Does anesthesiology require oral boards?

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Birdstrike

Birdstrike

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Debating whether or not to dump EM oral boards, over on the EM forum. Does anesthesiology require oral boards?
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Writtens don’t test whether you can adapt to different situations and think on your feet.
 
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Well, now wait a minute. Perhaps @Birdstrike is staying that EM is a field where going through and passing oral boards is more “optional” than anesthesiology. To put it simply - full board certification might not be necessary to secure and maintain a job. You know, the way it apparently was in Anesthesia 25-30 years ago.

I’m totally putting all of those words in @Birdstrike’s mouth, so if I’m wrong I apologize. And the answer is probably 90%+ of grads take and at some point pass orals. Some don’t but are relegated to the few jobs around the country that don’t require board certification within a set amount of time (largely poorly paying, very rural or very urban posts).

I have no clue if EM is that lax with board certification, just a theory.
 
AdmiralChz said:
Well, now wait a minute. Perhaps @Birdstrike is staying that EM is a field where going through and passing oral boards is more “optional” than anesthesiology. To put it simply - full board certification might not be necessary to secure and maintain a job. You know, the way it apparently was in Anesthesia 25-30 years ago.

I’m totally putting all of those words in @Birdstrike’s mouth, so if I’m wrong I apologize. And the answer is probably 90%+ of grads take and at some point pass orals. Some don’t but are relegated to the few jobs around the country that don’t require board certification within a set amount of time (largely poorly paying, very rural or very urban posts).

I have no clue if EM is that lax with board certification, just a theory.
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Not exactly.

EM requires written and oral boards. Some specialties don't require any oral board exam. We have a debate going on in the EM forum about whether oral boards in EM should be eliminated, started by someone who was successful academically but failed the oral boards. I can tell you from personal experience, it's a flawed test (which I have passed). Most people want to get rid of oral boards. Some (inexplicably) want to keep them, under the theory that if they got screwed then everyone after them should, too. What I'd like to have a look at is a list of which specialties require written and oral boards and which require only written. In my opinion, it's absurd for one specialty to claim they're necessary and other to seemingly get by without them at all. I couldn't find a comprehensive list, not even on the ABMS website, of which specialties do or don't. That's why I came on here and asked about Anesthesiology. So far, I've found out that IM, FM and Derm don't require oral boards, but Anesthesia, OB/Gyn and EM do. It seems absurd to me that the two biggest specialties (IM & FM) and the most competitive (Derm) seem to certify people just fine without oral boards, yet other specialties claim they're a must.

But honestly, I don't care that much considering I've already passed the EM written, EM oral boards, re-certified in EM once, and passed the Pain boards, too. I don't even practice EM anymore, but I do think we all need to pushback much more aggressively with board exam and MOC overreach. We could all stand to benefit from that; EM, anesthesia, everyone.
 
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From what it looks like in the EM forum (correct me if I’m wrong, which I may well be), EM orals in their current format are pretty different than anesthesia oral boards. Most people share HomeSkools attitude; they are horrific but also a test of basically everything you learned in med school and residency combined plus applied in a difficult situation. So they certainly make you learn in a way. Yours sound more like a standardized exam?
 
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2010houston said:
From what it looks like in the EM forum (correct me if I’m wrong, which I may well be), EM orals in their current format are pretty different than anesthesia oral boards. Most people share HomeSkools attitude; they are horrific but also a test of basically everything you learned in med school and residency combined plus applied in a difficult situation. So they certainly make you learn in a way. Yours sound more like a standardized exam?
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It's supposed to be a practical exam to test real life skills. It sounds like you're saying the anesthesia oral boards, are that. In reality, the EM oral board exam consists of artificial cases, discussed between you and an examiner in a hotel room. For example, you might have a case of an unresponsive patient. In real life, you walk in the room, see that the patient is an a stretcher, burned, brought in by firefighters that reek of smoke, you smell a weird "bitter almonds" smell and realize, "Hey I better also check them for cyanide poisoning." On the oral exam, you receive none of those visual cues at all. It's less realistic than a written exam and even less realistic than real life. Instead, if you don't think to ask, "What do I see and smell?" which you have never been trained to do and would never do in a real life setting which this test is supposed to simulate, then you miss a critical action, the patient dies, and you fail. It's straight up, a stupid test, that tests only your ability to learn the test's game, how to buy airplane tickets and write a check for a few thousand bucks. You can be brilliant, a great doc in knowledge and practical skills, and fail. Even though I passed it and never have to take it again, I think it should be eliminated and along with any test in any other specialty, that fails in this way.
 
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Birdstrike said:
Not exactly.

EM requires written and oral boards. Some specialties don't require any oral board exam. We have a debate going on in the EM forum about whether oral boards in EM should be eliminated, started by someone who was successful academically but failed the oral boards. I can tell you from personal experience, it's a flawed test (which I have passed). Most people want to get rid of oral boards. Some (inexplicably) want to keep them, under the theory that if they got screwed then everyone after them should, too. What I'd like to have a look at is a list of which specialties require written and oral boards and which require only written. In my opinion, it's absurd for one specialty to claim they're necessary and other to seemingly get by without them at all. I couldn't find a comprehensive list, not even on the ABMS website, of which specialties do or don't. That's why I came on here and asked about Anesthesiology. So far, I've found out that IM, FM and Derm don't require oral boards, but Anesthesia, OB/Gyn and EM do. It seems absurd to me that the two biggest specialties (IM & FM) and the most competitive (Derm) seem to certify people just fine without oral boards, yet other specialties claim they're a must.

But honestly, I don't care that much considering I've already passed the EM written, EM oral boards, re-certified in EM once, and passed the Pain boards, too. I don't even practice EM anymore, but I do think we all need to pushback much more aggressively with board exam and MOC overreach. We could all stand to benefit from that; EM, anesthesia, everyone.
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I have mixed feelings on the subject. I think there's a place for an oral exam, to assess doctors' ability to think on their feet and react to unexpected events. I think it's more important in procedural specialties when crisis thinking time is short. More important for surgery, anesthesia, EM. Less important for IM, FM, and derm.


They recently added an OSCE portion to the anesthesiology oral boards, which I think is pants-on-head reta--wait, not supposed to use that word any more--idiotic.


I think some of the surgical specialties get it more right than we do. Some of them have to compile a set of cases that they've personally done in the first year or two of practice, package them up, send them to the board, and then their oral exam is an extensive discussion of how they managed those cases. That seems to me to have some real value. Of course, there's a huge cost and amount of time associated with doing it that way ... but one of the truest of all true things in life is that most things worth doing are hard.

The two 35 minute sessions (or whatever it is now) that we do in anesthesiology are supposed to be the same for every examinee, so they are very structured and very scripted. On the pro side, there's a real effort to make the exam fair. On the con side, discussing two random cases and some random grab-bag questions seems awfully superficial way to make a final judgment on a physician's competence.

On the whole, I favor keeping the oral exam for our boards. Preparing for mine honed my ability to communicate and articulate why I do the things I do, and made me a better doctor.
 
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There is utility in the oral board exam for procedural high pressure fields like surgery, anesthesiology, OB, and EM. You can really put someone under pressure and see if they respond appropriately. It has actual real life value for patient care.

The problem is two-fold. Those administering the oral exams often times are academicians who haven’t seen real world medicine outside of an ivory tower in decades. Additionally, boards who’ve been shown to be corrupt are constantly looking for additional ways to bend us over backwards for $$$.
 
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Birdstrike said:
So far, I've found out that IM, FM and Derm don't require oral boards, but Anesthesia, OB/Gyn and EM do. It seems absurd to me that the two biggest specialties (IM & FM) and the most competitive (Derm) seem to certify people just fine without oral boards, yet other specialties claim they're a must.
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Southpaw said:
There is utility in the oral board exam for procedural high pressure fields like surgery, anesthesiology, OB, and EM. You can really put someone under pressure and see if they respond appropriately. It has actual real life value for patient care.
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Agree with Southpaw. The latter specialties require quick, on the fly, problem solving and action which can’t be tested in a written multiple choice exam.
 
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When I took my plastic surgery boards 20 years ago, a surgeon was able to take written boards one year after residency graduation. Two years after graduation, and if you passed the written boards you were eligible to take your oral boards. The oral boards consisted of two one hour sessions. The first hour you presented 9 of your cases, with complete medical records and before and after photos. The second hour you were
 
required to formulate treatment plans for cases like cleft lip, head and neck cancer, syndactyly, breast reconstruction. The failure rate was about 20% for each of the boards.
 
pgg said:
The two 35 minute sessions (or whatever it is now) that we do in anesthesiology are supposed to be the same for every examinee, so they are very structured and very scripted.
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Two 35 mins sessions? Man ...

"The third step for ABEM certification is the Oral Certification Examination. ABEM guarantees an assignment to the Oral Certification Examination the year after a physician passes the Qualifying Examination. The oral exam is a standardized test of Emergency Medicine knowledge, using scenarios based on actual clinical cases.

The exam is administered twice per year in Chicago, IL, requires approximately five hours to complete, and includes seven simulated patient encounters: five single-patient encounters and two multiple-patient encounters."

Was one of the most stressful non-working days of my life. I shook hands with the examiners and they felt my clammy, sweaty, pale hands. Absolutely thought I had failed.
 
The oral board exam in anesthesiology was an interesting experience. As soon as the examiner determined you not only knew a subject but were versed in the depths of a subject, they cut you off and went on to the next subject. After finishing the stem questions, at the end of the exam it was machine gun fire questions coming rapidly from one examiner then the other, that covered a wide swath of material. Although the experience was intimidating, it was an excellent way to rapidly mine the examinee's responses to a subset of clinical situations.
 
I'm ambivalent in the same vein as pgg, but honestly I've worked with a few attendings who required multiple tries to pass orals. More often than not I find that they are OK clinicians but not the type who keep up on the latest literature or practice guidelines, or the type who as newish attending I would go to for advice on tough cases. Only one guy has been the sort you hear about where he's pretty damn smart but so intractably shy and public speaking-averse that he couldn't get the words out of his mouth. The test is certainly not perfect by any means, but based on my anecdotal experience I think overall it's doing its job.
 
My general thought on the oral boards and the OSCE is: that is what residency is for. Assuming the ABA/ASA trusts their own residency system and the ACGME monitoring, there shouldn't be a need for an after the fact validation of a graduate's ability to practice. In my opinion, the oral boards and OSCE would be useful as a way to formally assess non-US graduates, but should not be an essentially required redundancy for US graduates.
 
The oral boards are little more than a money making scheme. Although I suspect EM, if pursued, would be less of extortionists than the ABA is. This is an exam that could easily be done via Skype for a low cost compared to the what $2500 plus airfare to Raleigh (you know nice and central location) and lodging...


Sent from my iPhone using SDN mobile
 
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Advanced practice folks already criticize docs for not maintaining board certification or doing CEs on the reg. Don’t give them more ammo by making it easier to obtain full boarding.

It’s obnoxious and annoying, but sort of is what it is. Other specialties should have orals as well, IMO. It would be much more practical if they didn’t require everyone to pay over 2K plus air/hotel to get to Raleigh. Such an arrangement for pediatrics, FM and IM would be impossible given the sheer number of graduates given the current format. At least MOCA doesn’t include a written exam anymore every 10 years in favor of doing question each quarter.
 
pgg said:
They recently added an OSCE portion to the anesthesiology oral boards, which I think is pants-on-head reta--wait, not supposed to use that word any more--idiotic.
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EM here - what, exactly, is ABA going to make people do? Tube the head, then a fake TEE? Start an IV on a BS piece of fake skin?

Helmet grade.
 
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Apollyon said:
EM here - what, exactly, is ABA going to make people do? Tube the head, then a fake TEE? Start an IV on a BS piece of fake skin?

Helmet grade.
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The content outline looks like garbage to me.

Stuff like getting consent. Disclosing complications. Some monkey skill simulator stuff. How to do a PI project.
 
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The actual OSCE exam somewhat varies but what you do essentially boils down to this:

Obtaining a thorough consent for an anesthetic procedure (general vs. neuraxial vs. regional, etc) on a patient actor. Discussing a complication such as a medication error with a patient actor. An ethical issue such as a goals of care discussion or a procedural on a DNR/DNI individual discussed with a patient actor. Pretending to do a regional block, basically you ultrasound a patient actor and obtain a "good" image and then discuss with an examiner in the room about how you would do the block, identify relevant structures, and describe where you would deposit local on the image. Performing vascular access (central line or a-line) which is the same deal as the block where you get the image on an actor, identify structures, show your point of entry and describe confirmation etc. Discussing a problem with a colleague (who is an actor) or cancelling a case and explaining why to an argumentative surgeon (also an actor). There's also an imaging/monitors section where you are in a room with an examiner and are told to interpret findings on either a TEE or a series of monitor changes (a-line, SpO2, EKG, etc.). The PI project one makes no sense and isn't worth explaining.

Overall it's a "can you pass a turing test" exam with the exception of the possibility you have poor procedural skills or poor troubleshooting/diagnostics regarding the images/monitors. I know people who failed the OSCE portion and weren't people I would expect to (though there was a disproportionate trend towards pain fellowship).
 
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