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Part II of the Boards...

Discussion in 'Psychiatry' started by MBK2003, May 14, 2008.

  1. MBK2003

    MBK2003 Senior Member
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    I just returned from the oral boards and I wanted to share my rant/pain. I expected to have a difficult live patient interview and was not surprised with my patient who demonstrated symptoms from most DSM-IV domains. But the vignettes were a total shocker for how vague and ambiguous some of the cases were, and then many of the questions seemed to be from left field and not at all what I was expecting. I walked away from the vignettes thinking, gosh if I'd been able to figure out what question they were asking and given them the "right" answers, I don't think that would have actually demonstrated much in the way of practical competence to treat psychiatric patients. I felt like I was back in medical school with the "Guess What I'm Thinking" attending pimping. I looked back at the sample vignette online and found that what I experienced (and others in my group) were remarkably different. Did anyone else who took the boards this year or last year have similar issues with the vignettes?
     
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  3. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    This was my experience as well 2.5 years ago. I really think that it is designed to be vague, allowing you to discuss (and the examiner(s) to ask about) the entire DSM differential for the patient, what further info you would want, and what kinds of treatment options one might have, etc. In other words, as with our patients, there rarely IS a "right answer".

    I think if you found it frustrating, you probably passed! :thumbup:
     
  4. Doc Samson

    Doc Samson gamma irradiated
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    I agree. My experience of the vignettes was similar in terms of nebulousness, but I was actually happy with this since I had been told time after time in mock boards that the whole point of the oral boards is to make sure you can explore a differential. The more nebulous the presentation, the more there is to talk about. My live patient, on the other hand, threatened to kill me in the first 2 minutes of the interview, making for a very interesting half hour.
     
  5. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    :eek: It does narrow the differential down a bit, though...
     
  6. MBK2003

    MBK2003 Senior Member
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    Yeah but, I think what I found frustrating was where the case described a patient with sxs from multiple mood, anxiety, somatoform, and trauma domains, and it was "Name the classes of medications you would consider in this patient." I felt like just to name the various classes of psychiatric medications was a pointless exercise, and doesn't demonstrate an ability to think like a well-rounded psychiatrist. With that case I felt like, "Come on, ask me about what I would want to know to narrow the differential or to develop a psychodynamic formulation, etc." This is not to say that all the vignettes and questions were a pain, but some of them were clearly out of left field and I was challenged to control my "Huhhh?!?!" response.

    I was very fortunate to not have THAT type of live patient and mine clearly did not live up to the oral boards live patient horror stories that I've heard. My concern was that they only asked me a few questions during my presentation, and only at the very end during the psychosocial treatment discussion. I'm assuming that means they thought I knew what I was talking about or that I was a lost cause. :confused:

    I guess I'll know in 4-6 weeks whether I've been put out of my misery or will have to be tortured by this exercise one more time.
     
  7. Doc Samson

    Doc Samson gamma irradiated
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    In other boards news, just found out that I passed the Psychosomatic Medicine boards, so now I'm an official psychosomaticist (though I think I'll stick with consultation psychiatrist). ;)
     
  8. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    :banana::banana::banana::clap::clap::clap::banana::banana::banana:
     
  9. Anasazi23

    Anasazi23 Your Digital Ruler
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    Congrats!
    :hardy:
     
  10. Doc Samson

    Doc Samson gamma irradiated
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    [elvis voice] Thank you, thank you very much [/elvis voice]
     
  11. michaelrack

    michaelrack All In at the wrong time
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    The way to answer this type of question is something like " after obtaining more hx and reviewing records to confirm my provisional diagnoses of MDD and PTSD I would consider starting an antidepressant such as duloxetine, which would be helpful for his depressive and anxiety symptoms, and also possibly helpful for his pain symptoms. Other reasonable antidepressant options would include an SSRI such as sertraline. I would monitor for the emergence of manic symptoms and would consider a mood stabilizer such as vpa if manic symptoms emerged...." keep on talking until you're asked the next question, or are asked for clarification.

    I took the orals 5 times; the vignettes are much easier than the old 25 minute video patient. If you don't pass this time, you may benefit from a course that teaches the oral board format- the Beat the Boards (google Beat the Boards or google Blue Tower Institute) course was helpful to me.
    I also passed the April Psychosomatic boards, and am now done for a while with board exams- it's a relief, I've been taking an average of 2 exams per year for the last 6 years. Now there's only Maintenance of certification to worry about.
     
  12. Doc Samson

    Doc Samson gamma irradiated
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    Congrats (sorry, i don't know how to make dancing bananas appear). What did you think of the test? I found it slanted heavily toward OB, HIV, and pain, but am happy not to have to think about it again until 2018.
     
  13. Faebinder

    Faebinder Slow Wave Smurf
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    [​IMG][​IMG]
     
  14. michaelrack

    michaelrack All In at the wrong time
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    thanks Doc Samson; Congratulations to you too.
    Right after I took the test I though it was difficult. Of course, at that time I didn't know that the passing standard was going to be 67%. There were a lot of questions about transplant meds (sirolimus, cyclosporine, etc). I didn't have time to read that chapter in the textbook and found those questions to be hard.
     
  15. ronin12

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    Had my oral boards in may, 08. some vignettes were definitely vague and open to all kind of vague questions. i tried to make best out of them and tried to explore all options. video vignette was also quite vague and even examiner misheard the presentation and thought pt was still symptomatic ,but actual pt was talking about past symptoms.some of questions asked in video were not adressed in presentation. so this whole thing can be weired. overall i think i did ok in both vignettes and live pt and answered majority of questions. especially in my live pt most of the time was spent for questions and answers as they did not let me finish my presentation and kept on cutting me in between presentation.most of the questions were about psychosocial issues ,which i think i handeled well.i am keeping my fingures cross. this whole exam is heavily subjective and at the discretion of examiners, if they want to give you hard time they can easily do so.but hope for the best. good luck to all !
     

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