Med Onc Board Impressions - 2024

[ONC2023]

Just finished medical oncology boards, which I studied for very intensely due to how many gaps I had in my clinical training (subspecialized academic program, saw no malignant heme apart from 2 months in year 1, little breast, etc).

Here are my impressions, without giving away details, having left the test center 90 minutes ago.

1. Everything people say about HOQ QBank and ASCO SEP (and NCCN guidelines PRN) is correct. It’s all you need. I remember multiple questions where I could think back to the exact SEP or HOQ Qbank question that helped me answer it. The exam is fair in that way - I didn’t feel there were topics on the exam that weren’t present in the questions banks (even the rarer sarcoma, gyn, and neuro endocrine questions were present *somewhere* in the question banks.

2. That being said, the one thing I kept thinking throughout the exam is that it’s not actually like either one in style. The question stems are very short or often leave out information you would expect to have. The answers are often very “impressionistic” - rather than list out a chemo regimen and options for it, they’re more like “chemo alone” or “chemo with IO.” It’s testing the same concepts, but it did throw me off a bit. The content is similar to the questions banks but style is different.

3. In the same vein of the exam being “impressionistic,” there was some memorization (do you know one of the rarer side effects of this med) but the exam was also very conceptual - that is, here’s a clinical situation, exam taker. Do you know whether you need more workup or you can start chemo or need surgery? Some of the answers for treatment options were not “classic” answers that you would immediately recognize, and that also was a bit confusing.

4. Study your weak areas. Needless to say, ignore breast and malignant heme at your peril. Prostate was everywhere. Thyroid, neuroendocrine, gyn, and sarcoma were definitely represented on my exam well. The medical oncology blueprint from the ABIM was really helpful as I put together a study plan, and the percentages allotted to each topic were very reflective of my exam.

Best of luck to people searching online for info before their exam - basically, do HOQ QBank and ASCO SEP over and over, look at NCCN guidelines as needed, and you’ll be fine.

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[FaithSaves]

I took it today as well. Definitely had a lot of prostate cancer as well. Thought sarcoma, neuroendocrine, and GYN were overrepresented. Does anyone know when we should expect scores to come out? And approximate the % correct needed for passing?

 

[Duke1K]

Just to add some thoughts for posterity:
1. Agree with the framing of questions and answers on the boards as being more "general" than the qbanks. As stated above, the boards will frequently have answers that say "chemo" or "chemo+IO" rather than listing a specific regimen. This actually makes a huge difference. I suspect this is done intentionally so that we can't use the question stem/answer choices on one question and apply/learn from it for another question.

2. Sometimes the question stems will use regimens and approaches that you don't agree with, or aren't really done anymore, or aren't how most people would practice. I often had to systematically use process of elimination - basically recognizing which ones are clearly wrong, and then selecting the "least incorrect" or "not proven inferior" answer. I found that many correct answers would not be how I would treat a patient in real life.

3. I also found myself thinking that this test intentionally is designed for oncologic practice in the community, where not everything is the most contemporary - some diagnostic steps could be missing, or a prior line of therapy could've been subpar or not current, or a particular test/procedure hadn't been done yet - and to make decisions despite that.

4. In fact, I thought the exam did not really focus on late line metastatic disease; in comparison, locoregional disease and multimodal management with surgery/radonc were highly emphasized.

5. Knowing the staging for certain cancers is pretty critical. On qbanks, I could often get by without knowing exactly how a cancer is staged (i.e., "gestalting" a cancer as stage 2/3 sufficed), but on the actual exam, they tested some of the staging minutia not infrequently.

6. As a malignant heme person, this year's exam had some pretty tricky malignant heme questions - I was thinking to myself that most solid tumor people would not get these correct. The ABIM heme board's malignant heme questions (last year) were an order of magnitude easier in comparison. In fact, there were difficult questions (solid and liquid) that I don't think anyone could've studied for - the only way you would know the answer would be to actually practice oncology in these areas.

7. They give you too much unnecessary time - I would finish with an hour left in each section, so spent the rest of that time overthinking. My friend was done with the whole test in like 3 hours.

8. I thought the exam content per the ABIM Medical Oncology Blueprint was fairly accurate. Looking at the % of the exam content that should've been represented, my impression now is:
- Overrepresented: locoregional breast and lung, adjuvant colorectal, nonmetastatic prostate, gynonc, neuroendocrine, AML/MDS, DCIS, SCLC
- Underrepresented: bladder, HCC/cholangio, metastatic GE, H&N, mesothelioma, genetics, pathophysiology, clinical research/ethics, supportive care, CAR T/BiTEs

Somewhat crazy that melanoma is only 2% (5 questions) of the exam while gynonc is 10 questions, considering how most fellowships train fellows. Gyn was definitely a weak area for me and I didn't appropriately spend time learning it.

Historically scores have been released one month from the test date. My understanding is that you will likely pass if you get >70% raw correct, but no one knows for sure.

 

[ONC2023]

I took it today as well. Definitely had a lot of prostate cancer as well. Thought sarcoma, neuroendocrine, and GYN were overrepresented. Does anyone know when we should expect scores to come out? And approximate the % correct needed for passing?

I've always heard 70-75%, but I don't really know. 40 of the 240 questions are experimental and don't count towards your score, so you could miss more than 70-75% of the entire exam and still pass.

4. In fact, I thought the exam did not really focus on late line metastatic disease; in comparison, logoregional disease and multimodal management with surgery/radonc were highly emphasized.

Great point - want to emphasize this. Relatively few questions about second and third line regimens.

Numerous questions about early stage or locally advanced.

Also, quite a few questions with no clinical vignette. Just a sentence asking a question - you either know or or you don’t, no reasoning involved.

Overrepresented: locoregional breast and lung, adjuvant colorectal, nonmetastatic prostate, gynonc, neuroendocrine, AML/MDS, DCIS, SCLC
- Underrepresented: bladder, HCC/cholangio, metastatic GE, H&N, mesothelioma, genetics, pathophysiology, clinical research/ethics, supportive care, CAR T/BiTEs

This is exactly how I remember it. I would also add non-metastatic esophageal felt overrepresented on mine.

 

[faelivrin]

So, uh, did ABIM forget to score these?

 

[deis11]

Following this thread as well - I did however notice that when attempting to register for next year, the heme boards are no longer available to me (I took heme boards earlier this year and am awaiting scores). Perhaps this is an early indication of a pass?

 

[ONC2023]

Nice catch. I just did the same - I only took med onc boards, and it doesn’t give me that as an option available to me. Hematology, which I did not take, is still available to register for.

So this may be a hint.

 

[deis11]

Could always be a scenario where those whose scores are pending are locked out of registering, but here’s to hoping lol

 

[solidonc2020]

I just got hematology score back and passed but still nothing for medical oncology, even though it was the day before. Anyone else similar?

ETA: Never mind it’s back, fortunately passed.

 

[ONC2023]

Only took med onc. Got my passing score this AM.

Looking at my score breakdown by topic, I am wondering if I know anything at all about malignant heme. The score report suggests no.

 

[faelivrin]

It hurts my heart to have done better on onc than heme.

 

[DrDresophila]

Somehow palliative/supportive care was my best topic... maybe I should have done a pall care fellowship instead?

 

[njh219]

"I've always heard 70-75%, but I don't really know. 40 of the 240 questions are experimental and don't count towards your score, so you could miss more than 70-75% of the entire exam and still pass."

Nonsense. I passed (and by a wide margin). Either I got every experimental question wrong or the true percent of passing is much lower...

 

[MD2018_DM]

Passed med onc and heme boards. Took both at the same time because I felt I would be most fresh right out of training. For reference, I'm an anxious test taker who has developed a strategy of over studying to feel confident for exams. I did above average for both but fully admit the following study plan is likely over preparation for the vast majority people out there.

Background- academic fellowship with initial plans to subspecialize in GI then switched into preparing for a general heme-onc position at graduation. Did average on ITE's for med onc 2nd year and really poorly on ITE for heme for 2nd year before studying third year and doing above average on both

Heme
- Loved the Ash Academy Review Series- watched this twice and did the rapid review question lectures x 2
- HOME | Hematology Education Online is run Dr Soff and pretty good but I ended up watching the ASH series more and utilizing these lectures from Dr. Soff in spots I felt weak on
- ASH SAP x2 (not very many questions here and didn't take too long to finish x 2)
- Hematology Oncology Did the hematology questions once through and also did the practice exam sets
- Not sure if this counts towards study for boards but I had a long commute and would listen to the fellow on call repetitively for heme topics
- And of course as I was seeing heme patients just reading the relevant how I treat articles felt helpful for board study as well

Medical Oncology
- Fellowship bought us MD Anderson board review series so I watched solid onc x 2, okay lectures but didn't really touch it later on. I thought the most benefit was getting a sense of the landmark trials to bookmark and read through
- Hematology Oncology Did the solid oncology questions and malignant heme questions once through and the practice exam sets
- ASCO SEP- book is not very good IMO and even the questions were sometimes out of date. Used the question bank sort of like flash cards and did it mixed rapid fire for review towards the end before test day
- Listened to "two onc doc's" podcast which is geared towards board review although I did feel this was very hit or miss- I think the series is getting better and it was worth the listen during my commute
- One last thing I would highlight is that one of the above poster's described that knowing the staging can be crucial for getting the question correct. I found the TNM staging manual with figures and anatomical descriptions helpful for really having a better sense of the staging and nailing this down

Overall, I felt it was kind of stressful trying to start my new job and also take both boards so I do regret not taking one earlier in third year which is now an option. But like I said above, I'm an anxious test taker and the extra year to study probably really helped me feel better going into the test. And before a bunch of people reply saying this is too much etc. this post is just to highlight my approach and maybe help someone who feels the need for extra ideas on studying. I imagine I'm not the only one out there who has anxiety surrounding tests despite all the exams we have had to take so just wanting to highlight my approach if it's helpful to anyone out there in the future. Good luck!

 

[gutonc]

And before a bunch of people reply saying this is too much etc. this post is just to highlight my approach and maybe help someone who feels the need for extra ideas on studying. I imagine I'm not the only one out there who has anxiety surrounding tests despite all the exams we have had to take so just wanting to highlight my approach if it's helpful to anyone out there in the future. Good luck!

Actually, what I think your post highlights is that everyone's study style and test taking experience is different. By this time in your career, you've taken (and passed) so many of these high stakes exams (MCAT, Shelf exams, Steps, ITEs, IM boards) that you know what works for you.

Everyone should do exactly what you did. I don't mean use 73 different study resources for the exam. What I mean is, know yourself, know how you learn, know how you test and tailor your prep strategy accordingly. For some people that's half a dozen different lecture/review/QBank sources and for others it's a mad dash through half a Q Bank the week before the test. For most it's going to be somewhere in the middle. None of those are right or wrong, they're just appropriate for the individual.

 

[osprey099]

I would also add that generally speaking, your overall investment in effort/time spent studying will directly translate in performance. It doesn't really matter THAT much the timing of this effort/studying.

I spent my 2nd and 3rd year of fellowship studying my behind off for the ITEs, ended up scoring 90th percentile on both ITEs for both years. Then after graduation, I joined a very busy private practice where I was seeing 20/day and doing a lot of admin/business work on top of that, so not time to study. I basically did not study between graduation and test day besides cramming/reading my notes the 2 days before the tests. Ended up scoring 75th percentile on med onc and 30th percentile on hematology. Still passed both.

 

[GFP]

Just adding this for future folks:

Also passed oncology boards (comfortably above average). For reference, I did average on the ITEs during 1st and 2nd year of fellowship. My ITE in the 3rd year was above average which I attribute to my year-long continuity clinic rotation where I pretty much saw the more common tumors (lung, GI, GU, & breast), which provided good repetition in high-yield topics. That said, I do not believe one needs to have done a specific clinic experience in a particular tumor type to improve the score in that sub-section.

I studied both ASCO SEP (completed all questions) and HOQ (did most questions except the lower yield sections such as genetics and pharm). If I had to pick only 1 resource, it would be HOQ question bank. ASCO SEP questions were too simple, and the answer explanations didn't go into enough detail (I learn the best by reading the explanations, similar to UWorld during Step and IM boards). HOQ had in-depth explanations, although it felt like they frequently copied/pasted clinical trial abstracts into some of the text which makes it hard/long to read; I learned to skip these abstract sections and go straight to the adverse events since they'll sometimes highlight key toxicities and blackbox warnings.

Statistically, most people will likely pass - after all, we made it through the MCAT, USMLE, and ABIM so as Gutonc said above: use a study method that has reliably worked for you.

 

[DrDresophila]

Just adding this for future folks:

Also passed oncology boards (comfortably above average). For reference, I did average on the ITEs during 1st and 2nd year of fellowship. My ITE in the 3rd year was above average which I attribute to my year-long continuity clinic rotation where I pretty much saw the more common tumors (lung, GI, GU, & breast), which provided good repetition in high-yield topics. That said, I do not believe one needs to have done a specific clinic experience in a particular tumor type to improve the score in that sub-section.

I studied both ASCO SEP (completed all questions) and HOQ (did most questions except the lower yield sections such as genetics and pharm). If I had to pick only 1 resource, it would be HOQ question bank. ASCO SEP questions were too simple, and the answer explanations didn't go into enough detail (I learn the best by reading the explanations, similar to UWorld during Step and IM boards). HOQ had in-depth explanations, although it felt like they frequently copied/pasted clinical trial abstracts into some of the text which makes it hard/long to read; I learned to skip these abstract sections and go straight to the adverse events since they'll sometimes highlight key toxicities and blackbox warnings.

Statistically, most people will likely pass - after all, we made it through the MCAT, USMLE, and ABIM so as Gutonc said above: use a study method that has reliably worked for you.

+1 to all of the above. ASCO SEP and HOQ were my to-go resources, and the HOQ bank in particular had questions that felt matched the ambiguity of some of the actual boards Qs. Agree that the explanations in HOQ were hit-or-miss though - some were fantastic but others were extremely long-winded. There was frequently a summary of the important points either in the middle or near the bottom of those explanations.

 

[Duke1K]

To each their own, but I've always found these board studying recommendations overkill. Clearly we should study however we are used to studying/what has worked in the past, but as a counterexample, I'm not a solid onc guy and haven't done solids for 3 years, but did the MDA course and 3/4ths of ASCO SEP a week before the exam, and passed comfortably. I just don't want people to freak out if they haven't finished all the qbanks or studied for months - I was very close to canceling my exam due to past forum comments, but decided to go with it, and it went fine.