Guidance on reviewing staging for oral boards

[dieABRdie]

So I thought I would get a jump on oral boards review and got started by reviewing staging. Then I realized that I could be wasting a tremendous amount of time if I went about this the wrong way.

Any guidance on the best way to go about staging for the Oral Boards?

For example…. It’s obvious no one will be memorizing the AJCC 8th ed. Clinical and pathologic prognostic stage groupings for breast… is this going to come up?

And now multiple sites have clinical, pathologic, as well as neoadjuvant groupings. Some sites are also incorporating grade….

Since the data we use to make clinical decisions is from older staging systems… should we be focused more on 7th ed.? I imagine for some sites it’s obvious we need to know both (HPV oropharynx)

Any input would be greatly appreciated.

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[seper]

I think by this point everything is 8th ed and you should memorize staging. For Gyn, it's 2018 FIGO update. I agree that the breast is pretty insurmountable, hopefully it is not tested.

 

[Mandelin Rain]

I punted on esophageal for my oral boards. Adeno/Squamous/proximal/distal/grade/Node number. Bah.

Worked out.

 

[RollTideRadOnc]

I did not get asked a single formal staging question on oral boards.

 

[Aphtalyfe]

So I thought I would get a jump on oral boards review and got started by reviewing staging. Then I realized that I could be wasting a tremendous amount of time if I went about this the wrong way.

Any guidance on the best way to go about staging for the Oral Boards?

For example…. It’s obvious no one will be memorizing the AJCC 8th ed. Clinical and pathologic prognostic stage groupings for breast… is this going to come up?

And now multiple sites have clinical, pathologic, as well as neoadjuvant groupings. Some sites are also incorporating grade….

Since the data we use to make clinical decisions is from older staging systems… should we be focused more on 7th ed.? I imagine for some sites it’s obvious we need to know both (HPV oropharynx)

Any input would be greatly appreciated.

I got asked a few questions regarding stage, but mostly they were relevant for treatment. Like N3 disease for lung, T3/T4 for breast/h&n. I would stick with what seper said: AJCC 8th and FIGO 2018.

I feel like if it doesn't change management, then the staging isn't going to be asked. Even if it is asked, you likely won't get failed for just not knowing the stage. Now if you treat the patient inappropriately because of the incorrect stage... that's another story.

 

[RickyScott]

Been a while, but was very basic and simple.

 

[RadOncDoc21]

Just say you’ll treat with concurrent carbo/taxol and some type of immunotherapy drug. That will get you through 80% of Oncology.

Just know the basic treatments for early stage vs locally advanced for each disease site and you should be fine. I know for sure, most people haven’t memorized all the stages but do know what upgrades a site (size vs depth of invasion, #lymph nodes vs location, etc).

Also please ignore the first part of my message as you will certainly fail!

 

[dieABRdie]

Thanks for the comments... I am somewhat relieved

 

[ramsesthenice]

Make sure you know TNM staging. Would worry much less about stage grouping.

 

[Lamount]

I took boards last May and staging did not come up all that often... and I have been told by numerous breast boards examiners that they use an app on their phones for prognostic staging, so they would not expect examinees to know this.

The way that a staging blunder can really hurt you is when it leads you to recommend the wrong treatment. When you are actually taking the boards, the best thing you can do is... after you have heard the history, state a one-liner with relevant staging information (i.e. "Just to review, this is a patient with T2N2 NSCLC"). This way, if you are wrong or misheard something in the history, the examiner can throw you a lifeline (i.e. "Are you sure about that? I don't recall telling you about any lymph nodes").

 

[RadOncDoc21]

I took boards last May and staging did not come up all that often... and I have been told by numerous breast boards examiners that they use an app on their phones for prognostic staging, so they would not expect examinees to know this.

The way that a staging blunder can really hurt you is when it leads you to recommend the wrong treatment. When you are actually taking the boards, the best thing you can do is... after you have heard the history, state a one-liner with relevant staging information (i.e. "Just to review, this is a patient with T2N2 NSCLC"). This way, if you are wrong or misheard something in the history, the examiner can throw you a lifeline (i.e. "Are you sure about that? I don't recall telling you about any lymph nodes").

Or be a total douche and say “Why would this be considered T2 or N2.” Just saying, the exam is so subjective. I feel like I would be a total a$$ but would likely pass everyone.

 

[Mandelin Rain]

The classical teaching of oral Boards is to not offer more information than requested. I would not offer up T2 N2 unless asked directly because it does leave you open to further criticism and questioning if incorrect. But... if you have any doubt regarding the stage I would ask clarifying questions, which they are always happy to answer.

Usually they may show you a picture on a tablet of a PET CT and ask you to describe what you see.

"Approximately 5 cm right suprahilar mass, hilar node, and level 4R node."

-Correct. What do you want to do?

"I would recommend invasive mediastinal staging and presentation at multidis....."

-I'm going to stop you there. How are you going to treat this?


My impression is they wanted more nuts and bolts of radiation treatment and to see your thought process when approaching difficult cases. No one wanted to hear that "I would simulate the patient supine, with IV contrast with arms up, in a VacLok, and...."

 

[evilbooyaa]

The classical teaching of oral Boards is to not offer more information than requested. I would not offer up T2 N2 unless asked directly because it does leave you open to further criticism and questioning if incorrect. But... if you have any doubt regarding the stage I would ask clarifying questions, which they are always happy to answer.

Usually they may show you a picture on a tablet of a PET CT and ask you to describe what you see.

"Approximately 5 cm right suprahilar mass, hilar node, and level 4R node."

-Correct. What do you want to do?

"I would recommend invasive mediastinal staging and presentation at multidis....."

-I'm going to stop you there. How are you going to treat this?


My impression is they wanted more nuts and bolts of radiation treatment and to see your thought process when approaching difficult cases. No one wanted to hear that "I would simulate the patient supine, with IV contrast with arms up, in a VacLok, and...."

For the bolded - they don't ask you that even once during all of oral boards? I have been constantly harping on junior residents to go through the whole shpiel of talking through how the sim would be done during oral boards prep. Am I just a PITA for no reason?

 

[RadOncDoc21]

For the bolded - they don't ask you that even once during all of oral boards? I have been constantly harping on junior residents to go through the whole shpiel of talking through how the sim would be done during oral boards prep. Am I just a PITA for no reason?

More chances for you to go down a rabbit hole. Basically it’s all about getting from point A to B in as little time as possible.

 

[Neuronix]

My boards were more direct Q&A than describe a b and c. I think it changed some number of years ago to make it more reproducible.

 

[gmsquid]

Yeah, it’s less formal than its reputation. It’s more how to treat and how to think through tough cases. They also may throw nuance at you, and try to make you treat a patient in a manner they would not be eligible for based on the data, to see if you really understand who is eligible for certain paradigms.

 

[Mandelin Rain]

For the bolded - they don't ask you that even once during all of oral boards? I have been constantly harping on junior residents to go through the whole shpiel of talking through how the sim would be done during oral boards prep. Am I just a PITA for no reason?

I went through the same thing, but no. No one wanted to hear that.

 

[Carlin]

I took boards last year. I can think of several distinct times I was asked “What stage is this?” after reviewing imaging. If you were to get the T stage wrong, I doubt it would make or break you, unless it causes you to recommend an incorrect treatment. My study partner and I reviewed staging pretty thoroughly and I have to say I’m glad we did. It’s nice to feel confident you have the stage right when you’re starting to recommend treatments.

That said, do not waste time on breast prognostic staging.

 

[KHE88]

For the bolded - they don't ask you that even once during all of oral boards? I have been constantly harping on junior residents to go through the whole shpiel of talking through how the sim would be done during oral boards prep. Am I just a PITA for no reason?

I've never really bought that advice to memorize certain scripts. Virtually all anecdoctal stories I've heard say that the examiners don't want you to rattle off a memorized script of a detailed physical exam, laboratory workup, H&P, etc. I don't plan on doing it and am going to rely heavily on my experience of what I actually do. Being a solo rad onc treating everything (and I mean everything as there is no other rad onc for many miles), I feel somewhat fortunate in this regard as I am forced to stay up to date on all sites. I feel somewhat bad for those who've spent their entire first year only treating breast. A year out, and in reality probably more than that, from touching certain sites, I would think that reviewing for that would be rough. I could see where memorizing scripts might benefit someone in that situation. I suppose we'll see how it works out.

 

[Mandelin Rain]

Not one of my examiners wanted a script. They cut me off whenever I tried to get into it and seemed a little annoyed (probably because they had heard the same preamble 10 times already).

 

[KHE88]

I took boards last year. I can think of several distinct times I was asked “What stage is this?” after reviewing imaging. If you were to get the T stage wrong, I doubt it would make or break you, unless it causes you to recommend an incorrect treatment. My study partner and I reviewed staging pretty thoroughly and I have to say I’m glad we did. It’s nice to feel confident you have the stage right when you’re starting to recommend treatments.

That said, do not waste time on breast prognostic staging.

I would guess/hope the keys are knowing when staging changes treatment. I.e., going up in dose from a T2 to T3 anal. Covering external iliacs and inguinals in a T4 rectal, omitting chemo in a T2 tonsil, etc. The general treatment paradigms in Ward's book are extremely helpful for this.

 

[CptCrunch]

I took boards last year. I can think of several distinct times I was asked “What stage is this?” after reviewing imaging. If you were to get the T stage wrong, I doubt it would make or break you, unless it causes you to recommend an incorrect treatment. My study partner and I reviewed staging pretty thoroughly and I have to say I’m glad we did. It’s nice to feel confident you have the stage right when you’re starting to recommend treatments.

That said, do not waste time on breast prognostic staging.

Agree with this. I was asked a few times about staging, mostly in the context of disease management, but at least once as a standalone question. I think TNM staging is fair game but I probably wouldn't sweat the monstrous prognostic stage groupings such as breast, esophagus, etc.

 

[w00tz]

Any one know if APBI brachy breast is fair game? I don't do it in my practice, but I don't do peds either and I know I can't avoid that.

 

[RadOncDoc21]

Any one know if APBI brachy breast is fair game? I don't do it in my practice, but I don't do peds either and I know I can't avoid that.

Just focus on what makes patients “suitable” or more importantly “unsuitable.” Maybe know some of the dosimitry, dose and fractionation. I remember them not caring if I don’t do something just as long as I know when to do or not do it.

 

[RollTideRadOnc]

Any one know if APBI brachy breast is fair game? I don't do it in my practice, but I don't do peds either and I know I can't avoid that.

You have mostly certainly already totally rocked the Breast section if that question comes up. Know that it exists. Otherwise, don't bother.

 

[trainee]

For the bolded - they don't ask you that even once during all of oral boards? I have been constantly harping on junior residents to go through the whole shpiel of talking through how the sim would be done during oral boards prep. Am I just a PITA for no reason?

what is pita

 

[OTN]

Pain in the...buttocks

 

[evilbooyaa]

what is pita

Pita is a type of bread, frequently used in mediterranean cuisine, especially with Gyros and Falafel

PITA is an acronym for what OTN mentioned above

 

[trainee]

Lol, I see. thanks for explaining PITA (p.s. try Za'taar - life changing)

Anyone taking clinical written 04/2021 (not radbio/physics) and then orals in 09/2021? if so, when would the Oral review courses *potentially* be? thanks in advance