Oral boards for ophthalmology

[CaptainZappo]

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I did something similar but remove Wills and add Pemberton and Osler online course.

For me, Ophtho questions was horrible, only glanced through some videos but couldn’t stand the voices, the flash cards are useful though !

My gosh I hated the voices too. And the numerous mispronunciations. It was so bad 😂

But I have an hour commute to work 3 days a week. Listening to that crap over and over 6 hours a week for months sure does burn it into your memory though 😂

 

[Odincito]

Maybe it's changed since I took it 8 years ago, but absolutely not true for me, coming out of a brutal surgical retina fellowship where i was the only fellow on call 24/7 at a tertiary academic hospital. The retina section was a breeze both times (ended early) but I struggled with glaucoma and cornea because I forgot about aphakic glaucoma and other random anterior segment stuff. So, no, not wrong on my end. If you struggled in your respective specialty, you either got too much in the weeds about real-life treatment (the proctors aren't always in your specialty and are reading off a rubric, like the second time I took it, it was clear he was comprehensive), could not articulate your points well, or your fellowship didn't train you as well as you thought. Speaking to previous residents I've mentored, while the format is different, the overall style is the same, so I don't think it's changed drastically.

I don't know if you know this but I am speaking from someone who failed the oral boards the first time. I did what some of you did and thought was sufficient (pemberton/osler/etc.) and got wrecked. It wasn't a knowledge issue - my OKAPs were >80% each time I took them. The questions I missed I probably would have reasoned through if I had enough time. The review stuff for the oral boards is simply that - reviewing the format for oral boards. The issue is that the knowledge is there, but you have to be familiar enough with it to recall them quickly, and get it out orally in a legible fashion.

You can read in my history about what I did specifically, but I had to humble myself and refresh my knowledge thoroughly. Long story short I ditched what a lot of the other posters used other than Pemberton, and read through Wills and the Loma Linda cases, and practiced with a study partner for a few weeks to get the format down. Second time around I passed easily, and realized that I did not deserve to pass the first time around because I didn't present my competency well nor did I prepare properly. In the end, medicine isn't just a test, you have to talk to people and your colleagues and like it or not, your perceived competency is tied to how you communicate your knowledge. If you're not a native English speaker it sucks more so, but that's the game.

As a last aside, while I understand everyone's complaints about it, after several years I do understand its role. There is probably a better way to do this but ophthalmology from a certification/education standpoint has always had certain "exceptions"

Maybe it's changed since I took it 8 years ago, but absolutely not true for me, coming out of a brutal surgical retina fellowship where i was the only fellow on call 24/7 at a tertiary academic hospital. The retina section was a breeze both times (ended early) but I struggled with glaucoma and cornea because I forgot about aphakic glaucoma and other random anterior segment stuff. So, no, not wrong on my end. If you struggled in your respective specialty, you either got too much in the weeds about real-life treatment (the proctors aren't always in your specialty and are reading off a rubric, like the second time I took it, it was clear he was comprehensive), could not articulate your points well, or your fellowship didn't train you as well as you thought. Speaking to previous residents I've mentored, while the format is different, the overall style is the same, so I don't think it's changed drastically.

I don't know if you know this but I am speaking from someone who failed the oral boards the first time. I did what some of you did and thought was sufficient (pemberton/osler/etc.) and got wrecked. It wasn't a knowledge issue - my OKAPs were >80% each time I took them. The questions I missed I probably would have reasoned through if I had enough time. The review stuff for the oral boards is simply that - reviewing the format for oral boards. The issue is that the knowledge is there, but you have to be familiar enough with it to recall them quickly, and get it out orally in a legible fashion.

You can read in my history about what I did specifically, but I had to humble myself and refresh my knowledge thoroughly. Long story short I ditched what a lot of the other posters used other than Pemberton, and read through Wills and the Loma Linda cases, and practiced with a study partner for a few weeks to get the format down. Second time around I passed easily, and realized that I did not deserve to pass the first time around because I didn't present my competency well nor did I prepare properly. In the end, medicine isn't just a test, you have to talk to people and your colleagues and like it or not, your perceived competency is tied to how you communicate your knowledge. If you're not a native English speaker it sucks more so, but that's the game.

As a last aside, while I understand everyone's complaints about it, after several years I do understand its role. There is probably a better way to do this but ophthalmology from a certification/education standpoint has always had certain "exceptions".

My fellowship is a surgical retina fellowship, highly competitive and recognized. I don’t think it’s fair to attack it because your N=1, there are numerous posts from other people in highly competitive fellowships in other areas that felt that specific area of the exam felt rough. My coresidents also suffered through their respective subspecialty section and all are training at highly desirable places, thankfully all passed. Did their fellowships prepare them poorly or are they inadequate? No.

This exam wether you like it or not is aimed at general comprehensive ophthalmology. Scaring people saying they need to know really esoteric stuff of almost fellow level to pass it in my opinion is not ok. I for one sucked and always sucked at optics and anterior segment, I did make sure to study these topics like a mad man using the resources I shared previously. Do I have the knowledge of a cornea, glaucoma, or low vision fellow level? Hell no! But I did my best to at least not suck on those sections.

In the end I’m glad you and I passed and I wish for the people that failed that they find solace and can pass the second time.

 

[Slide]

My fellowship is a surgical retina fellowship, highly competitive and recognized. I don’t think it’s fair to attack it because your N=1, there are numerous posts from other people in highly competitive fellowships in other areas that felt that specific area of the exam felt rough. My coresidents also suffered through their respective subspecialty section and all are training at highly desirable places, thankfully all passed. Did their fellowships prepare them poorly or are they inadequate? No.

This exam wether you like it or not is aimed at general comprehensive ophthalmology. Scaring people saying they need to know really esoteric stuff of almost fellow level to pass it in my opinion is not ok. I for one sucked and always sucked at optics and anterior segment, I did make sure to study these topics like a mad man using the resources I shared previously. Do I have the knowledge of a cornea, glaucoma, or low vision fellow level? Hell no! But I did my best to at least not suck on those sections.

In the end I’m glad you and I passed and I wish for the people that failed that they find solace and can pass the second time.

You don't need to know esoteric fellow level knowledge for each section but at the very least you have to recognize these things and know the standard of care management. That includes specialty specific things that might be esoteric like Duane or ciliary body melanoma. As a comprehensive ophthalmologist, do you need to get into the specifics of how to address an RRD? No, but you need to recognize it and know that they have to be repaired via SB, PPV, or pneumatic. Same with a Duane syndrome or a ciliary body melanoma. On the orals the answer isn't to send to a specialist, you are it as far as they are concerned.

For whatever issues we have with it, one of the major purposes is this is the specialty's last chance to catch and rectify an ophthalmologist who doesn't know what he knows and may be a danger to the community. A lot of the questions asked are actual OMIC or precedent cases that ophthalmologists have been sued about or at least brought to some sort of lawsuit. So is it fair that a general ophthalmologist have to know these rare but potentially serious cases to their standard? Maybe, maybe not. But in the court of law you do, speaking as someone who had to be deposed on a case outside my specialty but still expected to know it well (guess that oral board review paid off in this case).

As far as you and your co-residents having issues with your specialty, if not a knowledge issue then it may be just being able to communicate your knowledge effectively in a high pressure situation . All of my colleagues in my generation plus and minus a few years never had issues with their specialty, but many of them were drilled during imaging conference and mock orals and were prepared as a result.

 

[Odincito]

You don't need to know esoteric fellow level knowledge for each section but at the very least you have to recognize these things and know the standard of care management. That includes specialty specific things that might be esoteric like Duane or ciliary body melanoma. As a comprehensive ophthalmologist, do you need to get into the specifics of how to address an RRD? No, but you need to recognize it and know that they have to be repaired via SB, PPV, or pneumatic. Same with a Duane syndrome or a ciliary body melanoma. On the orals the answer isn't to send to a specialist, you are it as far as they are concerned.

For whatever issues we have with it, one of the major purposes is this is the specialty's last chance to catch and rectify an ophthalmologist who doesn't know what he knows and may be a danger to the community. A lot of the questions asked are actual OMIC or precedent cases that ophthalmologists have been sued about or at least brought to some sort of lawsuit. So is it fair that a general ophthalmologist have to know these rare but potentially serious cases to their standard? Maybe, maybe not. But in the court of law you do, speaking as someone who had to be deposed on a case outside my specialty but still expected to know it well (guess that oral board review paid off in this case).

As far as you and your co-residents having issues with your specialty, if not a knowledge issue then it may be just being able to communicate your knowledge effectively in a high pressure situation . All of my colleagues in my generation plus and minus a few years never had issues with their specialty, but many of them were drilled during imaging conference and mock orals and were prepared as a result.

I don’t think knowing the basics of Duane syndrome, ciliary body melanoma or RRD counts as esoteric, especially coming from you who claims you got > 80 % on every OKAP exam. I believe that’s basic level stuff a comprehensive ophthalmologist needs to know, and guess what, also aphakic glaucoma (which if you went to a reasonable residency program with some Peds exposure or if you completed Ophtho questions or AAO qbank should know why it happens and how to manage it, etc).
You keep being obnoxious by judging me and the people I know and trained with plus the colleagues I have talked to with who obviously don’t agree with what you are saying. You are way too opinionated and think you have the sole valid truth and keep giving condescending answers, which I can see Can and has given you issues in the past, as it’s evident from your typed answers on this forum. I was trying to be reasonable but it seems with people like you that’s doesn’t work. As for me I won’t reply to whatever you have to say, case closed.

 

[Odincito]

My gosh I hated the voices too. And the numerous mispronunciations. It was so bad 😂

But I have an hour commute to work 3 days a week. Listening to that crap over and over 6 hours a week for months sure does burn it into your memory though 😂

I listened to it while taking the subway, I definitely would recommend the flash cards though! It has weird diseases I have never seen in like blepharoptosis and it’s Ddx.

My background: > 99 percentile on two okaps ( first one we didn’t get percentile as was it was the year after COVID and not many people took it) and did incredibly well on the WQE even tho I thought it sucked lol…

As for the oral exam:
I am a believer of over preparation, it’s impossible to know every disease but you do want to know about 80% cold and of course master any eye condition that can kill or blind a patient. Having said that, I don’t believe in having too many resources as it can be overwhelming and can create chaos or confusion.

The tools I used were as follows :
1 Ophtho questions oral qbank, videos for me sucked but the flash cards are worth it.
2 Pemberton—> I read it cover to cover thrice and practiced it about twice by myself and with some coresidents, timing myself and all, aiming to say my spiel in about 2.30 - 2.45 minutes
3 read luviano once, found it online, don think it added much, probably not worth it
4 Osler online videos to see how other candidates answered cases (this is good because the proctors offer advice and useful feedback which can apply to you, I found it really useful)
5 Ophtho genie—> practiced all cases by myself and then used its study buddy with some coresidents plus people I met online, repeated twice.
Time studied : 4.5 months, which may seem as overkill but I had many things riding on this exam. Including my job prospect and my family, so I took it seriously.

Contrary to what another individual said on this forum. I can say the exam doesn’t test esoteric , obscure information and content wise it’s is mostly fair. The cases I struggled with were mostly because of my inability to recognize the photo or because I really do suck at optics lol..thankfully due to my over preparation the cases were this happened were not many.
I didn’t read Wills eye or the BCSC manuals for this exam, there are many recipes to successfully pass this exam and they exist everywhere, but that’s roughly what I did!
I wish anyone that has to repeat this exam good luck and success! 🙏🏼

 

[Slide]

I don’t think knowing the basics of Duane syndrome, ciliary body melanoma or RRD counts as esoteric, especially coming from you who claims you got > 80 % on every OKAP exam. I believe that’s basic level stuff a comprehensive ophthalmologist needs to know, and guess what, also aphakic glaucoma (which if you went to a reasonable residency program with some Peds exposure or if you completed Ophtho questions or AAO qbank should know why it happens and how to manage it, etc).
You keep being obnoxious by judging me and the people I know and trained with plus the colleagues I have talked to with who obviously don’t agree with what you are saying. You are way too opinionated and think you have the sole valid truth and keep giving condescending answers, which I can see Can and has given you issues in the past, as it’s evident from your typed answers on this forum. I was trying to be reasonable but it seems with people like you that’s doesn’t work. As for me I won’t reply to whatever you have to say, case closed.

Lol, it's not a personal attack, don't get triggered over it. All I did was defend my viewpoint objectively and backed it up, and believe it or not other people may have different viewpoints and experiences that aren't wrong. Anyway congrats for passing, you'll look back at this in 5 years and realize letting the emotions of the oral boards take up this much space in your head rent free was unnecessary.

Addendum: now that I really think about it, the example I used was wrong. It was a congenital aniridia patient, not aphakic glaucoma patient. I didn’t realize it until I literally walked out the door. Did I need to know about it? Yes, but it’s much harder to recognize it quickly if you didn’t have much practical experience with the condition during training. You may not think it’s esoteric, but Peter Netland certainly did, and that’s what he saw a lot.

 

[TheLesPaul]

Lol, it's not a personal attack, don't get triggered over it. All I did was defend my viewpoint objectively and backed it up, and believe it or not other people may have different viewpoints and experiences that aren't wrong. Anyway congrats for passing, you'll look back at this in 5 years and realize letting the emotions of the oral boards take up this much space in your head rent free was unnecessary.

FWIW -- I'm >5 years out from the boards and I feel it was unnecessary and not a useful test of anything. None of us would make a clinical decision without doing a thorough exam first. Our specialty is uniquely dependent on the physical exam. Trying to come up with answers while purposely not being shown relevant parts of the exam is a useless guessing game.

also: in ophthalmology, you really don't have to talk to your colleagues. you can just document your exam with the necessary acronyms, and your colleagues will have the background knowledge to more or less pick up the pieces. our specialty doesn't really depend so much on patient history.

also: we shouldn't be treating this as a "last chance to filter out bad ophthalmologists". the older guys who haven't read a paper in 20 years and are still doing primary focal laser for DME (they exist!) are the ones we have to catch. but these guys grandfathered themselves out of it!

 

[Slide]

FWIW -- I'm >5 years out from the boards and I feel it was unnecessary and not a useful test of anything. None of us would make a clinical decision without doing a thorough exam first. Our specialty is uniquely dependent on the physical exam. Trying to come up with answers while purposely not being shown relevant parts of the exam is a useless guessing game.

also: in ophthalmology, you really don't have to talk to your colleagues. you can just document your exam with the necessary acronyms, and your colleagues will have the background knowledge to more or less pick up the pieces. our specialty doesn't really depend so much on patient history.

also: we shouldn't be treating this as a "last chance to filter out bad ophthalmologists". the older guys who haven't read a paper in 20 years and are still doing primary focal laser for DME (they exist!) are the ones we have to catch. but these guys grandfathered themselves out of it!

Eh I used to think this too, and I do think the oral boards probably need to be revamped in some ways (like clearer pictures), but this is true for a lot of things we do, like OKAPs. In fact if anything needs to be redone, it's the OKAPs because a lot of the test is useless minutae. This stuff should be caught at the resident-ACGME level, but realistically it’s difficult to do that because it’s very tough to ensure consistent training among all ACGME programs, so hence we have the orals. It’s hard creating an exam that is thorough while balancing cost and resources required to run it, since a lot of it is volunteer driven (the oral exam is essentially trying to simulate a "typical" clinic visit but no one is going to spend 30 minutes on a case). You need to have some sort of standard to ensure a basic minimum of care for the community and really to protect the ophthalmology “brand”. Lots of our patients can’t always tell between us and optometrists, much less specialists, and I don’t think we need to give more fuel breaking down those barriers.

I hate the whole grandfathering thing and agree, the worst care I’ve seen has come from these older guys, and luckily that generation will soon be retired. But if anything their existence why some sort of standard is needed to catch some graduates who need shoring up. The part about filtering out bad ophthalmologists is more about catching graduates who have specific deficits that weren’t caught on the WQE and on graduation, then correcting said deficits and then setting them free. The part about communication was more that you can be very book smart but struggle (not you) to translate it into clinical practice. It’s not a punitive process, else you wouldn’t get several chances to retake the exam. Speaking to a few who’ve failed, the process was humbling but in the end it did make bring to light if there were issues that needed to be addressed, and they felt in the end they were much better ophthalmologists. If you thought it was a waste? Well that’s good, you were very well prepared and the exam did its job. Personally, I thought the oral exam didn't do a bad job when I took it the second time - I really didn't have to play a guessing game and it was fairly straightforward. I dunno, maybe my proctors just did a better job second time around.

Also, part of the orals is the ABOP protecting itself. The exam is a way they can tell other accrediting bodies that “hey, we made sure our graduates who passed can recognize really bad things in the eye because they’re in the exam”.