Oral boards for dummies

[Yo GabbaPentin]

So here is my oral board advice now that this horrible test is in the rear view mirror. Take it for what it is worth.

First of all, a little background about how my test went. The first stem went great. It was difficult but reasonable and I felt confident with all of my answers. Going back over it hundreds of times in my head, there really wasn't anything different I would have done. I went into the second stem feeling very confident. And that lasted all of 20 seconds when I was asked the very first completely ridiculous question. This was followed by another ridiculous question and then really inappropriate body language throughout the entire exam. Behavior that I'm positive would not rear it's ugly head while they were being evaluated. Sighing, head shaking, VERY condescending tone/questions and other behavior that should not have occurred to that degree. It really, really threw me off. You will be told that the examiners are instructed not to behave in this way. Understand that they might and try to be prepared for it so it doesn't throw you off too much. Honestly I'm still in shock that I passed and my deepest sympathy goes out to those who failed. It honestly could have been ANY of us.

As far as review materials go, I used several sources. Passed my writtens in the 90th percentile however I am in pain management, so I internally assessed my knowledge as weak. No review courses were attended for either the writtens or orals. I despise Jensen and Ho for the tactics they use to scare the money out of already cash strapped residents/new attendings. If you insist on a review course, which I really feel are unnecessary, then please consider one with a more ethical method of advertisement. I have heard great things about the Skype course which is very pricey. I dont remember the name of that but it has been recommended on multiple other threads.

I began studying 2 months before the exam. One to two hours on weekdays after work (which SUCKED) and never more than four hours a day on the weekends.

Sources I used in order of most to least helpful:

1. Ultimate board prep - By FAR the most useful source that I used. It consisted of four books with 10 practice cases plus 10 grab bag topics each. Very well thought out answers and VERY helpful if you don't have anyone to practice with on a regular basis. These books were the reason that I passed. More companies should follow their lead with that layout.

2. 3 mock exams with examiners who were in San Diego torturing other applicants. One is considered to be in the "tough" category of examiners by all of his colleagues. He helped a lot and acted nothing like my second stem examiners. If you have access to these people, use them as much as possible.

3. Practice ABA exams - no answers but gives you a feel for the layout of the exam.

4. Knocking out the boards - good book but a little dry. Maybe helped a little.

5. Co-existing diseases handbook - didn't help me much. Too much focus on oddball diseases.

6. Michael Ho book - Yes, I got it for free from a friend. And apparently you get what you pay for. I give it two thumbs down. It overwhelms you with trivial info probably trying to push you towards his courses. Not helpful in any way. Please save your money. If you get a freebie like I did, skip ALL of the "additional topics" sections which probably makes up 300 pages of crap. Michael Ho owes me at least 80 hours of my life back that I wasted reading his book.

The night before the exam, it is difficult to relax. I'm pretty laid back, but I was wound up like you wouldn't believe. My bag was packed with books. Not a single one was opened. Instead I went to the hotel bar and had several beers. Don't go tie one on the night before, but do anything you can to relax.

The best advice I can give is to TRY to be ready for unprofessional behavior. I was completely blindsided. Otherwise just practice as much as possible. You don't necessarily need a partner. I just spoke to myself, most of the time in my head. Due to my speaking to patients all day long as well as extensive dictating in an organized fashion talking was not a problem... I just worried about what would actually come out of my mouth.

Congrats to all those who were lucky enough to pass. And my deepest sympathy goes out to those who did not make it. Please post your study strategies for next years victims.

 

[MedZeppelin]

I also learned I passed thankfully, after failing before.

My study prep consisted of Board Stiff Live one month, and weekend before exam. Well worth the cost looking back. The small group settings of practice orals and various case scenarios covered most of the actual content of my actual exams. This course was the key, in my opinion!

Also, I read Knocking Out Boards, some Ho, and Jensen's Spiels, memorized ACC/AHA guidelines and other ASA guidelines such as difficult airway, blood transfusion and sleep apnea.

Best wishes!

 

[nd92]

It really, really threw me off.

I would argue that is the whole point. If you made it this far you can handle the specialty in the abstract. The real question is how do you do under the stresses that comprise the real world practice of anesthesia?

 

[Yo GabbaPentin]

I would argue that is the whole point. If you made it this far you can handle the specialty in the abstract. The real question is how do you do under the stresses that comprise the real world practice of anesthesia?

I would argue that it's pure hazing and not what they are instructed to do. In no real world situation would I be asked about multiple NORMAL lab values and vital signs while someone sighs at me shaking their head an the other person keeps fooling with their IPAD. I'd look at the vital sign and take care of the patient.

To the credit of the exam, my first examiners were tough and professional. I didn't know the material any better on that stem but it was how the exam was intended to be given. I had two bad examiners but that is life. Be prepared for it. I was under the impression that it wouldn't happen to me.

 

[CambieMD]

I also learned I passed thankfully, after failing before.

My study prep consisted of Board Stiff Live one month, and weekend before exam. Well worth the cost looking back. The small group settings of practice orals and various case scenarios covered most of the actual content of my actual exams. This course was the key, in my opinion!

Also, I read Knocking Out Boards, some Ho, and Jensen's Spiels, memorized ACC/AHA guidelines and other ASA guidelines such as difficult airway, blood transfusion and sleep apnea.

Best wishes!

There are so many different valid approaches to passing the orals. The common denominator is mastery of your material and maximizing your efforts. You have o focus on high yield topics.

I viewed the oral stems like a soap opera. In OB something is always going to go wrong. The details may change but something is going to go wrong. I once worked with a female surgeon who felt threaterned by attractive young female residents. She always found a reason to demean them. They could try their best but I always knew that the resident was going to have a hard day. The attending would question the resident to exhustion. She had well rehearsed retorts. She would say,"I can't believe that you didn't know that." "Did you even prepare for this case." The sharp residents knew the drill and stayed calm. Male residents just had to act like they were in the presence of a goddess and their day went well.

The questions asked on the orals are always hard. Do not expect the process to be easy. You will beacome overwhelmed if you do not know what to expect.

You cannot be failed for giving reasonable answers. I failed because my respones were unreasonable.

Statistics are on the side of first time takers of the oral exam.If you failed the exam you can pass it next year but you must determine why you failed the exam. One bad response cannot cause you to fail. Giving sux to a patient with week old burns will not cause you to fail. You had to miss multiple opportunities to score. I gave some good responses but I could tell by the body language of my examiners that it was too late.

If you failed the exam you need to develop a program specially suited to you and your issues. I did not like speaking to patients and their families so I started to speak to them more and encouraged lots of questions. I could practice for the exam all day long.

Those really struggling with the orals would do better in a small group setting. Sitting in a warehouse and watching people make fools of themselves is a waste of time and money. Find a small course where you can really mix things up.

I did not use a review course for my second attempt.

All the best,

Cambie

 

[lilycat]

First of all, a little background about how my test went. The first stem went great. It was difficult but reasonable and I felt confident with all of my answers. Going back over it hundreds of times in my head, there really wasn't anything different I would have done. I went into the second stem feeling very confident. And that lasted all of 20 seconds when I was asked the very first completely ridiculous question. This was followed by another ridiculous question and then really inappropriate body language throughout the entire exam. Behavior that I'm positive would not rear it's ugly head while they were being evaluated. Sighing, head shaking, VERY condescending tone/questions and other behavior that should not have occurred to that degree. It really, really threw me off. You will be told that the examiners are instructed not to behave in this way. Understand that they might and try to be prepared for it so it doesn't throw you off too much. Honestly I'm still in shock that I passed and my deepest sympathy goes out to those who failed. It honestly could have been ANY of us.

I had a very similar experience to the above, except that was my first room; the second room was fine, and very much what I expected based on my preparation. In all my meetings with faculty from my residency program, and another nearby residency program, faculty who are board examiners, the take-away message was that the above behavior should be a rarity. But, obviously it still happens. Try to prepare for it, and if you prepare, hopefully it won't derail you.

Preparation: I found preparing for this so much more challenging, because I just didn't know where to begin. But, I think I method worked for me.

1) Timeline - really buckled down 2 months before the exam. At the two month mark I started studying every week day after work for about 2-3 hours/day, and every weekend about 3-6 hours/day. I also met with my study partner once a week for about 4-6 hours at a time - we would usually do 3 sets of practice questions (used the ABA sample questions) and then debrief, discuss, look stuff up, etc.

2) Yao & Artusio - This was my main source for preparation. I read this cover to cover, neglecting low-yield chapters (Acupuncture, pedi congenital hearts, etc.). I had read some of it before during CA3 year, but now I really read it with a fine-toothed comb. I took notes on stuff that I didn't know well or felt weak on. Some people complain that Yao is overly detailed, but I just skipped that stuff - I'm not going to waste my time on explaining the physics of TEE. It's just not going to happen, and if I get asked that in an oral board question, that is just going to have to be a "I don't know" question. You should be able to figure out what is high-yield and what is low-yield - stick with the high-yield stuff.

The other reason I preferred Yao to other texts is that it does a great job of going through a case step-by-step, which is invaluable when it comes to topics that you feel weak on. I haven't done a CEA since CA1 year - but, reading through all the steps in Yao, it really came back to me. No other book does that as well, in my opinion.

3) Barash, M&M - I used to supplement weak spots in Yao (ie, regional, pain), and as a reference.

4) Stoelting's Coexisiting Diseases - I had friends who swore by this as their only prep source for oral boards. I didn't feel like it was enough, so I only read a few chapters to supplement my studying in Yao.

5) Michael Ho book - I also got this free from a friend. I didn't read the whole thing, but I did the "Consultant Q&A" for every section - saying it out loud, trying to verbalize a response and then checking Ho's response. I think that is the most useful way to use that book, and the material presented in that format quickly becomes repetitive, which is sort of what you want - you want to be able to regurgitate the differential for hypoxia at the drop of a hat.

6) ABA sample exams - did these with my study partner. Very good practice.

7) Board Stiff Live review course - did the one in August, so about 6 weeks before the board. Go the earliest one you can - I found it helpful to get me thinking about what to expect, and helped me start identifying topics and areas that I didn't know well.

8) Practice exams with other anesthesiologists. Besides practicing with my study partner, I did 3 mocks with residency faculty who were board examiners, 1 other faculty who runs the CA3 oral board prep curriculum, and two friends who became board certified in the last year. These mock exams were invaluable in coming close to the actual experience. Cannot emphasize the importance of doing real mocks enough.

9) Notes - I made lots of lists. I wrote down a differential list for all of the following: Hypoxia, hypercarbia, tachycardia, bradycardia, hypotension, hypertension, increased temp, delayed awakening, increased airway pressures, etc. This was helpful to practice regularly and have immediately available in my mind. I also went through some common disease states, system by system (HTN, DM, OSA/Pickwickian, Down's, etc.) so I could quickly rattle off things that I was worried about. Also know your differential for postop oliguria, postop jaundice, etc. This is all stuff that we all know - the problem is being able to state it quickly and succinctly. So you have to practice, practice, practice.

I had access to a few other review books (Knocking Out the Boards, Board Stiff), but honestly didn't use them because they didn't seem that useful for the type of studying that I needed.

 

[lilycat]

One other thing that I forgot to mention - when practicing, constantly think about the other anesthetic techniques you could do for a case, and be able to verbalize WHY you won't use certain techniques. They'll ask you about cases that you would normally always do under general, about doing it under neuraxial, MAC, etc. Trying to succinctly verbalize why you won't do certain things that are sort of reasonable, while under pressure, is a little more challenging than I expected, and I wish I would have practiced that more.

 

[Jalopycat]

Well I'll give my study plan:
1. I started off reading Ho's book, then realized I wasn't studying smart or maximizing my time. I read it once only.
2. made a list of pros and cons of GA vs RA, all the opioids, inhalationals, , barbiturates, breathing systems, etc..because they WILL ask you advantages and disadvantages of stuff and it's nice to have a memorized list you can rattle off when you're under pressure
3. memorized asra anticoagulation guidelines, indications for further cardiac workup, and formulas
4. Went to this website: http://www.frca.co.uk/SectionContents.aspx?sectionid=165
It has 140 practice exams. I went through about 20 of them and made keyword lists of stuff I wasn't sure about then used Barash, Chestnut, and Faust to fill in the gaps. This was very high yield for me.
5. Made a list of surgeries I wasn't comfortable with (liver transplant, aortic dissections, etc) and used the Anesthesiologist's Guide to Surgical Procedures and made an outline of pre-op, operative, and post-op issues, what monitors to use, complications to expect, etc. to use for review. This turned out to be huge and is one of the reasons I passed.
6. Memorized how to draw the anesthesia machine, mapleson systems, and bypass pump. I ended up not having to draw anything or write out formulas, of course.
7. Did practice tests with a friend who had passed. We got started late, I only did about 8 with her over a period of 2 weeks but it helped
8. Took the Ho 4 day crash course. I really thought it helped me organize my thoughts and really secure stuff to my memory. Yes it's expensive but if you do the work to prepare for the course, it's worth it. If you don't study at all and expect the course to pass you, you might not pass.


Good luck everyone!

 

[Jalopycat]

I also meant to add that what also turned out to be an asset is that several days a month all I do is medically manage CRNA's and do the pre ops for them. I never thought that would turn out to be helpful but it really was. I am a pre-oping fool now and in session 2 I had no problem with the pre op questions. Do as many pre ops in your practice as you can.

 

[Precedex]

I also meant to add that what also turned out to be an asset is that several days a month all I do is medically manage CRNA's and do the pre ops for them. I never thought that would turn out to be helpful but it really was. I am a pre-oping fool now and in session 2 I had no problem with the pre op questions. Do as many pre ops in your practice as you can.

Please no I hate preops.

 

[Yo GabbaPentin]

I also meant to add that what also turned out to be an asset is that several days a month all I do is medically manage CRNA's and do the pre ops for them. I never thought that would turn out to be helpful but it really was. I am a pre-oping fool now and in session 2 I had no problem with the pre op questions. Do as many pre ops in your practice as you can.

Well done! You just came up with the FIRST positive I have ever heard about doing preops!

 

[Yo GabbaPentin]

....wait a minute. Do you supervise residents? Is this an evil plot to try and get them to see more preops? If so, you are a genius. As a former chief, getting residents to see preops was like pulling teeth.

 

[Jalopycat]

haha! God no I don't supervise residents. And I hate doing pre-ops. I'm just a girl who didn't want to take the orals twice. And I trust my pre ops. It takes all of 5-10 minutes to do a thorough pre-op, depending on how sick the patient is.

 

[PinchandBurn]

In my opinion the HO course is right on. You cant just buy the book, you have to go to the courses (a few of them).

Also supplementing with just oral boards (via skype) is a good idea.

I did Pain, so it was good to hear these guys talk things out.

My advice to test takers. You will hear a lot of people say it's "easy" and they 'barely' studied. Take that with a grain of salt. Study hard, know the material cold. Then go to a Ho course or two, he'll make you feel like you dont know anything and humble you. But I feel like I learned more about Anesthesia in general from taking his course, not just 'how to pass an exam'.

At the end of the day, getting that Diploma makes you feel good

 

[Yo GabbaPentin]

In my opinion the HO course is right on. You cant just buy the book, you have to go to the courses (a few of them).

Also supplementing with just oral boards (via skype) is a good idea.

I did Pain, so it was good to hear these guys talk things out.

My advice to test takers. You will hear a lot of people say it's "easy" and they 'barely' studied. Take that with a grain of salt. Study hard, know the material cold. Then go to a Ho course or two, he'll make you feel like you dont know anything and humble you. But I feel like I learned more about Anesthesia in general from taking his course, not just 'how to pass an exam'.

At the end of the day, getting that Diploma makes you feel good

YES! Key point! Tons of people told me its easy... It's not a knowledge test.... They passed by studying for one week. I would have been CRUSHED with that approach. Definitely spend some time brushing up your knowledge base.

FWIW I personally know 4 people who have failed over the last 3 years. ALL of them went to the Ho course... Three of them went to multiple Ho courses. Some people loved it. To each there own. Just understand that attending a course does not drastically increase you rate of passing. It's all about the practicing and having at least a solid knowledge base.

 

[lilycat]

FWIW I personally know 4 people who have failed over the last 3 years. ALL of them went to the Ho course... Three of them went to multiple Ho courses. Some people loved it. To each there own. Just understand that attending a course does not drastically increase you rate of passing. It's all about the practicing and having at least a solid knowledge base.

Excellent point. I also know several people who have not passed the exam, and nearly all of those went to at least one Ho course. Not saying it's a problem with the course, but I think some people might get a false sense of security from it - like, I did the course, I must be in good shape. You still need to know the material and be able to state it in your own words.

Fully agree with the previous advice about being leery of people who keep saying how easy the test is, how you'll definitely pass, etc. I definitely got that too, but I think people either a) forget how challenging it was, or b) have that mentality where they always have to downplay the actual work they put into something. The test is hard - passable, but hard. You have to practice and you have to study. There are no shortcuts, in my opinion. Yes, it sucks to give up a couple of months of your life (what I did) to study for the boards, but it is so worth it in the end.

 

[CambieMD]

Excellent point. I also know several people who have not passed the exam, and nearly all of those went to at least one Ho course. Not saying it's a problem with the course, but I think some people might get a false sense of security from it - like, I did the course, I must be in good shape. You still need to know the material and be able to state it in your own words.

Fully agree with the previous advice about being leery of people who keep saying how easy the test is, how you'll definitely pass, etc. I definitely got that too, but I think people either a) forget how challenging it was, or b) have that mentality where they always have to downplay the actual work they put into something. The test is hard - passable, but hard. You have to practice and you have to study. There are no shortcuts, in my opinion. Yes, it sucks to give up a couple of months of your life (what I did) to study for the boards, but it is so worth it in the end.

I took the Ho course not once but twice and still went down in flames on my first attempt.
A crash course cannot take the place of focused practice and study. Most people who take the Ho course will pass the exam. The truth is that most people who take the exam will pass. The pass rate for first time takers is about 85%.

The Ho review course helps one person consistantly, Dr. Michael Ho. Spending most of your time watching Borat taking mock orals is passive learning. I failed the orals because my presentation was disorganized and unconvincing. I had to fix that on my own.

Cambie