Epinephrine, if the patient is volume depleted I may need to bolus fluids and turn down the sevo flurane, as a temporizing measure I may consider a pressor such as phenylephrine.

    The examiners cannot fault you for these answers, the question was ambiguous and there is a differential diagnosis required before you can give an answer. If you skip ahead and don't give a differential then the examiner has just pulled a fast one on you and you have failed.

    This happens in real life, Anesthesiologists have jumped to the conclusion that it is an amniotic fluid embolus, when it was really just a mainstem intubation!
     
    Last edited: Oct 5, 2016
  23. easternether

    easternether

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    same boat as u buddy. doing justoralboards.com.
     
  24. 5twilight5

    5twilight5 7+ Year Member

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    I had an exact question from ultimate board prep. I would agree just oral boards for mock oral exams and ultimate board prep for breakdown of how you should dissect and respond. I took the ho course and thought it was not useful so close to the exam. all his answers are that there is no evidence for it but that does not help you on the actual exam. Good luck!
     
  25. IlDestriero

    IlDestriero Ether Man 7+ Year Member

    The difference in prep for this exam is really interesting.
    If you failed once, there is some luck involved, but you should assume that whatever you did was not adequate. This test isn't rocket science. You need to practice and have a clear and coherent plan for all the expected scenarios. The goal isn't to assess your knowledge base, though deficiencies might come out and hurt you.
    You need to clearly communicate your thoughts. You need to be able to develop a Ddx for all of the common OR problems and have a coherent plan for them, even if it isn't necessarily the "best" plan. You need to be flexible. You need to be able to coherently defend your position, again even if not necessarily the best plan, you need to avoid killing errors in judgement, and finally you need to keep your **** together. The patient is going to crash, arrest, be impossible to intubate, refuse regional, or whatever. That's the case. Don't take it personally. They'll crash if you did an awake fiberoptic or retrograde wire. It's not your fault. If you lose your **** because the theoretical patient crashes in a discussion in a hotel room, you're not inspiring confidence about how you will actually function in the real world.
    Also, the exam has to cover a lot of material in a short time. Coherent short answers, abbreviated differentials highlighting the most likely causes of x in light of the patients situation, etc. are critical. If you require a lot of follow up and "direction" to get to the relevant facts you're going to run out of time. Take a deep breath, gather your thoughts, then open your mouth.
    I also found it helped to make a brief list of key facts for the case. When asked about some issue, you can scan your list of the key things about the patient and reflect on that to frame your answer. The list might be something like "cardiomyopathy, MH, diff airway, sepsis, 6 wk old CVA"
    Whatever you choose you need good differentials and plans first, then you need some practice tests.
    Good luck.


    --
    Il Destriero
     
  26. Swizard210

    Swizard210 2+ Year Member

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    I second JustOralBoards too. Dr. Tran is on point.
     
  27. AZsed8r

    AZsed8r

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    I think that some people are naturally better at speaking and getting their ideas across clearly and confidently. Those people may not need as intensive a prep course. I personally am not much of a speaker so I really struggled with this test. Ultimately it was Just Oral Boards that helped me pass. I think practicing is important so you aren't answering questions like this for the first time when you get to the test, but I think some practice is better than others. With just oral boards you are practicing with attendings who can give you good feedback on how you can better answer the questions, both for style and content. The stems sometimes seemed ridiculously complex, but they do that intentionally so the stems seem quite reasonable when you get to the actual test. They also did a great job of covering relevant topics. I think pretty much everything that came up in the test we had covered on practice exams. For me it was worth every penny.
     

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