My Experience/Retaking Oral Boards Advice.

[AnesThrowaway]

I know this topic has been posted about quite a bit in the past but I'd like to share my experience and get some advice.

I took the oral boards last year and unfortunately ended up failing my first exam ever. I began studying around 4 months out and my main study schedule focused mostly on UBP and repeatedly practicing its' stems out loud with colleagues while supplementing my knowledge base in areas I felt weak using Yao & Artusio and Big Red. I also would listen to anesthesia-related podcasts/audio files while driving, at the gym, etc. I was basically living and breathing anesthesia for that entire study period. By the end of it, I had gotten through all of UBP three times and felt prepared to be able to tackle its' stems. In addition to this, I did a few practice exams with real oral board examiners at my institution. Generally, the advice I got from them was that my knowledge base was strong but that I was being ultra-conservative (which I guess I was modeling after UBP) in my answers and that I should try to answer questions how I would actually do the case in real life rather than essentially reciting the textbook approach. I'm now unsure whether or not this was good advice.

Without giving away any specifics, on test day itself, my preop/intraop stem was like something out of a dream. It was a topic that I knew cold. A case I had personally done dozens of times and one that I happened to have recently reviewed. I literally could feel the stress melt away when I read it and couldn't believe my luck. My balloon was deflated, however, when the patient ended up having a "kill-sequence" type complication during induction which I treated accordingly (and would still treat the same way today in real life) but my examiner kept perseverating on a specific portion of the treatment and not moving on despite the fact that I had answered the question. I thought that maybe they wanted a better explanation so I restated my answer again and explained exactly why I am choosing the route that I did. And then...the examiner re-asked the same question again. I even quickly jotted down the question word for word on my scrap paper to make sure I wasn't having a brain fart and misunderstanding. At this point, I was confused and unsure whether or not they were trying to "help me" go down a different route or just testing to see how I function under pressure. I went with the latter and re-stated my answer again and tried to use other facts to support it. While I can't restate the specific scenario, it was such a bread-and-butter classic complication that I still really don't see what else I could have said. Finally, we moved on but it almost felt like that kind of set the tone for the rest of the stem despite not really having any more situations like that.

My intraop/postop stem was a more complex patient but nothing insurmountable that I wasn't prepared for. However, the case itself was non-urgent/emergent and the patient was glaringly not optimized for surgery based on the stem. I recalled reading in Jensen something along the lines of "Many test-takers have failed for allowing their patient to go intraop at the persuasion of the examiners" and to make sure to bring up your concern even if the examiner doesn't lead that way. So before starting off with induction, I mentioned that this patient could probably be much better optimized before proceeding with this non-emergent case and then defended why I felt that way. The examiners did not seem pleased (though, that may be my read of the situation) that I was veering off course. Doing this was probably a mistake in retrospect but that line from Jensen had really stuck with me and I didn't want to fail for not mentioning something that seemed wrong to me. I guess it ended up biting me.

Leaving the exam I felt that it could have gone either way. While I was extremely concerned about the above-mentioned things, much of the rest felt like it went well and I only had to say "I'm not sure" a couple of times. Devastatingly, I ended up failing.

Anyway, that leaves me where I am now having to retake this exam again soon and I really don't know what else to do. I've already gone the UBP/constant practice out loud route last time and don't feel comfortable doing the exact same thing again. I feel like I need more help 'playing the game' rather than more knowledge. I would like to take a course but I am unable to decide which one is best. One that I was heavily considering seems to be heavily shilled (on these forums, especially) with its' greatest proponents clearly getting kickbacks or being involved with the course based on their post history and ingenuity of responses. Anyone that's not a spambot have any good recommendations?

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[Mr.S]

Don't fret please!!!
There is only one thing to do.
Seriously!!
The Essential Board Review. Michael HO.
Period.
You have to put in the work though.
I assure you that I have NOTHING TO DO withany advertisement for Michael HO.
the only thing I ask that you help the next guy when he/she needs help and not be a a*****e.

 

[deleted171991]

I know this topic has been posted about quite a bit in the past but I'd like to share my experience and get some advice.

I took the oral boards last year and unfortunately ended up failing my first exam ever. I began studying around 4 months out and my main study schedule focused mostly on UBP and repeatedly practicing its' stems out loud with colleagues while supplementing my knowledge base in areas I felt weak using Yao & Artusio and Big Red. I also would listen to anesthesia-related podcasts/audio files while driving, at the gym, etc. I was basically living and breathing anesthesia for that entire study period. By the end of it, I had gotten through all of UBP three times and felt prepared to be able to tackle its' stems. In addition to this, I did a few practice exams with real oral board examiners at my institution. Generally, the advice I got from them was that my knowledge base was strong but that I was being ultra-conservative (which I guess I was modeling after UBP) in my answers and that I should try to answer questions how I would actually do the case in real life rather than essentially reciting the textbook approach. I'm now unsure whether or not this was good advice.

Without giving away any specifics, on test day itself, my preop/intraop stem was like something out of a dream. It was a topic that I knew cold. A case I had personally done dozens of times and one that I happened to have recently reviewed. I literally could feel the stress melt away when I read it and couldn't believe my luck. My balloon was deflated, however, when the patient ended up having a "kill-sequence" type complication during induction which I treated accordingly (and would still treat the same way today in real life) but my examiner kept perseverating on a specific portion of the treatment and not moving on despite the fact that I had answered the question. I thought that maybe they wanted a better explanation so I restated my answer again and explained exactly why I am choosing the route that I did. And then...the examiner re-asked the same question again. I even quickly jotted down the question word for word on my scrap paper to make sure I wasn't having a brain fart and misunderstanding. At this point, I was confused and unsure whether or not they were trying to "help me" go down a different route or just testing to see how I function under pressure. I went with the latter and re-stated my answer again and tried to use other facts to support it. While I can't restate the specific scenario, it was such a bread-and-butter classic complication that I still really don't see what else I could have said. Finally, we moved on but it almost felt like that kind of set the tone for the rest of the stem despite not really having any more situations like that.

My intraop/postop stem was a more complex patient but nothing insurmountable that I wasn't prepared for. However, the case itself was non-urgent/emergent and the patient was glaringly not optimized for surgery based on the stem. I recalled reading in Jensen something along the lines of "Many test-takers have failed for allowing their patient to go intraop at the persuasion of the examiners" and to make sure to bring up your concern even if the examiner doesn't lead that way. So before starting off with induction, I mentioned that this patient could probably be much better optimized before proceeding with this non-emergent case and then defended why I felt that way. The examiners did not seem pleased (though, that may be my read of the situation) that I was veering off course. Doing this was probably a mistake in retrospect but that line from Jensen had really stuck with me and I didn't want to fail for not mentioning something that seemed wrong to me. I guess it ended up biting me.

Leaving the exam I felt that it could have gone either way. While I was extremely concerned about the above-mentioned things, much of the rest felt like it went well and I only had to say "I'm not sure" a couple of times. Devastatingly, I ended up failing.

Anyway, that leaves me where I am now having to retake this exam again soon and I really don't know what else to do. I've already gone the UBP/constant practice out loud route last time and don't feel comfortable doing the exact same thing again. I feel like I need more help 'playing the game' rather than more knowledge. I would like to take a course but I am unable to decide which one is best. One that I was heavily considering seems to be heavily shilled (on these forums, especially) with its' greatest proponents clearly getting kickbacks or being involved with the course based on their post history and ingenuity of responses. Anyone that's not a spambot have any good recommendations?

You've had enough courses. Convince 3-4 smart anesthesiologist friends (the kind who passed on the first try and do difficult cases, that could be orals, every week) to do mock exams with you, each of them once every 2 weeks or so, so that you do 2 mock orals/week. Listen to the feedback, make the corrections, repeat. You need to refine your technique.

I would also read up some more, and not let people fool you about your knowledge base (unless you're the kind who scores in the 80th-90th percentiles on written exams). There is no way in hell that examiner would have insisted if you were not missing something BIG and obvious. That's why you failed. They didn't feel you were safe out there. They tried giving you a 2nd and 3rd chance, and you probably hung yourself with the rope again and again.

P.S. I didn't pay for the Ho courses, but I studied and did mock orals from borrowed 5+ year-old Ho books. That, and Atchabahian's The Anesthesia Guide.

 

[mikey014]

You've had enough courses. Convince 3-4 smart anesthesiologist friends (the kind who passed on the first try and do difficult cases, that could be orals, every week) to do mock exams with you, each of them once every 2 weeks or so, so that you do 2 mock orals/week. Listen to the feedback, make the corrections, repeat. You need to refine your technique.

I would also read up some more, and not let people fool you about your knowledge base (unless you're the kind who scores in the 80th-90th percentiles on written exams). There is no way in hell that examiner would have insisted if you were not missing something BIG and obvious. That's why you failed. They didn't feel you were safe out there. They tried giving you a 2nd and 3rd chance, and you probably hung yourself with the rope again and again.

P.S. I didn't pay for the Ho courses, but I studied and did mock orals from borrowed 5+ year-old Ho books. That, and Atchabahian's The Anesthesia Guide.

I agree with FFP. I spent so much money on prep stuff. Like thousands. But what really helped me is practicing with examiners and classmates. I would not look into using more study material or paying for a course. I think it would just add a level of anxiety. I agree there is something you must have been overlooking when they kept prompting. Because both the junior and senior examiner must have seen the glaring error. Especially after they had a day full of examining people with the same stem.

I'd be happy to do practice stems with you if you want a fresh perspective. But to be honest, I would just keep practicing . And practice with co residents who are really picky. I felt like the feedback from those residents were the most helpful.

 

[AnesThrowaway]

You've had enough courses. Convince 3-4 smart anesthesiologist friends (the kind who passed on the first try and do difficult cases, that could be orals, every week) to do mock exams with you, each of them once every 2 weeks or so, so that you do 2 mock orals/week. Listen to the feedback, make the corrections, repeat. You need to refine your technique.

I would also read up some more, and not let people fool you about your knowledge base (unless you're the kind who scores in the 80th-90th percentiles on written exams). There is no way in hell that examiner would have insisted if you were not missing something BIG and obvious. That's why you failed. They didn't feel you were safe out there. They tried giving you a 2nd and 3rd chance, and you probably hung yourself with the rope again and again.

P.S. I didn't pay for the Ho courses, but I studied and did mock orals from borrowed 5+ year-old Ho books. That, and Atchabahian's The Anesthesia Guide.

Thank you for your response. I agree with everything you said in the second paragraph and that is to the tee what I thought too. It would make me feel better if I knew that it was the truth as I can live with failing because of a dumb mistake. I wish I could restate the exact scenario here but I obviously cannot due to the terms of the exam. I've spent a lot of time going over that exact same scenario in my head; reading about it again in multiple different sources and I cannot find anything I could have said differently. It was SO bread-and-butter that you could probably pull any CA1 to the side and they would be able to tell you how to manage it.

And thanks for the advice and the book recommendations; will definitely look into it. I am continuing to practice mock orals on a regular basis and obviously refreshing my knowledge. When I said I'm fine on knowledge, I just meant that I didn't need a recommendation for a course that was knowledge-focused as at this point I'm thinking what got me in the end was the way I phrased things? I truly don't know.

 

[deleted684261]

So one thing to realize is that UBP stuff are good for framing your way of thinking but you can't always answer like the book's answer. If the oral board examiner ask you, HR 20 what would you do? Don't go off wasting their time by saying first I would put ASA monitors , blah blah blah. Get to the the point and answer the question and move on. Your point about crossing the red line into OR. I get it but you can say patient not optimized once and whether you like it or not, the case is moving forward. My oral board examiner reply to me was "ok one of your college started the case but now you have to give a break" ... the case will move forward, just go with the flow.

 

[AdmiralChz]

You've had enough courses. Convince 3-4 smart anesthesiologist friends (the kind who passed on the first try and do difficult cases, that could be orals, every week) to do mock exams with you, each of them once every 2 weeks or so, so that you do 2 mock orals/week. Listen to the feedback, make the corrections, repeat. You need to refine your technique.

This is the best advice for you. Have your friends throw some usual and unusual curve balls at you.

If you aren’t comfortable doing that or only work amongst old, crotchety colleagues (or are the mega shy type) you could consider Just Oral Boards where you practice with people via Skype. I did 3 or 4 exams with them and found it helpful as I didn’t have a bunch of people around to help. Some of my friends used it and didn’t have great things to say.

Bottom line is practice, practice, practice. Don’t let a failure deter you, many excellent physicians get tripped up on the orals!!

 

[Mr.S]

This requires a PROFESSIONAL.

Do 20 must know cases over and over and over.

All thesame issues will keep coming up.

it should be reflexive at this point.
dont rely on friends.
Pay a professional

 

[Robotic Wis-Hipple]

I’d bet they sniffed out that you were too rigid and conservative because you had basically memorized UBP and then you got put between a rock and a hard place and you didn’t seem able to roll with the punches.

UBP is overkill, awake a-lines, PACs, TEE, awake intubation for MP2 BMI>30 etc.

There absolutely are things you should have memorized and be able to recite instantly (though reordered based on scenario and likelihood), things like hypotension, hypoventilation, delayed emergence differentials etc. Otherwise you need to be able to argue both sides of your terrible scenario and pick one based on some rationale you are willing to defend while also proving to them that you know the considerations of the other side too.

To me, sounds like you probably had the knowledge, just not as much experience being pressed into decisions. So I echo the others, do more actual oral board practice sessions.

 

[UrbanAchievers]

I echo what everyone else has said already. There is a point where you can do too much course or UBP where you are just regurgitating their answers and not formulating your own plan. The best possible thing you can do is mock oral exams. Ideally, these mock exams would be with real oral board examiners who were at your residency or your currentl job.

Nothing will prep you like these mock exams. They will guide you in how to answer the questions and keep the conversation going. The examiners want this to be a conversation. This makes it easy for them and more enjoyable. I theorize this probably also reflects in a higher score. If they have to drag answers out of you, this will leave a sour taste in their mouth.

Oral boards are a game of saying what the examiner wants to hear. You know where most of the stems are going. You know the complications and curveballs that are going to exist. The more you practice the more you will speak the language they want to hear.

You know the OB stem is going to be a difficult airway with thrombocytopenia and a full stomach. You know the guy one on one lung is going to get hypoxia and you have to go down the OLV algorithm.

Be flexible in the exam. Prepare. Trust your training.

 

[lizzers729]

I took my oral boards last year - used UBP and practiced with many of my colleagues leading up to the test but also did the Ho course. Like you mentioned, people here seem to be pretty anti prep courses, so I figured I'd chime in. On the recommendation of a friend who had previously failed and then subsequently passed, I took the 4 day Ho course in the days leading up to my test. I would highly recommend it. It was a great review but also taught me a lot of test taking strategies that proved to be extremely helpful during the test. I was super nervous about oral boards prior to the Ho course; it definitely gave me a confidence boost that I needed. That said, I didn't find his book at all helpful, and I think many of the extra things you can buy on his website are fluff and are unnecessary. I have no regrets with having spent the money for the course though; the biggest thing you'll get from it is strategy and timing.

 

[vector2]

I’m not really an advocate of review courses if you have ubp, old asa stems, and ppl to practice with, but fwiw, I had two colleagues fresh out of residency who read ubp and went to one of the Ho courses- both said they passed easily.

 

[ranvier]

If you are anxious, performing repeatedly in front of a group at any of the courses can help desensitize those emotions....a flooding technique if you will.

It is a talking test so as stated, practice practice practice doing mock orals. It doesn't sound like a gap in knowledge but delivery and perceived confidence.

Good luck to all as it is high stakes and anyone can have a bad day.

 

[DM27]

UBP is a good knowledge source, but do not use it to frame your responses. The UBP responses are much too wordy and often verge from conservative to comical. Also, as a lesser side note, some examiners are aware of the various resources out there and some may have some biases when it comes to receiving responses they view as the canned ultra-conservative UBP responses.

Another note that may help is to understand the goals of the exam. Your goal is to pass and make it to the end, the examiners goal is to get you through the whole exam in the allotted time and give you a "fair" exam. They are evaluated on their ability to do that. If you are very early on in your stem and you feel like there is a lot of perseverating or an unusual amount of time being spent on a part of a particular question there is a good chance it is because they do not feel it has been answered satisfactorily enough for them to be able to move on to the next part. A lot of what older attendings will tell you about the examiners trying to trick you or behaving maliciously is an antiquated notion, as today the exam is much more standardized and examiners are constantly being evaluated regarding their fairness. They will try to probe your knowledge or expand more on your responses, if time allows it, but they will not jerk you around just for the hell of it if it risks you not completing your stem.

 

[pie944]

I posted this after I took my oral boards in the Spring of 2013. Hope it helps. Read it over and I still believe what I wrote to be applicable. I can't speak to courses, I think that's a personal preference. I don't do well in that setting, so I didn't do one.

A few additions:

1) The Word file was great, 5-10 minutes before bed my wife would fire off a couple of situations to hear my response. She just compared it to what I had written down. "Hypoxemia in the PACU" etc etc. It burnt all those common situations in my head.

2) My friend, priceless. My wife said he and I had a more intimate relationship than she and I did for this period.

3) Real examiners, if you can find them it is worth it. You will be scared by them, so when the time comes for the real thing the fear isn't as pronounced. I had some where I was at fellowship, I also went back to my residency for a couple days to practice with attendings at that institution, shared a hotel with the friend above.


Old Post

I read past threads with interest in determining how to prepare for oral boards, so now that the Spring exam is over I thought people could provide their own strategy. I know the advice from year to year is consistent for the most part, but I figure the benefit of a thread like this outweighs the annoyance of any repetition.

Practice is important, but knowledge is the foundation. I started off not knowing the answers to 50% of the questions and the other answers unable to express verbally despite the knowledge. Once I had improved knowledge on some significantly weak areas(Pediatrics/Pain) the ability to answer the questions was improved. So I disagree with people who say it isn't a 'knowledge test' because I think some people preparing for oral boards might interpret this in the wrong way.

Despite the lack of knowledge starting to practice early is important. It is difficult looking stupid in front of people when doing mock exams, similar to having a friend proofread a english paper(personal fear). However, better friends critique and point out flaws than the examiners. You can spend weeks reading, delaying practice exams, and the first time you speak it will still sound awkward, so don't delay starting mock exams. For me, the inability to answer questions early on helped burn the information in my head.


Books:

Ho - The question/answer format is something I enjoy. The chapters have a lot of repetition in terms of the information which helped it burn into my brain. I utilized an old one purchased from a friend that was more than adequate.

Yao - A book I wish I had spent more time reviewing in residency. The book is dense, and I had to read many chapters multiple times to start retaining, but the case based scenario and question answer format was fantastic for me. If you read the information and can't answer the question, it isn't stuck in the noggin yet, read it again. I'd often read a section from Ho and reinforce the information with Yao. The link is for the latest edition, I used the prior(red book).

Board Stiff III - Some of the book is silly and the DVD is awkward to watch. The book is simple, but that is the beauty of the book since a lot of the exam consists of simple concepts. Going thru the book helped me recognize a deficiency in knowledge/ability to verbalize answers to fundamental concepts.

Word File - Similar to pgg I created a word file that had responses to common issues(BP, Oxygenation, Renal Failure, Transfusion, Swan, TEE, etc). I would add to it day after day and I'd try to review it multiple times per week before going to bed.

Reference Textbooks - Utilized for subjects that I had significant deficiency in and the above references were inadequate.

ASA Practice Guidelines - Easy to skim, high yield. Fasting guidelines, swan placement, ION, nerve injury,etc
ACLS/PALS
ASRA

Exams:

Old ABA Exams - Priceless.
Ho Exams - Not the value of the ABA exams, but force you to discuss some fundamental issues.

Practice

Friend - My friend from residency and I started doing mock exams over FaceTime/Skype starting in mid January. We probably averaged around four times a week(8 exams between the two of us), sometimes more and sometimes less. It would take around 80-90 minutes to do a session(2 exams and input). If knowledge was inadequate for us on a issue, one of us would read on the subject and create a short word file summarizing the information. By April we had a giant collection of word files summarizing a variety of issues.

ABA Examiners - I did 7 examinations with current ABA examiners at my current and former training programs. It is as close to the real thing you can get to the actual day. I think everyone is nervous during the exam, but by doing these practice exams it helped minimize that anxiety. Their input and suggestions had a significant impact on the way I handled the actual exam.

Hope this helps.

 

[neutro]

I had to re take my oral exam, I used all three - job, ubp, and dr ho. I went ape **** for 6 months trying to pass this exam. I attended dr ho live courses also.
Ubp is too dense but good for comprehensive information. You have to realize that most of their cases are 15-30 pages. There is no way you can verbalize these on the exam. I would skim this.

Between dr ho and job - dr ho wins hands down. He’s true teacher and by your side the whole time. His faculty is carefully picked and evaluation is good. The daily Textoid helped me a lot. Some job examiners and excellent but others are horrible to a point that they turn off the screen and are texting on the phone while doing your exam. They make it quick and are just not interested.

It does come down to knowledge mostly. Because as you may have experienced, much of the exam is about detail, nitty gritty and decision making. How ever the underlying theme is knowledge. For example, If you don’t know about the significance of ICP management for instance and how to estimate ICP clinically pre op, you’ll struggle on intra op mgt and extubation. That’s just an example.

Dr ho’s approach therefore is superior because it inherently trains you to be a better candidate as well as improve your practice.

As for bias - I’ve been on sdn for many years, and I don’t have any reason to advertise for anyone or detract people from other prep companies. This is my personal experience.

 

[Mman]

My board prep was reading Miller. Know that stuff cold and then just do the cases as you would do in real life. Every case you do is board prep. Every discussion with a colleague or a surgeon is a board stem. When you walk in for boards, it's literally the same as sitting down in the preop area and working out a case with a colleague.

 

[psychbender]

The better attendings in residency approached all phone calls to discuss the next day's patients as oral board practice. Every Friday in residency, we had formal oral board practice in from of the rest of the department. Whenever one is discussing a patient with a surgeon or consultant, being able to approach it as an oral board scenario better crafts thought processes, and give a more professional appearance to the discussion and one's concerns. This approach made the actual exam more straightforward, and only nerve-wracking because it was a subjective, all or nothing assessment of my abilities.

I liked UBP, not because of the responses (as everyone else says, way too conservative), but because it confirmed my approach to a stem. I was taught to respond, "I'm concerned about X, so I'm going to do Y, realizing that it may cause Z, which I am prepared to deal with by doing A."

Sent from my SM-G930V using SDN mobile

 

[pain2b]

I took the exam a few years ago and did Ho and Just oral boards. The Ho people I did mocks with weren't very good. One of the examiners gave me a mock while waiting for her dinner table at a restaurant. (i could hear the chatter in the back the entire time). I thought the just oral boards mock exams were more rigorous and thorough. i know everyone has a different experience but I would tip my hat to just oral boards.

 

[neutro]

My board prep was reading Miller. Know that stuff cold and then just do the cases as you would do in real life. Every case you do is board prep. Every discussion with a colleague or a surgeon is a board stem. When you walk in for boards, it's literally the same as sitting down in the preop area and working out a case with a colleague.

with all due respect, that is not good advice for this exam for most people.

 

[Mman]

with all due respect, that is not good advice for this exam for most people.

it actually is, it's just that they don't realize it.

 

[neutro]

it actually is, it's just that they don't realize it.

No, they do realize it and that is why big textbooks are not a good way to study for this exam. textbooks are read during residency and referenced during clinical practice.
This exam doesn’t just test book knowledge. It tests stamina, specific skills needed for this particular exam and tone, speech, communication and specific high yield topics that are hard to know when one is reading Miller verbatim.

 

[AdmiralChz]

No, they do realize it and that is why big textbooks are not a good way to study for this exam. textbooks are read during residency and referenced during clinical practice.
This exam doesn’t just test book knowledge. It tests stamina, specific skills needed for this particular exam and tone, speech, communication and specific high yield topics that are hard to know when one is reading Miller verbatim.

You won't have time or the opportunity to answer with a "Miller" or "UBP" style response. That is, a 3 paragraph diatribe on denitrogenation in a right-to-left shunter. Textbooks are best read at the start or during training (if you can do it) or as a reference. Not really all that useful as a primary source for exam preparation, in my opinion.

 

[Mman]

No, they do realize it and that is why big textbooks are not a good way to study for this exam. textbooks are read during residency and referenced during clinical practice.
This exam doesn’t just test book knowledge. It tests stamina, specific skills needed for this particular exam and tone, speech, communication and specific high yield topics that are hard to know when one is reading Miller verbatim.

No, my point is your prep for the exam itself is just doing cases as a resident or attending. You talk through answers all the time with colleagues and surgeons, you just don't realize that they are test questions when they are happening. Unless someone is truly terrible at talking their way through problems or cases, they don't need the other prep. Know the science (from Miller) inside out and then just go and do it. The next time some surgeon is giving you grief for insisting on waiting for NPO time or why someone should really see a cardiologist preop, that's an oral exam stem that you are talking through. The next time someone wants to know what labs or studies you want, that's an oral exam. The next time someone asks what your plan for analgesia is, that's an oral exam.

There are very few residents that actually need to learn how to speak clearly and answer a question in a succinct manner.

 

[neutro]

You won't have time or the opportunity to answer with a "Miller" or "UBP" style response. That is, a 3 paragraph diatribe on denitrogenation in a right-to-left shunter. Textbooks are best read at the start or during training (if you can do it) or as a reference. Not really all that useful as a primary source for exam preparation, in my opinion.

i think you meant to quote Mman there not me.

 

[neutro]

No, my point is your prep for the exam itself is just doing cases as a resident or attending. You talk through answers all the time with colleagues and surgeons, you just don't realize that they are test questions when they are happening. Unless someone is truly terrible at talking their way through problems or cases, they don't need the other prep. Know the science (from Miller) inside out and then just go and do it. The next time some surgeon is giving you grief for insisting on waiting for NPO time or why someone should really see a cardiologist preop, that's an oral exam stem that you are talking through. The next time someone wants to know what labs or studies you want, that's an oral exam. The next time someone asks what your plan for analgesia is, that's an oral exam.

There are very few residents that actually need to learn how to speak clearly and answer a question in a succinct manner.

So you are telling me you discuss each anesthetic with your surgeon pre op and colleague and reflect on that? Maybe that is possibe in an academic setting. Because as you know, real life is very different than preparing for oral boards...maybe you see a lot of pediatric hearts, pheochromocytomas, MH and delayed arousal from hypothyroidism than i do. you know, the common things they can ask on the oral boards...
if that is the case, then power to you - but I am just trying to get through the day and do things as efficiently as possible.

 

[Mman]

So you are telling me you discuss each anesthetic with your surgeon pre op and colleague and reflect on that? Maybe that is possibe in an academic setting. Because as you know, real life is very different than preparing for oral boards...maybe you see a lot of pediatric hearts, pheochromocytomas, MH and delayed arousal from hypothyroidism than i do. you know, the common things they can ask on the oral boards...
if that is the case, then power to you - but I am just trying to get through the day and do things as efficiently as possible.

no, I work in private practice. I'm not saying for 100% of cases you have a long winded discussion. I'm saying throughout the day and week you end up having those sort of discussions. And not complete ones, but bits here and there. That's why you just need to know the science from Miller cold so when somebody gives you the oddball you know the answer. But talking your way through the different things they will ask about is something you should be able to do fairly easily.

 

[Pepperblock]

I agree with FFP. I spent so much money on prep stuff. Like thousands. But what really helped me is practicing with examiners and classmates. I would not look into using more study material or paying for a course. I think it would just add a level of anxiety. I agree there is something you must have been overlooking when they kept prompting. Because both the junior and senior examiner must have seen the glaring error. Especially after they had a day full of examining people with the same stem.

I'd be happy to do practice stems with you if you want a fresh perspective. But to be honest, I would just keep practicing . And practice with co residents who are really picky. I felt like the feedback from those residents were the most helpful.

Agreed, practice and look for questions, basically have an explanation for all of them. That helps me a lot. Tho I did well in my ITE and boards the problem with this exam is the pressure, time and sometime hesitancies of the examiners. Just keep working on your wording and safety. they are looking for you to be a knowledgeable and safe person.

I have to repeat the OSCE part this year. And sincerely I am clueless on how to get ready for this part. I did very well in the diagnostic and US part but apparently I don't known how to deal with surgeons or how to take a consent....

Any thoughts/suggestions guys?

 

[TheLoneWolf]

What's an appropriate amount of study time for the oral board for those have been out of the operating room for some time, the fellows in pain and ICU?

 

[Mr.S]

What's an appropriate amount of study time for the oral board for those have been out of the operating room for some time, the fellows in pain and ICU?

Listen, it is not that hard to study for it.

Think of ANY scenario you can and talk your treatment and explanation of it.
Hypotension in the OR (suddenly, how about refractory hypotension?
Sweating in the OR? Causes? what would you do?
Total hip, anticoagulated, class4 airway. trach scar on his neck. what would you do?
etc etc
any scenario you can possibly think of you need to be able to have a well canned answer for. IF you dont, dont go to the exam because they WILL expose this.

 

[MirrorTodd]

Agreed, practice and look for questions, basically have an explanation for all of them. That helps me a lot. Tho I did well in my ITE and boards the problem with this exam is the pressure, time and sometime hesitancies of the examiners. Just keep working on your wording and safety. they are looking for you to be a knowledgeable and safe person.

I have to repeat the OSCE part this year. And sincerely I am clueless on how to get ready for this part. I did very well in the diagnostic and US part but apparently I don't known how to deal with surgeons or how to take a consent....

Any thoughts/suggestions guys?

That sort of crap makes me want to bash my head against the wall. How in the hell these jerkwads get off on telling people that a single test encounter means that they can't practice medicine is beyond me! It's the same **** for med school osce's. Huge waste of time and money!!!

 

[Psai]

It's crazy how board certification went from something special to a money making business by suits who justify it by saying that "if we don't self regulate someone else will do it for us". Oh btw we are grandfathered in so we don't have waste time doing the same bull**** we want all the young guns to go through. By the way that will be several thousand dollars and you have to do it every ten years because I say so.

 

[Mr.S]

It's crazy how board certification went from something special to a money making business by suits who justify it by saying that "if we don't self regulate someone else will do it for us". Oh btw we are grandfathered in so we don't have waste time doing the same bull**** we want all the young guns to go through. By the way that will be several thousand dollars and you have to do it every ten years because I say so.

Click here to support Practicing Physicians of America organized by Westby G. Fisher

Would you please donate to the lawsuit fund so we can fight back.

 

[Mr.S]

It's crazy how board certification went from something special to a money making business

It was NEVER special. I ALWAYS thought it was BULLS***. It was always weird to me that after finishing residency successfully you had to demystify the oral board process ON YOUR OWN and prove your knowledge to people who are NOT familiar with your training. It just seemed fishy to me. I went along with it and passed successfully but i had my reservations about it's legitimacy. They keep claiming this is VOLUNTARY but everyone knows that you are essentially unemployable if you are not board certified. They could have left it alone and I would not have known the difference and chalked it up to "right of passage". BUt they didnt. They showed their hand. They could not hold back the greed. MOCA, recertification, Peds boards, echo boards, Critical care boards, basic exam OSce, etc etc.. They will continue to bend you (us) over until we stand up for ourselves. And we have to do it together en masse. Donate money, write letters to your congressman, DO NOT JOIN THE ASA, DO NOT GIVE MONEY TO PAC until they start listening to their constituents. (US).

 

[MiddleOfNowherrr]

Been looking to share my two cents on the Oral boards so here we go (long post warning):

Originally took the oral boards the summer after finishing my pain fellowship (2016). I studied off and on with a cofellow who took them 4 months prior to me, with some old UBP cases we both had access to, just to keep *some* anesthesia on my brain (did NO anesthesia that year). I did 1 mock oral with a guy at my fellowship program—went ok. The other staff that i tried to schedule mocks with blew me off so i moved on and didnt bother with any more. After fellowship I decided to kick it into high gear for my september oral exam so I went through a set of UBP books, and did mock orals with former co-residents (and by “did mock orals” I mean I half a$$ did them while downing a glass or two of wine so i wasnt as invested as i should have been). Read that book Board Stiff 2 (worthless IMO), and started going through some anesthesia oral board flashcards (also worthless, stopped midway thru these). Also listened to Jensens mock oral CDs in the car. Let me add to this by saying I was a little cocky bc I scored the highest ITE in my residency class one year and consistently received recognition for scoring high on the ITE other years, and did well on the written board. In short, erroneousy used those successes as surrogates for how I would come out on the orals...

Welp, I got a failing score (meanwhile all the ppl I studied with Passed!). Looking back, I didnt necessarily feel I had done that bad; of course, there were things I remembered afterwards that I screwed up but no serious “killing mistakes” as far as I knew. (Who knows though—got so wasted at the airport afterwards that Im sure I drank away much of my memory surrounding that joyous experience). Had one “Jacka$$-y” examiner but the rest were fairly benign. Only one truly off the wall question and got thru both scenarios and all three grab bags (only partial grab bag #3 in the second room). I really think my articulation skills were not as finely tuned as they should have been, and I did not get my point across in a clear, efficient manner—probably bc i was too lax during my preparation and practice. I tell myself i was feeling charitable that fall, in the sense that I got the pleasurable opportunity to pay another $2K to the ABA who was clearly in need of my financial support to pay rent at their new penthouse suite in one of Raleigh’s nicest, newest areas. Either way if u fail u should sign up STAT for the next year’s exam bc spots fill up quick—I think I signed right back up as soon as i got my score and im pretty sure I snagged one of the last spots available for the following year.

Started my new pain job by telling my boss I was NOT yet board certified, what a way to make a good start. That January I started making a plan of how I wanted to really attack my boards the second time around (it wasnt until this time that my hurt pride healed enough that I felt I could return to “the grind”). I teamed up with a former coresident that had also failed orals and we decided to go to a live Ho oral board course together. I also bought a fresh new set of UBP books and this coresident and I took turns giving each other the mock exams from UBP and giving feedback/going over the explanations (most weekends from march thru august). Read thru most of the Ho Manual (about the size of a telephone book—coulda done w/o it). Also paid for 16 or so skype mock orals thru Ho’s course. So im pretty sure I paid for a semester of college for one of his kids but I passed the orals the second go around. I hated the live course bc it was literally 12h of nonstop cramming info, and he likes to call ppl out throughout his lectures. My attn span disappeared the second I graduated from college so I can’t sit all day in a classroom and actually learn a lot. They build ~3 individual mock orals into the live course as well (plus 1 “public” mock!)and those were helpful. The key for me was getting in MEANINGFUL and active studying. I made sure I went over common points constantly (ie quiz myself on the MH protocol, common ddx for hypoxia, what to do with myesthenia gravis patients and WHY, etc). If i felt sketchy about any topic i would make a point to keep reviewing it and come back to it until i knew it cold. I listened to the online lecture series Ho throws in for “free” if u buy one of the more expensive prep packages he offers (This helped me A LOT—easy to just listen to these in the car to/fro work etc). I took lots of notes and made sure I knew them stone cold. The skype mock orals were helpful in that I got accustomed to talking out loud with strangers and defending my points in a clear and concise manner. They give u instant feedback and you rate them as well. I kinda wish there had been a Ho “equivalent” for the Pain boards, as it gave me a lot of info for everyday practice as well (its amazing how much anesthesia u forget when you step away for 1 year). In short, Ho is an expensive course but it was thorough—Probably more than u need to know for orals but does give u good info for everyday practice as well. Not everyone needs course but u have to figure out what is best for YOU and how u learn. BTW if u do a mock with Ho, I felt he is pretty tough, but its good practice anways...

I did debate Jensens course and even called him up one day and talked to him abt his course offerings. (I used Big Blue all thru residency and i felt it helped me a lot.) But i didnt go with it bc basically if enough ppl dont sign up for a specific course, It was subject to get cancelled. Aint nobody got time to be scrambling around to find a different course last minute. If i schedule a week of vacation to go to a course i want to KNOW its going to happen.

I (thankfully) know nothing abt the OSCEs—finished residency in 2015 (before the cutoff making them required) so didnt have to think about them, slid by just in the knick of time.

Forgive me for all the abbreviations and if any spelling/grammar errors. Typing on my phone late night (insomnia is a b***h) so sorry! Pm me with any more specific questions, more than happy to spread the wealth.

 

[nbrunomd]

I took the exam a few years ago and did Ho and Just oral boards. The Ho people I did mocks with weren't very good. One of the examiners gave me a mock while waiting for her dinner table at a restaurant. (i could hear the chatter in the back the entire time). I thought the just oral boards mock exams were more rigorous and thorough. i know everyone has a different experience but I would tip my hat to just oral boards.

I would let Dr HO know about your experience with that mock examiner (if you haven't already). He is very receptive to feedback and I know he would be disappointed to hear about what happened! I am sorry that happened. It is stressful enough to prepare for these tests and to not have someone take it seriously like that examiner, would haver really upset me.

 

[Planktonmd]

I think the main problem here is that people think that the more your read the better you will do in the oral exam.
The oral exam is not about reciting memorized text books, it's about clinical management and about being able to formulate a reasonable plan, then execute that plan correctly and safely. There is often multiple ways to do everything, and as long as you know why you are doing it, and are able to modify your plan according to variables to throw at you, you should pass.
In order to pass, you have to learn how to put yourself in the clinical scenario they present to you, and tell them what you would do in your actual clinical practice. Don't say anything you wouldn't do in the real world, but learn how to explain your decisions clearly and decisively.
All this of course depends on the assumption that the examiners are reasonable clinicians who are actually trying to test your ability to formulate and execute anesthetic plans. Unfortunately some of the examiners are the rigid academic ivory tower types and they might enjoy making the poor examinees miserable and seeing them sweat. If you are unlucky enough to end up with that type of examiner then it becomes a psychological game and you are guaranteed to have a bad day.

 

[Paingas]

IMO this exam is not just about being safe. A CA-3 is safe. this is about being a consultant and answering questions like a consultant. From the ABA website
"The attributes are sound judgment in decision making and management of surgical and anesthetic complications, appropriate application of scientific principles to clinical problems, adaptability to unexpected changes in the clinical situations, and logical organization and effective presentation of information..."

I think for those that have taken the test, they would agree the questions they ask evaluate the above qualities. You have to have a great working baseline knowledge. Its not regurgitating, its using the information you know and the clinical scenario that is presented. Many people think there are right or wrong answers on this test. Very few questions have a single right or wrong answer. the questions have many different correct answers that just need to be justified, wrong answers are either not justified correctly or have incorrect baseline knowledge. I think the most repeated phrase I used in during my orals, which I passed , was " it depends..." and justified from there

 

[Arch Guillotti]

I think the main problem here is that people think that the more your read the better you will do in the oral exam.
The oral exam is not about reciting memorized text books, it's about clinical management and about being able to formulate a reasonable plan, then execute that plan correctly and safely. There is often multiple ways to do everything, and as long as you know why you are doing it, and are able to modify your plan according to variables to throw at you, you should pass.
In order to pass, you have to learn how to put yourself in the clinical scenario they present to you, and tell them what you would do in your actual clinical practice. Don't say anything you wouldn't do in the real world, but learn how to explain your decisions clearly and decisively.
All this of course depends on the assumption that the examiners are reasonable clinicians who are actually trying to test your ability to formulate and execute anesthetic plans. Unfortunately some of the examiners are the rigid academic ivory tower types and they might enjoy making the poor examinees miserable and seeing them sweat. If you are unlucky enough to end up with that type of examiner then it becomes a psychological game and you are guaranteed to have a bad day.

I agree 100% as usual with the caveat that if there is a significant knowledge deficit the examiners are apt to root it out and could be the road to ruin.

 

[AnesThrowaway]

Don't say anything you wouldn't do in the real world, but learn how to explain your decisions clearly and decisively.

I hear this a lot of the time and I think it definitely applies to the cases that I do on a daily basis. However, it is hard to answer, for example, pediatric cases with this strategy as I never do those and am essentially deriving all non-basic management choices from reading material.

To give an example, for management of TEF, it seems to be recommended to avoid gastrostomy placement unless necessary and to use high-frequency oscillatory ventilation instead if the child can't tolerate spontaneous ventilation. So my choices on the exam in that scenario would be either a. to ignore this and say that I would ask for a gastrostomy which would go against current recommendations or b. to say that I would consider HFOV, a topic that may lead me down a rabbit hole of hfov ventilator management that is hard to learn from a book.

 

[Mman]

I hear this a lot of the time and I think it definitely applies to the cases that I do on a daily basis. However, it is hard to answer, for example, pediatric cases with this strategy as I never do those and am essentially deriving all non-basic management choices from reading material.

To give an example, for management of TEF, it seems to be recommended to avoid gastrostomy placement unless necessary and to use high-frequency oscillatory ventilation instead if the child can't tolerate spontaneous ventilation. So my choices on the exam in that scenario would be either a. to ignore this and say that I would ask for a gastrostomy which would go against current recommendations or b. to say that I would consider HFOV, a topic that may lead me down a rabbit hole of hfov ventilator management that is hard to learn from a book.

board questions are not expected to be answered at the level of a subspecialty trained physician. I would be somewhat surprised if a TE fistula patient was in one of the stems, and if you got one in a grab bag it would be more superficial level questions

 

[Sonny Crocket]

Have you put yourself in the examiner’s shoes? Would you have passed you? Why or why not?

Have you looked at what they have to do in an exam? Essentially they go through a series of questions listed on a piece of paper. And then score it. That’s it. They give no feedback because they have so much to get through. They are looking for confidence and competence/safety. Not textbook answers.

Having said all of that. I think the whole exam board thing is nonsense. You have probably already been though hell during residency. Or maybe not. Why do we have to prove ourselves once again.

And why don’t they give feedback to people that failed??

Good luck

 

[Mman]

Having said all of that. I think the whole exam board thing is nonsense. You have probably already been though hell during residency. Or maybe not. Why do we have to prove ourselves once again.

And why don’t they give feedback to people that failed??

Good luck

Maybe someone went to a crappy residency and got poorly trained. Simply "going through hell during residency" doesn't mean someone is competent to be a board certified anesthesiologist. And remember each individual examiner does not know if you failed or not. They are merely one of 4 people grading you.

 

[Sonny Crocket]

Maybe someone went to a crappy residency and got poorly trained. Simply "going through hell during residency" doesn't mean someone is competent to be a board certified anesthesiologist. And remember each individual examiner does not know if you failed or not. They are merely one of 4 people grading you.
[/QUOTE]

Just because you passed the boards, doesn't mean you are competent.

 

[Mman]

Just because you passed the boards, doesn't mean you are competent.

Perhaps you could suggest a better way to do things than the combination of passing residency and written and oral boards.

 

[T-burglar]

Oral Board exams are more than a little ridiculous because anything is fair game and you can’t know everything.

This adds an element of luck , a good anesthesiologist can fail if he or she gets unlucky on test day. To me that’s unacceptable for something so inconvenient and expensive. we should be told ahead of time EXACTLY what’s going to be tested and it should be a manageable amount of information . In my opinion this oral board exam should only test recognition and management of emergent situations. Don’t ask me the details of chronic abdominal pain as a practicing cardiothoracic attending, that’s bullshyt

 

[DM27]

I can second that while the boards do sometimes devolve into minutiae, it is not possible for the examinee to distinguish whether what they are being asked is actually part of the official stem, or simply the examiner improvising off of it in order to maintain their desired time frame or simply doing it because they want to. My understanding of the typical grading of an examinee is that it is not based purely off of explicit responses, but more of the thought process being seen and how often the examinee "acted as a consultant".

That being said, I also think the oral boards are an unnecessary redundancy. They test qualities that should have been tested throughout residency and anyone they are "weeding out" should have been "weeded out" during residency and not graduated. The existence of the oral boards, is in my opinion, an indirect indictment by the ABA of how reliable or effective they perceive the anesthesiology residency process for training doctors and identifying deficient individuals, and should instead be reserved for individuals who did not train in a US or ACGME accredited residency.


I have the same opinion about Step 2 CS.

 

[2Fast2Des]

Perhaps you could suggest a better way to do things than the combination of passing residency and written and oral boards.

Apparently DO boards they watch you perform Anesthesia, my friend told me who is peds fellowship. One of the neurosurgeons said they have to keep a case record and get certain numbers and then get grilled on the cases they perform.

 

[DM27]

One of my friends is a DO in anesthesia and said the logging is very tedious and still on paper.

 

[Dr Grant]

There isn't a "one-size-fits-all" approach that will work for everyone. For example, I DID memorize and regurgitate UBP...to the point where I had basically the entire book memorized. As far as doing what I would actually do in an OR...I haven't the slightest clue, as I haven't practiced anesthesia in over 1.5 years (pain management)....and I likely never will. This test was just a "hoop" I had to jump through to be allowed to be pain board certified. I agree that formulating good responses and being adaptable and quick thinking is key, but so is knowledge. For most non-geniuses, this test is an absolute monster that requires at least 3 months of heavy prep with both building up knowledge base (in my case almost from scratch again) and lots of practice flailing out loud.