Failed second attempt.. what am I doing wrong?

[magdellan]

Just found out I failed my psych board exam again.. this second time I had taken it more seriously and studied more (did Mypsychboard, Psychgenius, K&S while focusing on weak subjects). I felt more prepared and after the exam I felt like I had passed comfortably.. but my score had only improved by a few measly points and I was still short of passing it by 10 points.. looking at the median score I feel like I took an entirely different exam than everyone else.. or my entire knowledge base is wrong.. I don’t know what I’m doing wrong or missing here… feeling very defeated and lost.. what do I need to do to pass this exam?

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[vespers]

Hey man, I’m really sorry this happened. Here are a few questions that come to mind:

- Is it possible that you spread yourself too thin with the review materials?
- You mention focusing on weak subjects, but what proportion of your study time was subject-driven vs random? Maybe the ratio wasn’t totally right for you.
- Was there a difference in your weak areas on the results of the recent exam?
- Was your prep a lot of rapid fire churning, or did you spend a decent amount of it slowly thinking through why wrong answers were wrong, making sure you understood the explanation provided, Googling tangentially related concepts when you were interested, etc.?

This sort of thing is really difficult. I know that some people have big leaps in scores on occasion, finding a distinct “what works for them,” or identifying a really glaring mistake on previous attempts. But I think many of us just kinda get what we get after what was a basically reasonable approach. We just have to try to improve our overall quality of prep/thought to nudge ourselves slightly higher best we can. Consider some of the above questions when you get started on a study schedule again.

But beyond the routine you set up, try to develop psychbrain for the next 9 months. Read the interesting clinical threads that pop up on here and Reddit routinely, listen to a podcast or two now and again, maybe regularly read some sort of clinical journal or high quality blog. Not going wild with it, but just as a matter of casual habit.

 

[funtertaining15]

I'm sorry to hear that.
I can't tell you what will or will not work for you. I can say that for me, I spaced out the time I started studying... from mcat to step 2 my scores were generally okay but below average of "average" scores of the time. Plus I would get stressed out and anxious.
Some are just better test takers and may only need a few weeks to study...I am not that person.
So, I realized taking more time to study, spacing it out and gradually being more consistent helped, especially w being in fellowship.
So I started studying a bit as early as March-April...probably April I think...so about 6 months. But I did a few practice questions here and there, not daily but just to not overwhelm my myself...on a q bank on my phone and the k&s book. Then I increased the number I did after April but tried to be consistent..so ie 10q of one q bank and 10 of the other...I could catch up on the weekends if I didn't have much time during the week.
I calculated how many questions I needed to do a day within a certain number of months so I could go through everything at least once with at least 1 month to spare (to August).
On top of that I tried to summarize in 1 sentence the answer for each question in the k&s book so I could review that when I got thru the book.
I mainly used that and rosh Review as my resources but any can work, I considered maybe BV too. But for me I needed to go over the questions at least once and go over my incorrects...if I had time go over the questions again. Repetition, repetition repetition. I went thru the 3 prites I had like a week or so b4 the exam.
I didn't use prite Ninja too much tbh.
You want a q bank that helps you know the dsm 5 criteria well... there are some things that are just hard to study for tbh. But that worked for me.
Cafers books for the cyp enzymes I looked at last min were helpful too...I think you can find it free somewhere for the main ones, he posted it on reddit or something.
I did this over 5-6 month, bc of how busy work can get, I don't have as much time to just study for a month or so.
But for me I don't want to feel overwhelmed...so I paced it out, did a bit at a time and worked on just being consistent.
Also making sure to read the incorrects too.. some qbanks may or may not be as good with explanations... I felt the ones I used were good at this..even if it seems too detailed, better to be overprepared than under prepared.
I think having the book and some qbank and not having too many things you're using consistently - since you should look stuff up and use things here or there when needed in studying, but don't feel you need 5 different study aids.
Just being consistent and give your self more time to prepare and repeat/review everything again if you need to is what I recommend, even if it's in topics you feel you know..reinforcing material was helpful on stuff I thought I knew but I was humbled on when studying.
But you got this! Just think about what you did this time around...
Tl;dr bc i repeated myself alot - I'm sorry-If nothing else, I would recommend going over practice questions at least once and doing all incorrects at least...if you can go thru it 2x even better.
But think about how much time you need and try your best to plan for it. If you have a busy schedule, if it were me, I'd give myself a bit more time to study.
Best of luck to you!

 

[Merovinge]

I think at this point I would pony up and pay someone who did very well and is board certified to tutor you and make sure you are ready for the third attempt. This is too big a deal to not put all your might/resources behind at this point, particularly since you doing it on your own with real gusto lead to less than desirable results. Even if you spent 5-10k on preparation, it will be money very well spent, don't cheap out on resources or effort after spending all the time of undergrad/medschool/residency. Finish line is in sight!

 

[Sushirolls]

Even if you don't pass... you can still practice.
You can open a cash only private practice.
You will have less headaches and bureaucracy to deal with. Less stupid emails about doing journal articles, and MOC and paying out $175/year.
I dream of dropping my certification every few days. Really is meaningless. Especially in this era of ever increasing ARNP/ PA, and oh, Biden gov just allocated hundreds of millions more towards ARNP expansions!

In summary, put forth the effort again to study/pass, to keep open more employed jobs if that's what you want. But don't let it break you or define you. You still have a bright future ahead - and likely brighter if you venture into cash PP.

 

[whopper]

K&S will not help you for the board exam. It has a Q&A book whose questions and answers share none of the format, material or style found in the actual board exam. It will have you memorize several terms never to be seen in the actual board, exam, nor used in real life by any physician I know such as "forme fruste." I know this because I've known some of the authors who write these alleged board review Q&A books. None of them wrote questions for the actual exam. They themselves are different authors who just made up some questions on their own. I've only seen 1 psych book that had question that were reflective of the actual board exam, but I don't see it on sale anymore. I wrote about it years ago in this forum.

Years ago I took the forensic psych board exam, and I could tell which textbook where they took the questions. I know the author who wrote the APPI book for forensic psychiatry and she didn't use the same textbook, nor does any of her questions have similar style, content, or focus on what's high yield in the real exam.

 

[splik]

I think at this point I would pony up and pay someone who did very well and is board certified to tutor you and make sure you are ready for the third attempt. This is too big a deal to not put all your might/resources behind at this point, particularly since you doing it on your own with real gusto lead to less than desirable results. Even if you spent 5-10k on preparation, it will be money very well spent, don't cheap out on resources or effort after spending all the time of undergrad/medschool/residency. Finish line is in sight!

I have helped with this before, though in my experience there are usually issues related to anxiety, poor test taking or other factors beyond knowledge. If you pass all these other exams and make it through residency, chances are that lack of knowledge is not the main problem. Some people really overthink/overcomplicate questions and spend too much time learning about low yield topics.

 

[ObsequiousAplomb]

K&S will not help you for the board exam. It has a Q&A book whose questions and answers share none of the format, material or style found in the actual board exam. It will have you memorize several terms never to be seen in the actual board, exam, nor used in real life by any physician I know such as "forme fruste." I know this because I've known some of the authors who write these alleged board review Q&A books. None of them wrote questions for the actual exam. They themselves are different authors who just made up some questions on their own. I've only seen 1 psych book that had question that were reflective of the actual board exam, but I don't see it on sale anymore. I wrote about it years ago in this forum.

Years ago I took the forensic psych board exam, and I could tell which textbook where they took the questions. I know the author who wrote the APPI book for forensic psychiatry and she didn't use the same textbook, nor does any of her questions have similar style, content, or focus on what's high yield in the real exam.

Really? We used forme fruste all the time in residency, whenever there was a forme fruste presentation.

 

[Bartelby]

You have probably already done this, but are you focusing on question banks? I find answering and missing questions helps it stick much better than reading a text. I liked Beat the Boards, going through the question bank and then at the end retaking all missed questions again. You can also practice doing blocks of questions with a pace similar to the real exam to make sure you get comfortable with it.

 

[whopper]

Really? We used forme fruste all the time in residency, whenever there was a forme fruste presentation.

You're the only one I've seen, and I've worked with several high up academic psychiatrists, over 12 hospitals, and several researchers.

 

[annoyedpsychiatrist]

Just found out I failed my psych board exam again.. this second time I had taken it more seriously and studied more (did Mypsychboard, Psychgenius, K&S while focusing on weak subjects). I felt more prepared and after the exam I felt like I had passed comfortably.. but my score had only improved by a few measly points and I was still short of passing it by 10 points.. looking at the median score I feel like I took an entirely different exam than everyone else.. or my entire knowledge base is wrong.. I don’t know what I’m doing wrong or missing here… feeling very defeated and lost.. what do I need to do to pass this exam?

Historically have you struggled with board exams like usmle/comlex? Or is this new for you? First scenario points to maybe test anxiety/time management/etc whereas second one may be an issue of strategy/review.

When I did my exam a few years ago, i felt like most question banks I did were completely useless. And i did way more questions than the average person. Honestly the most useful resource surprisingly was beat the boards. I didnt think it would be that useful but i was wrong, the lectures turned out having a lot of useful information. Many question banks wasted time asking you questions on percent prevalence of disorders or other random things and the guy was like "dont focus on this, its extremely low yield and they wont ask". Sure enough not a single question about it.

There were also many things they covered that showed up. The questions on BTB were useless but i memorized lectures and it def helped for a solid number.

 

[ObsequiousAplomb]

You're the only one I've seen, and I've worked with several high up academic psychiatrists, over 12 hospitals, and several researchers.

Out of curiosity, what do you say when there's 2/3 elements of a triad and the medical team refuses to accept that the full triad only occurs in 20% of patients? I mostly say forme fruste to directly address that concern.

 

[magdellan]

Historically have you struggled with board exams like usmle/comlex? Or is this new for you? First scenario points to maybe test anxiety/time management/etc whereas second one may be an issue of strategy/review.

When I did my exam a few years ago, i felt like most question banks I did were completely useless. And i did way more questions than the average person. Honestly the most useful resource surprisingly was beat the boards. I didnt think it would be that useful but i was wrong, the lectures turned out having a lot of useful information. Many question banks wasted time asking you questions on percent prevalence of disorders or other random things and the guy was like "dont focus on this, its extremely low yield and they wont ask". Sure enough not a single question about it.

There were also many things they covered that showed up. The questions on BTB were useless but i memorized lectures and it def helped for a solid number.

I passed all my USMLE exams the first time and I've never struggled with anxiety or time management (I'm a go-with-my-gut-instinct-answer-choice and move on), but I'm just not a good test taker compared to my peers. For example I failed the anxiety disorders section on the boards and I don't even know how that is possible?? I did horrible on the PRITEs during residency because I thought the questions were challenging in the sense you either have that very specific information memorized or you don't know it.
You make a good point about question banks asking about prevalence being low yield and I totally agree with you (this was the case when doing PsychGenius qbanks). I did BTB lectures during 4th year residency but I admittedly had a bad habit of tuning out of the lectures cause I thought I already knew the material... I will have to reconsider doing BTB again..

 

[clozareal]

Out of curiosity, what do you say when there's 2/3 elements of a triad and the medical team refuses to accept that the full triad only occurs in 20% of patients? I mostly say forme fruste to directly address that concern.

Atypical

 

[Stagg737]

Atypical

Or something like "presentation suggestive of (insert problem) due to blah, blah, blah".

 

[ObsequiousAplomb]

Or something like "presentation suggestive of (insert problem) due to blah, blah, blah".

Yeah, but when you're saying forme fruste there isn't that room for interpretation. You're saying it is NMS/Wernicke's/whatever, needs that treatment, and you're teaching them that the full triad is rare. By saying "atypical" when it's not atypical, you are telling them that this is a rare presentation / maybe not what you're saying it might be.

To each their own, I guess.

 

[FlowRate]

I passed all my USMLE exams the first time and I've never struggled with anxiety or time management (I'm a go-with-my-gut-instinct-answer-choice and move on), but I'm just not a good test taker compared to my peers. For example I failed the anxiety disorders section on the boards and I don't even know how that is possible?? I did horrible on the PRITEs during residency because I thought the questions were challenging in the sense you either have that very specific information memorized or you don't know it.

It seems/feels like passing boards only requires getting the questions you should know (vs random stupid inane factiods) right. But those questions you should know sound like the ones you're missing. Since you say you don't have issues with anxiety or time management but do have issues with test taking, that implies you need to slow down and think about what answer the person writing the question wants you to give and why. Even if not the same format, this is something you can practice consciously with any q bank on any question that isn't just a one-step rote factoid.

I only used Kenny+Spieg for prep so I don't have a great suggestion for which prep material most closely matches the board questions. Only people who have taken boards twice, written questions for boards, or dramatically overprepared by sampling all available options for their first try, can answer that accurately.

Were you at a residency that was low on therapy training + theory? I feel like on PRITE and boards those questions were easier b/c my residency was the opposite in that regard and there were a decent number of those questions.

 

[Stagg737]

Yeah, but when you're saying forme fruste there isn't that room for interpretation. You're saying it is NMS/Wernicke's/whatever, needs that treatment, and you're teaching them that the full triad is rare. By saying "atypical" when it's not atypical, you are telling them that this is a rare presentation / maybe not what you're saying it might be.

To each their own, I guess.

I get what you're saying. I don't call it atypical unless it's unusual to not present with full criteria or is presenting with symptoms that are...atypical...

I'll echo Whopper that I've never seen any physician use the term forme fruste in any clinical context or really any context other than historical discussions (so much so that I forgot what the term meant, lol). I think if you say "forme fruste" to almost any physician you'll most likely get met with a blank stare or a "huh?"

 

[clozareal]

I get what you're saying. I don't call it atypical unless it's unusual to not present with full criteria or is presenting with symptoms that are...atypical...

I'll echo Whopper that I've never seen any physician use the term forme fruste in any clinical context or really any context other than historical discussions (so much so that I forgot what the term meant, lol). I think if you say "forme fruste" to almost any physician you'll most likely get met with a blank stare or a "huh?"

I've heard two psychiatrists use it in my life and this forum is the third time I'm hearing about this term.

 

[ObsequiousAplomb]

Well, I guess I'm the only one that says it then.

 

[Merovinge]

Well, I guess I'm the only one that says it then.

Don't feel bad, now I will feel like a bad@$$ when I'm hanging with my psych homies and drop this banger! (I'm only semi kidding).

 

[magdellan]

It seems/feels like passing boards only requires getting the questions you should know (vs random stupid inane factiods) right. But those questions you should know sound like the ones you're missing. Since you say you don't have issues with anxiety or time management but do have issues with test taking, that implies you need to slow down and think about what answer the person writing the question wants you to give and why. Even if not the same format, this is something you can practice consciously with any q bank on any question that isn't just a one-step rote factoid.

I only used Kenny+Spieg for prep so I don't have a great suggestion for which prep material most closely matches the board questions. Only people who have taken boards twice, written questions for boards, or dramatically overprepared by sampling all available options for their first try, can answer that accurately.

Were you at a residency that was low on therapy training + theory? I feel like on PRITE and boards those questions were easier b/c my residency was the opposite in that regard and there were a decent number of those questions.

My residency program was pharm heavy.. no real therapy training tbh.. what do you suggest I can use to supplement that material?

 

[whopper]

Yeah, but when you're saying forme fruste there isn't that room for interpretation

Forme Fruste-the bigger point with this thread is it's not on the board exam, and that K&S is filled with stuff it recommends you study that's not on the board exam, but because K&S is considered the main textbook of the field, people think the board exam writers utilized K&S for their questions. They do not.

The merits of this term are up to debate. I get the point of why the term could be important, but my main point in bringing it up is memorize the thousands of terms in K&S, and almost none of them are on the board exam. Seriously almost none of them. It is not a high yield source of data for the board exam.

 

[whopper]

Psychiatry Test Preparation and Review Manual​

3rd Edition - April 23, 2016
Authors: J Clive Spiegel, John M. Kenny
Paperback ISBN: 9780323396158

These authors are the only ones I've seen who write exam questions that are similar to that on the board exam. How similar? They'll pull out esoteric and hardly ever seen disease in their question book, and they all popped up my my exam. This is the only high-yield source I've ever seen other than the expensive neurology/psychiatry board prep course in NYC.

 

[FlowRate]

Forme Fruste-the bigger point with this thread is it's not on the board exam, and that K&S is filled with stuff it recommends you study that's not on the board exam, but because K&S is considered the main textbook of the field, people think the board exam writers utilized K&S for their questions. They do not.

The merits of this term are up to debate. I get the point of why the term could be important, but my main point in bringing it up is memorize the thousands of terms in K&S, and almost none of them are on the board exam. Seriously almost none of them. It is not a high yield source of data for the board exam.

I think usually when people refer to K&S in reference to boards it's because they actually mean S&K. (Spiegel and Kenny)