Oral boards musings — where is the line?

Discussion in 'Anesthesiology' started by WashMe, Mar 11, 2018.

  1. WashMe

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    Now that the 1st week is done, we’re getting heavy into “oral boards season” which is now several months long. It seems nearly universal that people walk out doubting whether they passed. There are many opinions about where the “passing line” might be, i.e. “Don’t make an egregious killing error” vs. “you can only say ‘I don’t know’ once or twice,” which are rather different levels of performance.

    For those who have previously taken the test — pass or fail — do you have any anecdotes or stories about the types of mistakes you made and how your exam went overall? For instance, how many times did you admit lack of knowledge? Did you say anything you later found to be factually incorrect and the examiners just moved on? How many times did that happen? Did you have any pauses where you struggled to answer a question? Etc.

    It would be massively helpful for posterity if we could define the sort of performance that actually constitutes a pass.
     
  2. Mman

    Mman Senior Member
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    I felt like I mostly got through everything on every stem. Occasional misstep that I realized when I got prompted by a further line of questioning. Eventually said "I don't know" on almost every line of questioning because they just keep going until you have to say it. I felt I communicated safe anesthetic plans well and walked out thinking it wasn't that bad. Passed. In hindsight I think it's mostly a test of communicating clearly in a stressful situation. Just remember, you already know the anesthesia. It's just spitting it out so someone can understand your thought process.

    Also, I didn't hesitate to pause for 5 or 10 seconds to gather my thoughts before answering things. While it might be awkward in conversation, it isn't a conversation, it's a test. Make sure you collect your thoughts before saying them. Just gabbing to keep the conversation flowing is a bad idea IMHO.
     
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  3. pgg

    pgg Laugh at me, will they?
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    Quite a while ago I was deposed for a malpractice suit against the government. I was a resident in the ICU when a surgical complication was admitted.

    The government attorneys who prepped me for the deposition said over and over again that while the plaintiff's attorney would control the tempo and substance of the questions, I had control of my answers. And that I should always, always leave a deliberate pause (even if only a second or two) before answering a question. And the faster I wanted to blurt out an answer, the more important it was to wait before speaking.

    The kind of sorta-hostile, leading, baiting, probing questions the plaintiff's attorney asked me was like the worst bits of my oral board exam.

    The wanker even had the audacity to challenge one of my answers about the transfusions the patient got. He whipped out some random article from some throwaway journal and slapped it down, Perry Mason style, like he'd caught me defending the indefensible, declaring that the standard of care Right Here says we should have given XYZ instead of ABC. I opened my mouth to retort, closed it, and then said I would have to read the article to be able to comment intelligently on it. And then I sat there for about 30 minutes reading it before precisely and scientifically telling him his article was a bunch of crap. And he moved on.

    Eventually the government settled (surely for some ungodly amount of money) but it wasn't because I handed them a win.

    A 30 minute pause won't work for the ABA oral board exam, but don't underestimate the power of a pause to slow down the tempo of the exam and collect your thoughts before saying something stupid.
     
  4. WashMe

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    Thanks for the posts :)

    Anybody else care to chime in? Anything would be helpful, but the most beneficial things to hear about would be:

    (1) anyone who failed and was surprised to fail -- what is your honest-self assessment of the number and type of objective mistakes you made?
    (2) anyone who passed but basically expected to 100% fail -- how bad was the test day, what sort of things did you screw up and somehow get away with?

    The goal of this is to come to some sort of understanding about the minimum level of expected performance to result in a passing score. Not that it's smart to aim for that, but given the prolonged wait time for results it would at least allow us to frame our expectations more accurately in the mean time.
     
  5. agammaglobulin

    agammaglobulin ASA Member
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    My understanding is they score your performance on each question they ask on a given stem 1-4, and average it out for the stem. The pass line I would think varies depending on the curve of that stem over the day/week. They may have some automatic fails (ACLS/PALS incorrect, etc) but I think it's a score that determines pass/fail...not a 'feeling' about your performance at the end of each session. When I hear back re passing or failing I'll be happy to share the stupid things I said.

    Regarding taking time to collect your thoughts, I think it's a good idea if it saves you from saying something incorrectly. However, keep in mind there are a lot of questions to get through and you want to be efficient in answering them.
     
    #5 agammaglobulin, Mar 11, 2018
    Last edited: Mar 11, 2018
  6. dchz

    dchz Avoiding the Dunning-Kruger
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    Exactly what PGG said.

    My institution gives us a mock oral boards every year.

    I use it to practice my Tempo rather than knowledge since they give you really easy prompts.
     
  7. Newtwo

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    Aside I can't believe ACLS or pals missteps are auto fails especially considering they're a load of ****e anyway thought up to help novices help Jane doe who is completely unknown to anyone, which is almost never the case in theatre where we spend 99% of our time
     
  8. acidbase1

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    What are some things you wouldn’t walk in there without knowing absolutely cold?

    ACLS
    PALS
    Neonatal resuscitation
    ...
    ...
     
  9. agammaglobulin

    agammaglobulin ASA Member
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    Classic comorbidities/complication for each subspecialty of Anesthesiology (if that makes sense...)

    Regional - LA toxicity
    OB - pre-eclampsia, Post-partum hemorrhage
    Peds- MH, basics of 4T's and 4D's of cardiac defects (especially ToF), TEF, Pyloric Stenosis, others i cant think of
    Cards - Bypass complications/troubleshooting
    Neuro - TBI management and difficult airway management, Air embolism, GCS
     
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  10. B-Bone

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    The most high-yield thing I committed to memory (and was able to barf out in my sleep) was the chapter on vital sign abnormalities from Board Stiff. Every stem will have questions about hypotension/hypoxia/etc, and having a calm, organized, and complete differential diagnosis to rattle off makes you sound like you know what you're doing, gives you a chance to think about what's actually going on, and is actually useful in real life situations. I use it to this day in the OR.
     
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  11. 0kazak1

    0kazak1 ASA Member
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    I talked to a few attending's where I'm training, any many of them felt they did poorly on the oral portion of the exam, but they all passed on their first try. I understand a lot of the stress come from it being a high stakes exam, but if for some weird reason you don't pass, you'll get it the second time around I'm sure.
     
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  12. crash2500

    crash2500 ASA Member
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    What about realising and admitting a mistake in management? Can you still salvage that?
     
  13. Sonny Crocket

    Sonny Crocket ASA Member
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    You should look into how they grade the exam and how they determine passing and failing. The pass rate is like 90% I think. They have a series of questions that they need to get through so they often cut you off as you are explaining the right answer. That can make you feel weird as you are getting zero feedback and it makes them seem a bit rude perhaps. So even though you get a lot of questions right , you walk out of there not feeling that great.

    I recommended a nuclear perfusion scan for a patient in the pre op section of the exam. They then asked me to explain the ins and outs and what have yous of this perfusion test. I went blank and told them confidently, “ I think we should move on.”

    They were a bit surprised and they said fine. And we moved on. I did pass on first try as most people do.
     
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  14. Robotic Wis-Hipple

    Robotic Wis-Hipple ASA Member
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    Yes, absolutely. Don’t feel committed to arguing the wrong side because you hurriedly spat out the wrong decision. Just parry by saying something like, “alternatively one could do x,y,z”. You can misspeak, you can change your mind. Just don’t do it everytime they start grilling you on your choice because that is the point of the exam.

    You will be grilled, you will be made to feel as though they believe you’re going down the wrong path. But in reality a lot of the decisions you are forced to make are from the place between a rock and a hard place and there is no clear “correct” way so you need to be able to address the pros/cons of each choice, pick one, and defend it.
     
  15. Robotic Wis-Hipple

    Robotic Wis-Hipple ASA Member
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  16. crash2500

    crash2500 ASA Member
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    Ya, I basically said one thing, went down a line of questioning that basically priced my original answer wasn't a good idea, and they then questioned me on my original plan. Realizing my mistake, I didn't think I could defend my original plan so I said, ' that was a mistake. I would actually do xyz.' And the exam went on to other topics.

    We shall see. It was a key big misstep of an important part of the stem, in my opinion, and people always say you sold be decisive and defend your plan. Thus, I am concerned.
     
  17. WashMe

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    Yeah, nothing for us to do now but wait. Well, and wallow in misery and self pity.

    I wonder if the results will come out in batches within a week. Like will Monday takers all get results, then the next day the Tuesday takers will get results, etc.

    I hope the “2 week turnaround” suggested in the videos, which they actually showed on test day, is accurate. The process is uncertain enough without adding a lie on top of it.
     
  18. Gern Blansten

    Gern Blansten Account on Hold
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    If your original plan was defensible, then defend it with the recognition that another plan may be a reasonable approach as well. If your original plan is indefensible, the longer you stick to your guns and keep doubling down on that plan, the harder it will be to recover, in my opinion. Sometimes they will throw you a life line to try to allow you to save yourself by reminding you of a nuance in the case that may make your plan sub-optimal. Decide quickly if this is a life line they are throwing you or an anchor that will lead you into an unrecoverable situation.
    The sooner you recognize that you have made a grave error, the better you will be able to reverse your fortune. However, if the exam has completely moved on and you want to go back to an early question and completely change your plan, that is unlikely to be successful. For instance, if they are on the grab bag questions and you decide you want to discuss the preoperative preparation on the patient from the stem question, they will likely look at you as if you are crazy. It is best to just move on and not keep stewing about a bad answer if the moment has passed.
     
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  19. Gern Blansten

    Gern Blansten Account on Hold
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    The 2 week turnaround is pretty accurate in the past couple of years. I don't believe they ever batch them by days. I am pretty sure they release them all at once for those who took it that week. It typically involves a site shut down of access for those who are not candidates which allows the candidates the opportunity to log on and find their status without having to find out about it from others.
    For example, if we both took the exam the same week, I could look at mine and see that I now have diplomate status and that you do not. Therefore, if I am astute, I will know that you did not pass. With limited access for a ~24 hour period, it gives candidates ample opportunity to log in and check their status for themselves so that they are the first to know. At least, I think that is why they do it in this manner.
     
  20. Gern Blansten

    Gern Blansten Account on Hold
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    Using Jedi mind tricks against oral board examiners? Awesome.
    [​IMG]
     
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  21. crash2500

    crash2500 ASA Member
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    Thanks for the info Gern. I think in my situation they clearly steered me in the direction of correcting my mistake. They then questioned my initial plan. After I admitted my mistake and corrected it we moved on. Hopefully it was not bad enough that I fail. I think the rest of my exam went well.
     
  22. pmichaelmd

    pmichaelmd Senior Member
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    Overall I felt pretty good about it, but that was a pretty long time ago.

    Generally, I would advise you to realize that there are many ways to skin a cat and that you should feel comfortable going down any of those feasible pathways. There are also some relatively absolute wrong things that you will want to avoid saying ("I see this patient has severe aortic stenosis so I would obviously place a spinal!"). It is all about being flexible, which is also useful when out practicing in the real world. When I am interviewing candidates for employment with my group, we may occasionally venture into "what if" territory just to get a feeling as to whether or not the candidate exhibits flexibility in his or her thought processes.

    Also, keep your cool and, as mentioned above, don't be afraid to pause and collect yourself. On my second stem, a long OB stem, I walked into the room and learned that my senior examiner was none other than David Chestnut. After my momentary flash of shock and awe, I settled myself and proceeded to regurgitate Chestnut wisdom to Chestnut himself. Boom, pass.

    Don't feel the urge to demonstrate how smart you think you are or how much you know either. I guarantee you, they know more than you do. Give a well-reasoned answer and then let them draw more out if they didn't get what they wanted. The more you volunteer, the more they can steer the conversation down a rabbit hole and allow you to bury yourself within.
     
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  23. acidbase1

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    Do Chestnut and Miller still proctor orals?
     
  24. FFP

    FFP Wiseguy
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    All they want to know is that you can practice anesthesia safely. Just don't harm the patient and you'll be fine. Be conservative, but reasonable. This is not the place where you do a laparoscopic case with an LMA, but also not the place to AFOI everybody. Be flexible when possible, firm when not (e.g. surgeon does not want to respect NPO guidelines for elective surgery).
     
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  25. Dr.whom

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    Remember that the stem is an incomplete picture of the patient you are taking care of. Your clinical decisions will require additional information that you can assume, but you should state these assumptions out loud so they know you are thinking about it. If they don’t like your assumption, they will tell you. During each session, your patient will change depending on additional information given to you, so your decisions should change accordingly. So be flexible. Know your basic stuffs cold. Missing a question about a rare disease isn’t as important as missing a question that everyone should know.
     
  26. WashMe

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    Results will evidently be delayed at least a week based on an email they sent out this morning. Frustrating behavior on their part, since they stated in no uncertain terms on both the website and on test day that results would take 2 weeks. Not 1, not 3, not “2-4” or any other interval. If they’re this far behind on week 1, I imagine it will be bad by the summer.
     
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  27. acidbase1

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    Based on the crap they pulled with the advanced, I’m not surprised
     
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  28. p30doc

    p30doc Ever true and unwavering
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    Agreed, not cool! Send me my results of the OSCE in a couple months, but at least give us the results of the oral portion. That’s what everyone really cares about.
     
  29. WashMe

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    For future readers of this thread, I passed. Said some pretty dumb stuff in retrospect, but also said some smart stuff and made zero “killing errors.” I would have felt more comfortable if I had prepped more knowledge based stuff, like what you see in Faust. Ended up not mattering, I guess. Done! :D

    Edit: for those interested, I read this book twice

    I also did Toronto TEE website and looked over some block anatomy. Practiced oral exams alone, never had a study partner. That probably would have made me feel more comfortable but is not 100% necessary.
     
  30. AdmiralChz

    AdmiralChz ASA Member
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    +1 to this book, it's an excellent overview and not too wordy. Can easily get through it in a week or two. Basic but good for those just starting to study for the orals, and as a quick review on certain topics.
     
  31. crash2500

    crash2500 ASA Member
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    PASSED!! Feels great. Words can not describe it.

    Looks like the major mistake I made was not enough to fail me since I identified and corrected it. If you have an oversight where you're management is not justifiable, do not hurt yourself more by sticking to your guns and defending the indefensible. Admit the mistake, fix your management and move on.

    I used the UBP pdf of books 1-6 which was good for knowledge but was honestly overkill. The answers were too detailed and too long and didn't give you a good feel for how to actually answer the questions or the level of detail that you really need. It was good for knowing what were high yield topics. Study for improving your knowledge base not necessarily for formulating answers.

    Board stiff three was great on the other hand. Very high yield and practical. Easy read.

    Just oral boards mock exams were great for getting a feel for the actual exam. Likely would have failed if I hadn't done these. You just cannot simulate the speed or aggressiveness in your own or with a non board examiner. I would say two at minimum but probably four or more to be comfortable depending on your progress.

    As everyone says, practice.
     
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  32. Swizard210

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    Crash2500, congrats! Glad to see that you were able to have a similar experience as I did with Just Oral Boards, but I definitely agree, it's smart to diversify your resources and find what works best for you! Way to go!
     
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  33. Hvm

    Hvm

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    Hi guys I just took my oral board, I did well on OSCE but in SoE part, total in 2 stem questions, I had 6-7 wrong answers and total 5 times I said( please move on ) . Do I have chance to pass?!
     
  34. Hvm

    Hvm

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    Hi guys I just took my oral board, I did well on OSCE but in SoE part, total in 2 stem questions, I had 6-7 wrong answers and total 5 times I said( please move on ) . Do I have chance to pass?!
     
  35. Twiggidy

    Twiggidy ASA Member
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    NO ONE know everything, no matter how much they think the do. The stems may seem complicated but in reality they are the basics of every aspect of anesthesia and you just need to know how to communicate what you will do. I got a pain question in the “grab bag” portion and I only know the surface of pain but I just said “Sorry I don’t know” if i didn’t know. They can smell BS from the first floor of the hotel.

    Somethings you absolutely want to know cold
    Airway algorithm
    ALCS (maybe PALS but that a big maybe)
    And just “ready to go” answers for hypoxia, hypotension, tachycardia, etc

    Example: “I would give 1 cc of phenyephrerine for hypotension ” may be the correct answer in practice but it’s an incomplete and possible failing answer in orals. That’s where a course or a real good prep program in residency will help.
     
  36. Hvm

    Hvm

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    are we getting the results tomorrow?
     
  37. buddababa

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    Yes, not sure if I want my results though. The stress/anxiety with this exam is/was more than I've ever experienced in my life.
     
  38. Hvm

    Hvm

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    Can we talk? can I have your phone number?
     
  39. ElPais

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    Yea, tomorrow I will find out that I failed and that I need to completely change and redirect my life into a different course.
     
  40. buddababa

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    Send me a PM. in the process of moving don't have access to my phone
     
  41. ElPais

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    Today is the day :(
     
  42. timgasman

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    Glad to hear it
     
  43. interscalene

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    Thanks to everyone on these message boards ; finally passed the oral boards thanks to ubp sets, just oral boards , board stiff, and that dr trans rapid review book that is mentioned in this thread, The most helpful are mock exams from just oral boards as just reading for me doesnt do it. I needed experienced examiners and a realistic pace
     
  44. timgasman

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    Good job!
     
  45. Star2285

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    I have a ton of Oral Boards material I am selling. If you are interested message me!
     

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