Oral boards question

[iradi8u]

I'll be taking my oral boards this year and I don't have a study group, so I will be attending Osler to get as much mock oral practice as I can, but I don't have people to bounce questions off of.

I do not perform brachytherapy and do not have SBRT/SRS available where I practice, so I'm not sure how to answer questions on those techniques appropriately in the boards.

For example, do I say something like, "I do not perform brachytherapy at my institution, but I would certainly discuss the risks and benefits of LDR/HDR with this gentleman to help him decide and refer him accordingly if he were to choose that route" and then expect to answer the 'how would you do it?' question afterwards, or should I just not mention that I don't have brachy available to me? Same thing for SBRT/SRS.

Thanks.

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[medgator]

Did you not do brachy in training? They will probably ask what you did in training, particularly in GYN where it's pretty much standard of care (studies document poorer outcomes without brachy).

 

[OTN]

Not having a good answer when it comes to brachytherapy is going to be really problematic for the gyn sections. For everything else (prostate, skin, etc) you have other viable tx options you could elect to pursue (after talking about how you would go over brachytherapy with the patient, naturally), but with gyn brachy is an integral part of treatment.

 

[iradi8u]

Yes, I was trained in brachy in residency. My question is really about whether I tell them up front that I do not currently perform brachy and would refer but then properly walk through the steps, or if I should just start answering. I'm sorry, I didn't make that clear.

My question really stems from the fact that I don't perform it in my clinic and I want to make sure an examiner wouldn't find it misleading if I said something like, "I would perform LDR brachy by doing the following..." and to then have him/her come back with a question like, "What planning system do you use?" I would have to answer that I don't currently perform brachy.

I'm just trying to figure out whether it's important for them to know that I do not currently perform it but I do know what I'm talking about.

 

[radiaterMike]

Yes, I was trained in brachy in residency. My question is really about whether I tell them up front that I do not currently perform brachy and would refer but then properly walk through the steps, or if I should just start answering. I'm sorry, I didn't make that clear.

My question really stems from the fact that I don't perform it in my clinic and I want to make sure an examiner wouldn't find it misleading if I said something like, "I would perform LDR brachy by doing the following..." and to then have him/her come back with a question like, "What planning system do you use?" I would have to answer that I don't currently perform brachy.

I'm just trying to figure out whether it's important for them to know that I do not currently perform it but I do know what I'm talking about.

I would definitely say what you actually do. I agree with others that you will need to describe brachy for gyn. So for gyn- if you refer a patient with gyn to another site for brachy, I would not say that, but would rather say "I would offer the patient brachy", and then explain how you would do so. So- defer to what you did in residency since you don't want to be caught describing something you do not do.

On my exam, when I said that I know some people would offer [insert option here] for ... but I would not do that ... the examiner quickly told me to only describe what I would do.

 

[seper]

must know how to describe doing vaginal cylinder and T&O (either LDR or HDR). Otherwise - high risk of failing.

 

[napoleondynamite]

In general, yes, the dictum is to say what you actually do.

But you are aiming to become a board certified radiation oncologist..so just because you don't do it, doesn't mean you don't have to be able to describe how SRS/SBRT should be done..because your license will allow you to do it. You should NOT say "I don't do SBRT so would refer them elsewhere"..no, no, no!

You need some scripts for brachy and SRS/SBRT. Talk it through with people who do it..

 

[ramsesthenice]

Pretty detailed from my understanding. I have not taken my orals yet but I have been told multiple times (by an ex-examiner and young attendings who recently completed) you have to know practical details of GYN brachytherapy. My friend last year had to look at a sim and identify the problems (improper flange placement for one, not enough packing in the other). Nothing all that hard if you have some experience. If you didn't do that many, could be harder. You have time. I strongly agree (for what it's worth) with everyone above. GYN is the one brachytherapy that really is THE recommended therapy and that makes it fair game.

 

[arthurdent]

anyone know when we get final notification of our actual exam date from the ABR?

 

[HatchetJack]

ABR told me earlier this week that exact exam dates will be known in early March.

 

[Bequerel]

When asked about GYN T&O brachy procedure, could I answer what I do in my current practice? Currently, during the last week of EBRT, I am having the GYO put in a smit sleeve and the patient has an MRI. She then gets 5 T&O placements under conscious sedation in my clinic. Or do I need to answer that I take the patient to the OR every time and sound the uterus, dilate the uterus, etc? Also, in residency and practice, we never took xrays in the OR..is this necessary with MRI/CT volume based planning? Thanks.

 

[seper]

I'd say this is perfectly fine. May mention that planning CT gives you scout AP/Lat views , which you scrutinize.

 

[CharlestonRadOnc]

I just took and passed the 2014 ABR oral boards so here are my comments:

(1) I would urge everyone to find a study group - it is very important to discuss your treatment approach with residents from other institutions to make sure that your answers are in line with the standard-of-care.
(2) Your examiner will not ask if you do GYN brachy - that's because GYN brachy is the standard-of-care for cervical cancer and you must know how to describe a T&O, vaginal cylinder for endometrial cancer, etc.
(3) Even if you do not do prostate brachy (it's fine to admit that if they ask), you must be able to describe the technique for either LDR or HDR.

Good luck to everyone taking the oral exam this year!

 

[seper]

yeah, for prostate brachy, I was asked: "Can this be done HDR" - "Yes, but I've never seen a case personally" - "How is HDR BCT dose prescribed?"

 

[UCLAradonc]

2nd Annual Rad Onc Case-Based Education and Skills Assessment Workshop
The Department of Radiation Oncology at UCLA will be hosting this course for current and recently graduated residents in LA April 25-26. Prominent faculty in academics and community practice throughout the country will be administering the exams and didactics. It should be a fun weekend of review (with disease sites appropriate to your PGY level) and an opportunity to meet other residents and faculty in our field! See the following page for details and to register (resident fee $100 until March 1).http://radonc.ucla.edu/edsymp2015

 

[woodview]

2nd Annual Rad Onc Case-Based Education and Skills Assessment Workshop
The Department of Radiation Oncology at UCLA will be hosting this course for current and recently graduated residents in LA April 25-26. Prominent faculty in academics and community practice throughout the country will be administering the exams and didactics. It should be a fun weekend of review (with disease sites appropriate to your PGY level) and an opportunity to meet other residents and faculty in our field! See the following page for details and to register (resident fee $100 until March 1).http://radonc.ucla.edu/edsymp2015

Did anyone take this course last year? If so, could you please consider PM'ing me with your honest opinion of whether it was helpful? Thanks.

 

[Bequerel]

For oral boards, what is the safest answer to an HPV+, EBV-, nonsmoker unknown primary...oropharynx alone or entire pharyngeal mucosa? Thanks.

 

[BobbyHeenan]

For oral boards, what is the safest answer to an HPV+, EBV-, nonsmoker unknown primary...oropharynx alone or entire pharyngeal mucosa? Thanks.

HPV(+)/ EBV (-) nasopharynx cancer, especially in white patients, has been described in the literature.

I still treat nasopharynx/oropharynx down to vallecula for these cases and try to spare larynx especially if the node is level II. It's probably overkill, but until someone publishes a series of patients treated to oropharynx alone (because I don't want to be the only one or first one doing it), I'll probably continue to treat the nasopharynx/oropharynx per the recommendations in Gunderson.

I think it's completely fine to treat only the oropharynx and would not question anyone for doing so in the case you mentioned above, but for now that's not what I do.

 

[seper]

I'd say treating ipsilateral BOT and tonsillar fossa only is a safe board answer for TxN1 unknown primary in level 2, p16+.