Boards Case Review

[podfam3008]

Unfortunately, I did not pass the case submission review and am pretty disappointed on the somewhat vague reasons given why (mild elevatus for a bunion), etc. Does anyone have any suggestions/tips for documentation in post op notes moving forward? Or if you failed too, can you list the reasons why? For example, did you include ROM at MPJ involving cases with implants and bunions both? Did you measure post op angles (in addition to preop angles) in your notes, is it better to over document etc. Would appreciate recommendations and advice. Not used to failing anything, and I think I’m trained pretty well, so it’s definitely disappointing. Hopefully will pass next year. Thanks so much for any advice.

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[podfam3008]

Also, has anyone heard if we will get another year to get Board Certified due to COVID-19?

 

[DYK343]

Unfortunately, I did not pass the case submission review and am pretty disappointed on the somewhat vague reasons given why (mild elevatus for a bunion), etc. Does anyone have any suggestions/tips for documentation in post op notes moving forward? Or if you failed too, can you list the reasons why? For example, did you include ROM at MPJ involving cases with implants and bunions both? Did you measure post op angles (in addition to preop angles) in your notes, is it better to over document etc. Would appreciate recommendations and advice. Not used to failing anything, and I think I’m trained pretty well, so it’s definitely disappointing. Hopefully will pass next year. Thanks so much for any advice.

You should really over document everything until board certified.
You should really over document everything even after board certified in case a lawsuit pops up.

You dont need an IM angle measured for you personally to know if a quick Austin would suffice vs need for lapidus but the board doesnt know that. Document all angles. It takes time and is a pain but thats just what you gotta do.

 

[podfam3008]

Thanks for the quick response. I just wish they would provide more detailed feedback on missed points. Looking at previous threads, this issue seems pretty common with Case Review.

 

[HardRoadPaved]

Here's the best part: if you want to appeal the test it directly coincides with signing up for the next exam. So now they can squeeze you for the 4-8k while holding onto another thousand (and dont forget the bogus $225 application fee in case they dont know you already from annual dues) because if you lose then you need to work on the 2021 submission.

Remember if you finished residency on or after 2014, you have 7 years to certify. No ability to requalify. A fellowship does not extend this deadline. Now with elective surgeries getting held up in the second wave of COVID, that time dwindles fast.

 

[podfam3008]

The pass rates are shockingly low. That's too bad.

 

[Feli]

I would just call them up. They are pretty good at explaining things... can look at your profile and tell you options, timeline of qualification expiring (COVID), etc. They won't tell you exactly why you didn't pass but can make sure you are using best study guides available.

...for case review, they basically just want to make sure it's you doing the cases and you're thinking things through. They have to watch out for folks trying to use residency/fellowship cases, cases done with colleagues, etc. They also have to make sure you're not just the surgery machine that is getting cases from colleagues and blindly boarding the cases without thinking and eval yourself.

Basically, they already know you're smart since you passed qual exams, etc... case review is more to verify you are making good pre-op decisions and doing the cases yourself than to quiz you on angles and dangles and stuff like the written parts did. I've had a few friends who are great RRA surgeons fail due to lack of pre-op documentation (usually trama/infection cases where you have to do the case that day or the next am). Still, you have to roll with the punches, study and document better... you will pass next go-round. You already have the harder part in the rear view mirror.

 

[podfam3008]

I would just call them up. They are pretty good at explaining things... can look at your profile and tell you options, timeline of qualification expiring (COVID), etc. They won't tell you exactly why you didn't pass but can make sure you are using best study guides available.

...for case review, they basically just want to make sure it's you doing the cases and you're thinking things through. They have to watch out for folks trying to use residency/fellowship cases, cases done with colleagues, etc. They also have to make sure you're not just the surgery machine that is getting cases from colleagues and blindly boarding the cases without thinking and eval yourself.

Basically, they already know you're smart since you passed qual exams, etc... case review is more to verify you are making good pre-op decisions and doing the cases yourself than to quiz you on angles and dangles and stuff like the written parts did. I've had a few friends who are great RRA surgeons fail due to lack of pre-op documentation (usually trama/infection cases where you have to do the case that day or the next am). Still, you have to roll with the punches, study and document better... you will pass next go-round. You already have the harder part in the rear view mirror.

Thanks so much for the positive advice.

 

[Scrantonicity]

It's mostly about persistence and money. The more years you try, the more money you spend, the higher the chances of passing. That was my experience.

 

[GreenHousePub]

They also have to make sure you're not just the surgery machine that is getting cases from colleagues and blindly boarding the cases without thinking and eval yourself.

In what world is a podiatrist getting cases from podiatry colleagues? I'm certified in both and I've had to fight for all of my cases lol

 

[Feli]

In what world is a podiatrist getting cases from podiatry colleagues? I'm certified in both and I've had to fight for all of my cases lol

It happens, more so in rural areas where pts have nowhere else to go, but you can find those spots even in the metros sometimes if the docs are charismatic and keep the pts around awhile without doing much or any surgery. My present job was a little like that... others I've had were not super dissimilar. The same goes for some of my co-residents and classmates from school.

Usually, you have older and/or minimally trained (or just plain buuuuuusy) doc(s) who have been doing orthotics and injections and paddings, etc for everyone for years. There is a ton of surgery demand pent up in the early goings there, but you generally burn through it within 6-12mo. Either way, if you ever have one of those situations, for boards, you just don't want to have charted "patient X presents for bunion surgery after conservative care from Dr. Y who has referred for base wedge operation"... you want to show you did full H&P eval as if it were a new pt with no history and you chose on your own- you didn't just parrot back the surgery idea sent from the refer doc.

 

[CutsWithFury]

We have to document bunion angles? That sucks. Looks like I have up addend my notes for whatever cases they request

 

[GreenHousePub]

We have to document bunion angles? That sucks. Looks like I have up addend my notes for whatever cases they request

For bunions I only documented IM, HAV, PASA,Sesamoid Position and then lateral CIA, 1st Met-declination.

 

[CutsWithFury]

For bunions I only documented IM, HAV, PASA,Sesamoid Position and then lateral CIA, 1st Met-declination.

Blah blah blah

 

[podfam3008]

For bunions I only documented IM, HAV, PASA,Sesamoid Position and then lateral CIA, 1st Met-declination.

Seriously? All of these? Thought IM angle, Hallux abductus angle, and sesamoid position would be adequate.

To the folks who passed rearfoot, did you document calc inclination angle lat/ap, talar dec angle, mearys etc as well for each case?

 

[podfam3008]

If anyone else has any tips at all please keep sharing. Lets keep helping and encouraging each other. You all have been so great and helpful.

 

[DYK343]

To the folks who passed rearfoot, did you document calc inclination angle lat/ap, talar dec angle, mearys etc as well for each case?

More or less yes

 

[air bud]

you do not have to document bunion angles. I have never documented one and just passed both case reviews. I failed foot last year. Yes it is frustrating. The first time I failed I had one case where yeah i screwed up, picked the wrong procedure and patient ended up needing a fusion a year later. My bad I can accept that. The other ones like you said were ridiculous. An alleged open growth plate on a peds lapidus (i have asked 3 former ABFAS board members if they see an open growth plate - NOPE), an austin with a dorsal arm not completely healed 12 weeks out with the patient completely satisfied, an asymptomatic elevatus on a lapidus....

my advice. if you are truly well trained, critical of your work, always trying to improve...don't sweat it. keep doing what you are doing and will work out. Thats what I did and I passed.

Of course i did fail forefoot computer for the second time this year, so even though I have now passed 3/4 of test, still not ABFAS board certified...for the record the part of the forefoot computer I failed --- was the physical exam. Yes, you heard me right. My assesment was correct, my treatment was correct, my follow up treatment was correct...I just didn't click on the right buttons for a physical exam on a computer.

 

[air bud]

More or less yes

by less if you mean there is an increased mearys angle... then yes. Never put an actual number in a note. Sure, I may measure it when I am talking to the patient so I can say oh above 10 is abnormal (is that right?) but when I finally get around to doing my note I don't include numbers.

 

[DYK343]

If anyone else has any tips at all please keep sharing. Lets keep helping and encouraging each other. You all have been so great and helpful.

Document everything. For all surgical patients your notes should be books until certified IMO. List alternate treatment options and list you discussed these alternate treatments (surgical and non surgical). List risks/benefits in detail.

Dont accept pretty good in the OR. Make sure its perfect. I know that is not always best for the patient but a funny looking screw is a funny looking screw to a reviewer.

Document screening for or no evidence of post op complications: "No evidence of DVT, PE, hematoma, dehiscence, infection" etc etc with every post op note.

 

[DYK343]

by less if you mean there is an increased mearys angle... then yes. Never put an actual number in a note. Sure, I may measure it when I am talking to the patient so I can say oh above 10 is abnormal (is that right?) but when I finally get around to doing my note I don't include numbers.

I dont think any of us know for certain but I passed both first time with my books for notes. It doesnt hurt to over document. They are grading you on procedures chosen, technique, and your notes. I really think the more you document the better.

 

[air bud]

my advice, as I have stated before is this: if you are smart, well trained and you fail? so what who cares. It is all an f*ing joke. I know so many people that are well trained, fellowship trained (top programs) that have failed. Get em next year. Our professional organizations are a joke anyways.

 

[HardRoadPaved]

the other issue is that the 11 cases can be chosen at their discretion. let's say you do slam dunk cases, then you are gonna skirt by a lot faster. if you take on the big cases and it doesnt go well then guess what those are the cases that end up by sheer luck get picked for review.

 

[Feli]

Yeah, as was mentioned, you don't need angles (for bunions or anything else). Personally, my notes and XR reads just say "mild/mod/severe" for bunion or cavus or PTTD or etc. Those conversions of mild or severe into ranges of angles/degrees are actually defined for HAV and most deformities in Coughlin & Mann text or Myerson's classifications, but it doesn't come to that. It wouldn't hurt to have the IM angles and such in your notes, but it is not a deal breaker either.

...Again, they just want to know your thought process is solid pre- and post- , and they want to know it's you doing the cases. Besides lack of documentation, another big trip point is not jumping on complications.... get prompt vasc consult for slow healing, enhance broken/failing fixation asap, debride necrotic flaps or dehisence, start abx, amp further back, etc as needed. You will never get faulted for having reasonable complications, but you will look incompetent if you don't recognize complications and fix them or bring in help that can. A lot of new grads, even well trained ones, like to take the "wait and see" approach on that stuff since they've seen a lot of OR surgery but relatively few post-ops and fewer complications. Sure, you are scared, but it is seldom the best choice to bury one's head in the sand when a complication is clearly occurring or highly suspected. Get them back to the OR or at least call in the cavalry via consults or admit or imaging or testing.

 

[king22]

Random question: did ABFAS start accepting in-office procedures for logging purposes?

 

[podfam3008]

Yeah, as was mentioned, you don't need angles (for bunions or anything else). Personally, my notes and XR reads just say "mild/mod/severe" for bunion or cavus or PTTD or etc. Those conversions of mild or severe into ranges of angles/degrees are actually defined for HAV and most deformities in Coughlin & Mann text or Myerson's classifications, but it doesn't come to that. It wouldn't hurt to have the IM angles and such in your notes, but it is not a deal breaker either.

...Again, they just want to know your thought process is solid pre- and post- , and they want to know it's you doing the cases. Besides lack of documentation, another big trip point is not jumping on complications.... get prompt vasc consult for slow healing, enhance broken/failing fixation asap, debride necrotic flaps or dehisence, start abx, amp further back, etc as needed. You will never get faulted for having reasonable complications, but you will look incompetent if you don't recognize complications and fix them or bring in help that can. A lot of new grads, even well trained ones, like to take the "wait and see" approach on that stuff since they've seen a lot of OR surgery but relatively few post-ops and fewer complications. Sure, you are scared, but it is seldom the best choice to bury one's head in the sand when a complication is clearly occurring or highly suspected. Get them back to the OR or at least call in the cavalry via consults or admit or imaging or testing.

What about asymptomatic complications like mild elevatus with no pain? Scarring with no pain, equinus after procedure or stiffness of joint all without pain? Obviously the patients did not want to return back to surgery if there was no pain. Advice on something like this? Maybe next time I should say I recognize all these complications and patient did not wish to go back to surgery for such an issue? Maybe acknowledging it more and offering a solution wouldn’t result in point loss.

 

[podfam3008]

you do not have to document bunion angles. I have never documented one and just passed both case reviews. I failed foot last year. Yes it is frustrating. The first time I failed I had one case where yeah i screwed up, picked the wrong procedure and patient ended up needing a fusion a year later. My bad I can accept that. The other ones like you said were ridiculous. An alleged open growth plate on a peds lapidus (i have asked 3 former ABFAS board members if they see an open growth plate - NOPE), an austin with a dorsal arm not completely healed 12 weeks out with the patient completely satisfied, an asymptomatic elevatus on a lapidus....

my advice. if you are truly well trained, critical of your work, always trying to improve...don't sweat it. keep doing what you are doing and will work out. Thats what I did and I passed.

Of course i did fail forefoot computer for the second time this year, so even though I have now passed 3/4 of test, still not ABFAS board certified...for the record the part of the forefoot computer I failed --- was the physical exam. Yes, you heard me right. My assesment was correct, my treatment was correct, my follow up treatment was correct...I just didn't click on the right buttons for a physical exam on a computer.

PE? That’s so crummy I’m sorry :-/

 

[Scrantonicity]

you do not have to document bunion angles. I have never documented one and just passed both case reviews. I failed foot last year. Yes it is frustrating. The first time I failed I had one case where yeah i screwed up, picked the wrong procedure and patient ended up needing a fusion a year later. My bad I can accept that. The other ones like you said were ridiculous. An alleged open growth plate on a peds lapidus (i have asked 3 former ABFAS board members if they see an open growth plate - NOPE), an austin with a dorsal arm not completely healed 12 weeks out with the patient completely satisfied, an asymptomatic elevatus on a lapidus....

my advice. if you are truly well trained, critical of your work, always trying to improve...don't sweat it. keep doing what you are doing and will work out. Thats what I did and I passed.

Of course i did fail forefoot computer for the second time this year, so even though I have now passed 3/4 of test, still not ABFAS board certified...for the record the part of the forefoot computer I failed --- was the physical exam. Yes, you heard me right. My assesment was correct, my treatment was correct, my follow up treatment was correct...I just didn't click on the right buttons for a physical exam on a computer.

Someone didn't play enough text-based adventure games on the computer growing up. I seriously thought the computer part was so easy--but only cause I played it like a game lol. I agree it's ridiculous, though. So many smart people I know failed that at least once.

 

[podfam3008]

Random question: did ABFAS start accepting in-office procedures for logging purposes?

I don't think so. Unless something has changed.

 

[NatCh]

It's mostly about persistence and money. The more years you try, the more money you spend, the higher the chances of passing. That was my experience.

He (or she) is not wrong...

 

[GreenHousePub]

Seriously? All of these? Thought IM angle, Hallux abductus angle, and sesamoid position would be adequate.

To the folks who passed rearfoot, did you document calc inclination angle lat/ap, talar dec angle, mearys etc as well for each case?

Always. For RRA I did every relevant angle and others if I could (tibio/calc angle etc). They're going to fail you for not documenting it, and trying to guess which one they want is risky.


You're paying a lot of money for this exam, do you want to gamble on it?