Just Oral Boards.com

Discussion in 'Anesthesiology' started by gascopper, Aug 6, 2015.

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  1. gascopper

    gascopper Account on Hold Account on Hold

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    Is this course suitable for pain fellows who aren't in the ORs? I did Ho and hated it. Big waste of money
     
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  3. narcusprince

    narcusprince Rough Rider 10+ Year Member

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    The gamma quadrant
    Save your money get all the released oral board exams and do a few with your partners and you will be fine!
     
    epidural man likes this.
  4. leaverus

    leaverus New Member 10+ Year Member

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    Nowhere in particular
    that's not the answer to the question asked. what if like, me, he does as you suggest and isn't fine? in retrospect, I would have preferred to lose a few thousand dollars than a year of my time....I understand that courses aren't for everyone, but that doesn't mean they're not for anyone.
     
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  5. narcusprince

    narcusprince Rough Rider 10+ Year Member

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    The gamma quadrant
    I have never believed in board review courses. I had friends who took Ho and failed and passed. Best advice is do as many mock exams with others as possible. Save your money. If someone else pays for it sure why not.
     
  6. gascopper

    gascopper Account on Hold Account on Hold

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    Thanks narcusprince,

    I have an idea. I'll follow your advice and in case it doesn't work out for me, you will reimburse me $2,100 for a repeat registration for this exam and provide me with air tickets, hotel fees, and compensate me for vacation time lost? How does that sound?

    I'm going through a tough time here and it isnt really professional for you to suggest that board courses are all garbage and i should just "do as many mocks with others..." I asked about justoralboards.com because i heard they are very thorough and solid when it comes to mock exams and their stems are very close to the real thing. However, this is all hearsay. Please advise.
     
  7. fakin' the funk

    fakin' the funk ASA Member 10+ Year Member

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    Well, in lieu of experience with that site, the posters on here are trying to help you. If that counts as unprofessional in your book...

    Your #1 best plan is to do as many mocks with professors where your fellowship is at, your co-fellows, junior attendings who've just taken the thing, and do the ABA released stems. I liked Yao, the Lovich-Sapola book, and Board Stiff. YMMV.
     
    FFP likes this.
  8. ether123

    ether123 Banned Banned 2+ Year Member

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    I think justoralboards.com may be the best way to go. There's a ton of personalized one-on-one attention and I think the board exam does have a fair amount of repetition so pattern recognition and understanding how to verbalize your response is very important. I dont like Ho bec most of his examiners just make their mock stems on the fly and there's no quality control. Justoralboards.com apparently has their own stems which they have different examiners use, so u can be sure the exam u have is solid and of high caliber. Thats just my take but in the end you have to decide what's best for you.
     
  9. narcusprince

    narcusprince Rough Rider 10+ Year Member

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    The gamma quadrant
    I understand your nervousness regarding the exam. We all get nervous to some extent some more then others. Another reason I shyed away from the Ho is I did not want to be surrounded with folks with nervous nelly pessimistic attitudes before the exam. For the orals you have to be relaxed you have made it this far for a reason. Relax, breath it will be ok. Good luck.
     
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  10. gascopper

    gascopper Account on Hold Account on Hold

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    I agree ho is garbage. most of the examiners for his "private exams" made their exams on the fly...a real waste of time...the McDonalds of board review. On that there can be no doubt. BUT, i have heard from others that there are some real players with trained and dedicated faculty where u get more personalized attention. I appreciate the feedback on justoralboards.com from ether123. If there are any thoughts on any other review courses please do tell. Narcusprince, I tried being "relaxed"...didn't work out too well for me...
     
  11. narcusprince

    narcusprince Rough Rider 10+ Year Member

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    The gamma quadrant
    Gascooper, good luck next time around. Also, im sure you have already done it but try doing mock orals with people from different institutions with which you trained. All the best.
     
  12. mostwanted

    mostwanted Senior Member 10+ Year Member

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    I didn't use just oral boards, but ultimate board prep explanations were on point. I had couple of questions that were almost exact from UBP question booklets.
     
  13. waterhammer

    waterhammer ASA Member 7+ Year Member

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    I did 4 mock orals with them last year and thought they were pretty good. I really liked their course book. I passed on my first try.
     
  14. Colba55o

    Colba55o Junior Member 10+ Year Member

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    gascopper I highly recommend justoralboards. For my first attempt (unsuccessful) I did 4 mock orals with them combined with Ho's course. For my second attempt (success!) I just did the rapid sequence course with justoralboards. It was overpriced but it forced me to be well prepared and I don't think I would have gotten the same results practicing with colleagues.

    Don't read too much into the people on this board who brag about passing their boards without taking a course. They are the same ones who have 100% success rates on their blocks and have 0% complications. Some people have access to board examiners that are willing to coach them daily, I didn't have that access. Do what you need to do to pass.
     
  15. cockblockandrun

    cockblockandrun 7+ Year Member

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    I took the JOB course and would recommend it to anyone considering it. Everyone of my friends who took the JOB course passed the orals. Just PM me and I'll give you the details from my experience. For those who didn't need a course to pass, more power to them. But I was in private practice with no one to help me study so the JOB course was ideal for me. The program is tailored to your needs and around your work/call schedule. In the beginning its a real kick in the ass but after you do couple of exams, you get the real hang of the exam. On the day of the exam, I was super relaxed and well prepared.
     
  16. Ronin786

    Ronin786 ASA Member 5+ Year Member

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    This thread reads like a bunch of bots advertising for an oral board prep course.
     
    okayplayer and cockblockandrun like this.
  17. ether123

    ether123 Banned Banned 2+ Year Member

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    i took ho and justoralboards.com but liked justoral more. just my experience.
     
  18. chfo

    chfo Banned Banned Account on Hold 5+ Year Member

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    agreed.
     
  19. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    No verbose fellating testimonials from 1-post people who created accounts today, yet, so the thread's only hitting about a 3.7 on my Troll-O-Spam-O-Meter. :)
     
  20. Impromptu

    Impromptu ASA Member 7+ Year Member

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    I took the Just Oral Boards course after failing the orals for first time. It was a dark 1/2 of a year with low self esteem, nervousness, and uncertainty about the future, since board certification is now a requirement for practically every job out there. I had never failed a test before in my life. I found the Just Oral Boards textbook to be the most beneficial part of their course. My sequence (which I would change) was to take 4 Skype exams, then read the book, which contains 10 practice exams as well as detailed reasons behind their responses. I did the practice exams with my wife and/or my newborn daughter. Looking back I would have changed that order to doing the Skype exams last. 4 live exams was sufficient, but you could do all of them if you wanted.

    The reason I liked the textbook so much was it explained exactly what kind of answer the examiners were looking for when they asked a type of question. It helped me to be much more focused and organized. Ho's book and course didn't do that for me. It was mostly knowledge, which I had. There were lots of questions, but no explanations as to why certain answers would check off the boxes of what the examiners were looking for and why other answers would not. Big Red also had lots of information and tried to get it organized, but it was still mostly memorizing. For me the light didn't go on until I read the JOB textbook.

    I also liked the textbook because I could take a post assessment and get 41 CME credits that I can use for MOCA. Just had to make sure to take that exam after I passed the text. Anything up to the day of the exam (including the exam) is not counted toward MOCA.

    Good luck for the future. Life is so great not having to study each night when I get home from my long hours of private practice. I spend much more time with my wife and daughter. It was worth it just to get that monkey off my back.
     
  21. Trisomy13

    Trisomy13 ultra 10+ Year Member

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    Yes it is suitable for fellows who have been out for a year. I used it (not as a fellow) because it forced me to do mock exams, which as you see in this thread is the key to preparing. Yes, you can do mocks for free with colleagues. I chose this route for several reasons. I didn't want to inconvenience colleagues who have their own busy lives. I didn't want to get a mock from a colleague who hasn't experienced the exam yet (although I did some of this too). I didn't want my colleagues to see my deficits or nervousness. I wanted to be "forced" to do it on a schedule (because I was paying for them). I wanted strangers who were not afraid to act like pompous assholes and give a true simulation of what might be encountered on game day. Get rattled in practice and be cool in the exam.

    If none of those reasons apply to you, then get released exams and practice with your spouse or local barista. I shelled out for the UBP books for exams with friends so they had a solid stem and questions, and did the Skype with JOB and have no regrets. Warning - they will try to up sell you (fair enough). I bought 4 at a time until I was confident. Walked out of the exam beaming because I knew I smoked it. I don't work for them. Your mileage may vary.
     
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  22. ether123

    ether123 Banned Banned 2+ Year Member

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    i agree they will try to up-sell u! The best thing is to know your weaknesses and how much prep u need. After a few exams u will get a sense of that. the same goes true for UBP...the books encourage registration for the live course, etc.
     
  23. gascopper

    gascopper Account on Hold Account on Hold

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    What is the scale for troll-o-spam-o-meter?
     
  24. polar403

    polar403 10+ Year Member

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    It goes to 11.
     
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  25. spike7585

    spike7585 ASA Member 2+ Year Member

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    The 4 exam package is the one that is $880? Damn, that can add up quite a bit after a few of those packages.
     
  26. ether123

    ether123 Banned Banned 2+ Year Member

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    yeah but each session lasted 1.5 hrs which is quite a long time to be talking to an examiner one-on-one. i found 4 to be a lot and i was usually drained by the end. i guess the question u have to ask if how much do u think the time of a board certified anesthesiologist is worth? with 4 exams that comes out to 6 hours roughly. thus, i found the prices to be steep but reasonable.

    that being said, everyone is different and some people may need more some less. just my 2 cents
     
  27. gascopper

    gascopper Account on Hold Account on Hold

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    to what extent should one assume that the cases we see at courses are similar to "real" exams. I mean, questions are released, not the answers so how does one know which will be accurate?
     
  28. Impromptu

    Impromptu ASA Member 7+ Year Member

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    During the real test (after using JOB textbook) I felt as if I knew exactly the type of responses that the examiners were looking for. I felt that I could tailor my response to check off all of the boxes they wanted, rather than let my answer contain all of my unfocused knowledge and hope that I checked off enough boxes with the words I said. I almost felt like I had their answer card in front of me.

    But, I also had to have enough knowledge in order to focus it. The Skype exams won't give you knowledge beyond the specific questions they ask. You'll need to learn that knowledge, either through Big Red, Audio Digest, textbooks, or any of the other fact review books.
     
  29. gascopper

    gascopper Account on Hold Account on Hold

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    So does the JOB textbook not have enough content for knowledge base development? Is this book available online or amazon?
     
  30. timgasman

    timgasman

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    wondering if this kind of a course is the future of medicine?
     
  31. sigrhoillusion

    sigrhoillusion ASA Member 2+ Year Member

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    Sorry to comment on an old thread, but love how OP asks for advice, gets advice from narcusprince, doesn't like/appreciate advice and proceeds to argue and get emotional... :rolleyes:

    Can only imagine how the actual boards went when the examiners started questioning his decisions and piling on more complications... Would have loved to be a fly on the wall in that exam room. :corny: Some people just can't play "the game".
     
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  32. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    I don't understand what you're asking.
     
  33. sigrhoillusion

    sigrhoillusion ASA Member 2+ Year Member

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    I think future of medicine = paying lots of money for unneeded services...
     
  34. Gern Blansten

    Gern Blansten Account on Hold 10+ Year Member

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    If the course is to be taken later today or at any time beyond that, then yes. If the course has already been taken, then it is the history of medicine.
     
  35. timgasman

    timgasman

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    Well the course in online based with skype mock orals. You do mostly all of your learning through tele-conference and online interfacing so no lecture halls, hotel rooms, air-travel. Is this where we are headed? If so, can we conceive of the day when doctors in Asia will tutor students and residents here in the US?
     
  36. easternether

    easternether

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    And for dermatologic appointments you will use high resolution images to send to docs abroad and not waste money and time here in the US. Oh wait...that is already happening!
     
  37. easternether

    easternether

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    I just heard a rumor that some candidates for the 2017 oral exam will have an OSCE also!! This won't count towards their grade but they are doing this to try to see how candidates do so they can roll out a thorough exam for 2018. Anyone else heard of this?? One of my attendings who is friends with a board examiner told me. The ABA site is mute on this...
     
  38. neutro

    neutro 7+ Year Member

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    I did both Dr Ho and JOB.
    Dr Ho actually has a teaching platform - videos, etc. The book isnt the greatest, but the best part is feedback and actually knowledge acquisition. JOB teaches you how to pass the exam, Dr Ho is far more comprehensive and teaches you how to be a good anesthesiologist.
    Dr Ho has been doing this for 20 years. He has a reputation and is available by text and email immediately if you ask. His business model is better also, a lot of the faculty are academic anesthesiologists and really are interested in teaching, vs. JOB where sometimes the examiner rushes through the exam.



    *not advertising, rather an honest opinion IMO.
     
  39. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

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    OSCE coming in 2018: Cl,inck on "WATCH" to seethe video

     
  40. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

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    I foud the "ethical portion" of the video quite interesting. At my hospital I have an automatic temporary removal of the 'DNR' order for all surgeries. This policy is discussed with patient and/or family members prior to surgery. If they want anesthesia then the DNR is removed for at least the duration of the O.R. and PACU stay. This eliminated any "gray areas" regarding care of intra-op patients. The ABA seems to have a different viewpoint on the subject (see post 44). Let's hope this area doesn't become an "abortion type" debate over the value of life and end of life care.
     
    Last edited: Feb 4, 2017
  41. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

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    Why do we agree to do surgery on patients with DNR orders?
    Many types of surgery provide palliative benefits to patients who either will not survive long-term, or who do not wish resuscitation in the OR. A patient with an esophageal obstruction from cancer might benefit from gastrostomy placement through reduced pain and improved nutritional status, yet not want CPR if cardiac arrest happens in the OR. Requiring such a patient to suspend their DNR orders to be a candidate for surgery uses their discomfort, pain, and desire to benefit from surgery to coerce them into accepting medical care (CPR) they do not want. Patient refusal of some medical therapy, such as CPR, does not ethically justify physicians denying them other medical therapy, such as surgery, that might benefit them.

    What should be included in a discussion of DNR orders in the OR with the patient or patient's surrogates?
    As discussed above, surgery and anesthesia may require the administration of medical therapies, which under other circumstances might be considered resuscitation. It is an ongoing source of discussion about what constitutes appropriate information and choices to present to patients about to undergo surgery who have DNR orders on their charts.
    Since the goal of medical therapy is to provide meaningful benefits to the patient, discussion of DNR orders in the OR should center around the patient's goals for surgical therapy. Patients may have fears of "ending up a vegetable" on a ventilator after surgery, for example. In those cases, discussion should center around the positive prognosis for patients who have CPR in the OR, together with reassurance that the patient's stated wishes in their advanced directive regarding ventilatory support would be followed postoperatively after anesthetic effects are ruled out as a cause of ventilatory depression. Most authorities now agree that a "smorgasbord" or checklist "yes-or-no" approach to the various procedures in the operating room is confusing and counterproductive to the purpose of DNR discussions.

    Anesthesiologists in particular need to be aware that studies indicate that many patients with DNR orders in their charts (up to 46%) may be unaware that the order exists, even when they are competent. While policies at the University of Washington Medical Center require documentation of discussion of DNR orders with the patient or appropriate surrogates, anesthesiologists and surgeons should nevertheless approach the patient about to undergo surgery with sensitivity to the fact that they may be unaware of their DNR order. If this proves to be the case, a full discussion of the DNR order should be undertaken prior to proceeding.
    https://depts.washington.edu/bioethx/topics/dnrau.html
     
  42. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

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    The Commentary
    When a patient with a ''do not resuscitate'' (DNR) order undergoes surgery or conscious sedation, there may be a tension between wanting to provide beneficial interventions and respecting her informed choices.(1,2) When the patient's vital functions are deliberately depressed by anesthesia, several interventions are routinely used that also are employed during ''resuscitation,'' such as vasopressors and mechanical ventilation. If a patient has a DNR order, an anesthesiologist might need to withhold such interventions and even reduce the level of anesthesia and analgesia to ensure stable vital functions; either situation could compromise the outcomes of surgery. Therefore, many physicians would like to ''suspend'' DNR orders in the operating room to avoid these predicaments. This approach is supported by the fact that CPR is much more successful in the operating room than elsewhere in the hospital. In one study, 65% of patients who suffered a cardiopulmonary arrest in the operating room survived to discharge, and 92% of those whose arrest was caused by anesthesia survived.(3) After being informed of these differences in both approach to and outcomes of life-sustaining interventions in the operating room versus other clinical situations, many patients accept resuscitative measures in the operating room and the immediate postoperative period.

    https://psnet.ahrq.gov/webmm/case/135/dnr-in-the-or-and-afterwards
     
  43. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

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    POLICY AND PROCEDURE
    An appropriate medical center policy would state that a previously written DNR order remains in effect in the operating room or during a procedure unless clearly addressed beforehand. When a patient with a DNR order is scheduled for a procedure, a physician involved with the procedure must discuss with the patient or his or her surrogate decision-maker the possibility and implications of discontinuing the DNR order.

    It is the responsibility of the patient or surrogate to consider the risks, benefits and alternatives of the procedure, including the possibility of intraoperative cardiac or respiratory arrest (to be clearly distinguished from pre-arrest complications and related interventions) and, under those circumstances, whether or not the patient wishes to have the DNR order revoked. The physician must put in the medical record both the discussion and any change in orders.

    As a general rule, a previously recorded DNR order cannot ethically be suspended or unilaterally discontinued by a physician. Respect for the dignity of the human person, the principles of informed consent and patient autonomy require that the patient's preferences be honored.

    https://www.chausa.org/publications...-it-ethical-to-suspend-a-dnr-order-in-surgery
     
  44. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

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  45. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

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    the ASA Committee on Ethics revised the guidelines in 1998 to incorporate a third option: a limited attempt at resuscitation with regard to a patient’s goals and values [19]. This new three-pronged guideline permitted the anesthesiologist to consider the patient’s goals and values as a guide to decision making with respect to attempts to resuscitate. Patients now could define desired perioperative resuscitation in terms of outcomes rather than procedures, leaving more decisions about specific resuscitative procedures to the anesthesiologist’s (and proceduralist’s) judgment. The context of a cardiac arrest or hemodynamic deterioration now could play a more significant role in determining the clinician’s response. Although this option gave the anesthesiologist an enhanced understanding of the rights of autonomous patients, it concomitantly imposed a pragmatic and ethical requisite upon the anesthesiologist and proceduralist to understand a patient’s values and objectives [24, 25].

    http://journalofethics.ama-assn.org/2015/03/nlit1-1503.html
     
  46. timgasman

    timgasman

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    Either way whether the simulation is there but not scored or not there completely the situation is the same: you need not do well on it to pass
     
  47. easternether

    easternether

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    I have heard from several sources about the osce being used this year. I guess only time will tell
     

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