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Oral advice

Discussion in 'Anesthesiology' started by sweetalkr, Oct 15, 2011.

  1. sweetalkr

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    For what it's worth,
    i got michael ho's workbook. i read the major highlights of each subspecialty from hall's, took 5 days all day. then spent a full day extra on peds and CV each. i then did 3-4 stems a day everyday, basically breaking down the stem, asking the "questions" i would expect to be asked, and looked up answers i didn't know. and i did at least one practice oral per day with a friend. I did this for 10 days straight every day.
    the last 3 days was intensive, and i basically had my algorithm for an airway disaster, ACLS/code, MH, and major complication of each subspecialty (for example, neuroanesthesia VAE). i practiced basically an answer for each major disaster situation.
    the knowledge portion is the hardest to prepare for because it depends on your knowledge base. mine came back very quickly for whatever reason, minimizing my review time (1 week).
    the 2 keys to passing -
    1) is to have a response to hypoxia/hypotension/hypertension/etc the basic anesthesia things u lelarned as a CA-1. don't over think it, it is as simple as the question that is asked.
    2) then have a response to every major disaster as i listed above.

    the knowledge portion of the test, either u know it or you don't. i got lucky and knew the curves and charts they asked me to draw, and i said "i don't know" a total of 10-15 times in both rooms combined. they question to failure so don't be flustered.
    also, half of it is confidence. they asked me to draw something out from basic science (i can't specify obviously), and i happened to know it. i pre-empted questions and answered things i thought they would ask me without being prompted and they were under the impression i knew my ****. that's half the game. i dressed the part (dark gray suit, white shirt, red tie), talked the part (spoke the "king's english", no slang, generic medications not brand), and got the part.
    the oral exams are not hard, they are stressful. the test is set up to scare you and make you nervous and see how you handle the pressure. if you can pass the written exam, the oral exam is easier knowledge wise (memorize some lists) but is much more nerve-rattling. so good luck, feel free to PM me if you have any questions although thousands of people have passed so just grab someone that was successful on the exam and get advice.

    good luck and don't be nervous.
     
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  3. Bertelman

    Bertelman Maverick!

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    I was unaware they might actually ask you to put pen to paper.

    Have others had this experience?
     
  4. PMPMD

    PMPMD 4G MD
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    Yeah, me too. Sort of defeats the purpose of an "oral" exam.
     
  5. PMPMD

    PMPMD 4G MD
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    Great post. I find the orals much more nerve-wracking than the writtens.
     
  6. sweetalkr

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    i had to interpret multiple abgs, draw compliance curves, others had an ekg to interpret on the spot. i've heard people drawing flow volume loops also

    and ya it is nerve wracking but it's not bad

    also last tip for all residents. i learned the anesthesia machine my first year and understand it. .however for the writtens and orals, i read NOTHING about circuits (mapleson, etc) and never read the esoteric boards crap for the machine and i was 90% in all exams. so don't waste ur time. learn the science. understand ur machine to be safe. but don't need to be an anesthesia tech to pass. that saved me weeks of studying
     
  7. proman

    proman Member
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    Someone I know who was asked to draw the Mapleson circuits. If you've gotten to that point, you've passed.
     
  8. Bertelman

    Bertelman Maverick!

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    I think I would LOL if they asked me to do that.
     
  9. PMPMD

    PMPMD 4G MD
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    Bert was, guess he has the upper hand there.
     
  10. Lee123

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    That is not completely true. Just because one is asked a complicated question does not mean they have passed. It is asked to separate out those that can just answer what they have read (when they would use one) vs truly understanding how they work and why they would use one in a given situation. The boards seeks to determine not only how many topics one knows, but how much of each topic they truly know.

    Example: You have a pediatric stem and you are asked what type of ventilation you are going to use. You then mention you will use a mapleson D circuit. you are then asked why and please show how this differs from a standard circuit. This line of questions does not imply in any way you are passing. It seeks to find out if you know why one would or would not use a mapleson D in this situation.
     
    #9 Lee123, Oct 16, 2011
    Last edited: Oct 16, 2011
  11. Gaseous Clay

    Gaseous Clay ASA Member

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    I was asked to draw something. I also was given an EKG and asked to interpret it.
     
  12. sevoflurane

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    I had to demonstrate precise understanding of the differences between Le Fort 1-3 fractures and it's anesthetic implications. This was not part of the stem... but as many exams go... the stem has the ability to morph into anything.

    The Orals are challenging. No multiple choice answers to choose from.

    Your depth of knowledge will be tested so make sure you study everything and don't leave anything out.

    IMO, only going for high yield information can leave you open to attack. In many cases this will be uncovered during your examination and can be detrimental to your overall performance.

    Having deep understanding (or not) of anesthesia will surface during your examination...

    Pain Medicine is fair game by the way.
     
  13. pgg

    pgg Laugh at me, will they?
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    Yeah, if you are generous and foolhardy enough to hand the examiners rope, they'll be happy to hang you with it.

    You must be prepared for ANY tangent you initiate.


    I didn't have to draw anything, but I went in prepared to draw flow-volume loops, machine schematics, all kinds of stuff.
     
  14. countingdays

    countingdays ASA Member

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    This talk makes me even happier never to have to take it again.
     
  15. proman

    proman Member
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    I think they've tightened the exam structure up a bit. The stem questions are completely scripted. I said I would start a neonatal resuscitation with 21% FiO2. The examiner asked me why. That likely wasn't part the script but the neonate crumping was. I think that if they venture off into esoteric odd ball questions (like drawing Mapleson circuits, or the coagulation cascade), they're just filling time until the knock on the door.

    Of the people who had to do oddball stuff, was this during a stem or after the grab bags?
     
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  17. Lee123

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    Not true. The examiners don't go off into esoteric stuff; they are following up on comments made by the examinee. If you get to a 4th grab-bag then time is being filled up.

    The exams are structured to give all examinees as close to a similar exam as possible. Once upon a time, an examiner could ask anything and there was no way to standardize the exam. How would one know how much better candidate A did than B if they were asked two different questions? The exam is structured, but the examiners will follow up on answers given by the candidates.
     
  18. proman

    proman Member
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    True but the examiners are tasked with getting through the required questions. Pretty sure diagramming the coagulation cascade would be considered esoteric. We're not saying dissimilar statements.
     
  19. sweetalkr

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    Postop was all icu in my first one. One of my grab bags was pain, which went on for 5 minutes into depth and I'm a pain doc. Every topic from ect to hypothermia to ob and bypass were covered on the test. I never said gloss over it. I'm saying there is a clear strategy to passing the test. I missed questions, but I did not miss any gimme questions, well maybe my first question of the exam. But every major question ( how do u treat icp, vae, tension pneumo, etc) I nailed it and I preempted their questions, answering in detail everything on how to treat disease x. But some esoteric stuff I missed, and everyone did and everyone will. Learn your basics. If you know that droperidol can treat wpw but miss how to treat a difficult airway, you failed. However flip those questions and u miss droperidol treating wpw w it's alpha antagonism and you pass. That was my strategy. Plus I had a solid background to work with. But the test was fair and nothing crazy. Literally 1/3 of test I was thinking back to my ca-1 year! Sorry for lengthy response.
     
  20. Lee123

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    Yes, examiners have a fixed set of material to cover. They also have latitude to deviate from the stem if they feel it is appropriate.

    I agree that asking someone to write the coag cascade is expecting a lot, and I would not consider this the same as drawing a mapleson or a capnograph curve. It also takes too much time, which I would not want to waste on one topic. For the comments above I was referring to drawing a mapleson, which I have definitely asked residents.

    If someone was asked to draw the cascade it was probably a new/probational examiner that has not been weeded out. The Board has a strict policy to keep examiners consistent, and that they do not ask ridiculous questions. They want to find out that you are a good consultant in Anesthesia, and not that you have a photographic memory.
     
  21. proman

    proman Member
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    Yikes. I'm happy if the residents put the tube in the right hole. Even when I tell them what we're going to talk about the night before and read about it they still don't. I would be amazed if any of them could draw the Maplesons.
     
  22. pgg

    pgg Laugh at me, will they?
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    :eyebrow:

    At my program, blowing off an attending like that and showing up unprepared to talk about a topic you were given advance notice on was not a minor offense.

    I remember forgetting to read up on something once, and my attending said (paraphrased) "Oh, you don't know anything about this? I thought I had a resident today, not a SRNA. I'll do everything, you can just chart for me today." And he did, and I did ...
     
  23. Doctor4Life1769

    Doctor4Life1769 **tr0llin, ridin dirty**

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    oh snap.

    im quite intimidated about next year. trying not to think about it.
     
  24. leaverus

    leaverus New Member

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    That is awesome! We need more academic guys like that who will challenge residents and hold them to high standards.
     
    #22 leaverus, Oct 20, 2011
    Last edited: Oct 20, 2011
  25. Flowerette

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    Hi anyone wanting to sell. Ho's. Book

    Pls contact
    Ta
     
  26. countingdays

    countingdays ASA Member

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    I have one, unused. PM
     
  27. geddymd72

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    This was the hardest exam that I've ever had to take, and it had been the bane of my career for years. I took 5 months off just to consistently study for it. I probably did at least 50+ exams. I took just about every major course there is. I verbalized every chapter of Ho into a digital recorder. I looked up answers to just about all his exams. Jensen's was useless. Ho is good, but not fully adequate, and exams don't focus on efficient answers. I read through just about all of Yao and Artusio's book, and verbalized much of it as well. It covers the root and esoteric topics that come up, especially pain. The best is probably Ultimate Board Prep, a relatively new course that focuses on how you present answers, although is extremely informative as well. The 4 course books from UBP are excellent, with full answers, the way you would verbalize, and cover just about all case topics. In the end, you are still going to be presented with something unexpected and unrelated to the crux of the stem. They almost tend to make sure that any prep that you have of the stem contents becomes utterly useless. They also provide zero space for written notes on the front side of the 1st stem (which has gotten to be 2-3 paragraphs long recently).
    The key is not to bluff, and not to give answers without explanations. They'll give you clues like "would you consider giving/doing x", but you better have a caveat to add to just saying "yes". They always seem to often give you numbers on a piece of paper (PAC or ABG) and ask you to interpret and treat. They will even give you a grainy printout of a film from time to time, and just ask "what do you think?". One frustrating part I had was actually getting them to ask a decent question. They would sometimes present a bunch of material, and then would delay prompting a question like "how would you interpret?" Honestly, if the questions were established or scripted from the board ahead of time, the process would go much smoother. In my experience, you should get to the root of the answer as fast, but smoothly as possible. There just isn't time to get the nice formulated full paragraph answers that you can make while practicing or as seen in the video example that the board provides.
    Anyway, I felt horrible afterward every time, sure that I failed, but somehow I passed this time and I can have a life again.
     
  28. Lee123

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    Geddy

    You are definitely right about not bluffing. As far as asking questIons:

    The exam tries to mimick OR situations and consultations/interactions with
    Other specialties. If you are in the OR and the pressure is 60/40, the hr is 130 and the inspiatory pressure is rising, what question would you want the patient to ask you? The pause many times in the exam is to see how you take charge of the situation. Ther is a difference between being aggressive and a deer in the headlights
     
  29. Hockeyguy

    Hockeyguy Senior Member

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    I took and passed test once. I took the Ho course and would recommend saving your $ and time. The exams he gave were so ridiculous and his advice was so bad. He told me after my exam that I had "a pretty decent knowledge base but I come off as arrogant". Well I changed nothing about my presentation and passed. He preys on FMGs and people that have failed. The other thing is the course goes late into the night because a bunch of morons (usually the same people) continue to ask stupid question after stupid question. It's like first year of med school all over again. Buyer Beware!
     
  30. Lidodrip

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    The intent of the oral boards is to test your clinical judgement and decision making abilities, not the depth of your clinical knowledge. In order to make sound clinical decisions one obviously needs to have a solid fund of knowledge, but the purpose of the oral exam is to test how you apply this knowledge to clinical practice.
     
  31. Lee123

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    That is all correct; however, depth of knowledge is also considered.
    This is the difference in knowing what an obstructive tracing on a capnograph loOks like, and the physiology as to why it looks like that. It is the difference in knowIng what an inspiatory valve problem looks like and why it has a specific pattern. True understanding allow one a better grasp fOr recognItion and treatment
     

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