We took it as interns as well. As a chief, I always told me residents the following:
As an intern you should take the exam and have no idea what the questions even mean. (because your job now is to learn how to treat surgical patients, not how to be an Otolaryngologist).
As an R2 you should take the exam and know what some of the question mean, but not most of the answers.
As an R3 you should understand what the questions are asking, but have some trouble narrowing dowin the answers.
As an R4 you should know what the quesitons are asking and be able to narrow down the answers effectively.
As an R5 you should understand the questions and realize that in many cases the right answer isn't even listed.
The truth is that there are no books or study guides that really reflect the type of questions asked on the ENT inservice exam or the written board. All of the texts touch on the important issues, and if you ask me the texts provide more useful information. The inservice and the board exam are all broken down into 3 parts (as far as I am concerned):
Reasonable, clinically oriented questions.
New questions (that don't actually count towards your final score, but are being field tests)
Completely random crap questions, asked by someone who spends most of their time behind a computer and nearly none infront of a patient, directed towards very specific, non-standard-of-care research in very narrow niches of the field that you can only answer correctly through a lucky guess or by having by chance read the exact article they're referencing. They're just a small step about "guess what I'm thinking" questions.
You should know the first group cold. You will often do just fine on the second (not that it matters), and the last group is a total crap shoot. You cannot prepare for it other than to keep up to date on the literature as much as you reasonably can and hope to get lucky. You have a post-gradute degree, so you should be able to effectively weed out 1-3 of the bad answers to increase your chances of answering correctly. Some people say that some of the clinical case study guides that are out there are helpful, or some of the subscriptions that pull together useful articels...I never found that to be any more helpful than just reading a lot of journal articles at random.
As an intern, a LOT of the questions seem to fall into the last group, but that is simply due to the fact that you cannot be expected to know the full gamut of ENT as an intern 9 months into your training. That's stupid. I did very well each year that I took the inservice, and passed the boards with no trouble, and my experience (at least) was as I mentioned above. That being said even now I feel like a lot of the questions were low yield and not helpful for clinical practice. But they're not supposed to be. They're supposed to help identify the upper echelon residents (the great guessers or the guys who spend all of their time reading journal articles). I don't know WHY they feel like they need to identify those people, since no one ever asks how you did on your boards....seems like they should be more interested in just finding out who needs more help....but nonetheless....
It won't get any better on your boards, wherein you are asked to interpret sleep studies even though you are then not supported by ABOTO to actually read them in practice without a fellowship....etc., etc.....
Read a comprehensive text during the year (I always read Cummings, although that does get into the weeds), and when the inservice got closer I'd read KJ Lee...twice as an R2....although be warned that there are blatant misprints/mistakes in Lee...
