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2+ Year Member
Dec 2, 2015
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I am writing to discuss preparation for the pediatric board exam and hoping to encourage your own efforts with my n=1 experience. I had checked this forum for posts but hadn't seen many recent ones.

Exam background: the exam is 330-350 multiple choice questions on a computer administered in 4 blocks of questions over one day at a testing center. It is actually quite similar to the ITE in that the prompts are relatively short. Regarding the pass rate, you can find more information about the boards pass rate on the ABP website. The pass rate (before my year) for the prior 5 years was 81-86%. My residency however typically scores a 100% pass rate, which you can compare with other programs at the above link. Surprisingly, you can only take the exam on a single day during a three day period, which was for me in early October (I hadn't known that until I actually registered for the exam).

My background and approach: for the USMLE exams if memory serves I scored in the 70th-80th percentile range, however that was just above average for my residency class. For the ITE exams, I scored at or above the average for my residency class, and of note we did perform well compared to the national average for pediatric residency programs. My PGY-3 score gave me a 90% probability of passing the board exam.

During residency: I predominantly learned through our residency curriculum and by reading about patients almost exclusively on UpToDate. Because I performed curiously well on the ITEs despite not having done any diligent independent boards study regimen, and I was engaged in active research pursuits during residency, I did not begin a more active approach to boards until PGY-3 year (a system I do not recommend).

I asked my current and previous Chiefs about how they approached boards and received varying responses. My summary would be that one should complete as many years of PREP questions as able (3+), with attention to weak areas and review of missed questions, and augment this with either the Medstudy books (excellent information but overly dense for some) or Laughing Your Way (easier to read).

I chose to review 3 years of PREP Questions (2016, 2015, 2014 ; ~250 questions each), review Medstudy books for weak areas or those that need repeated memorization (syndromes, vaccines, milestones) and then supplemented this with a Medstudy Qbank subscription, completing ~750 of those prior to the examination. I attempted to review 10-20Q per day during the second half of PGY-3 year and didn't come close to accomplishing this until the end of residency, so I went into starting a very busy cardiology fellowship having done just about 350 PREP questions.

Unsolicited advice: Despite understanding that residency is very difficult and busy, your life after graduation will likely be harder and/or less compatible with studying. For those in fellowship there is another steep learning curve and the continued trainee lifestyle, and for those out in practice, you will have a very challenging new role to fill. You will likely be moving and living in a new place on top of this. Suffice it to say, your future self will thank you for, within reason, preparing as well as you can during residency (which I did not).

For the exam itself, it was actually very similar to the ITE. This was unique in that I'm familiar with the 'long prompt, vague tertiary answer' type USMLE question, or the random factoid question. The board exam seemed to be largely comprised of arbitrary judgment type questions, which makes it challenging to feel confident in one's approach or in one's performance on the exam. Following the exam, though I figured that with my residency's typical performance and my past performance on standardized exams, that I would likely pass, I was also really nervous that I didn't. I had essentially crammed over the two months before boards. This made me much less confident in my performance, and wish I could go back to residency and do my due diligence.

I ended up scoring a 200, a passing score is 180. People can score as high as 250. I was above average by the scaled scores but not by much.

In summary:
-given my prior testing related performance, a residency program that seems to prepare grads well for the boards, and having completed 3 years of PREP + 750 q Medstudy + Reviewing the Medstudy books for weak areas, I was ultimately well-prepared for the boards
-if I could go back, I would:
-actually read the Medstudy chapter for each rotation I was on (Gen Peds for CPAM, Adolescent for Adolescent, Allergy for Allergy, etc...)
-try to review more study questions in residency to build a knowledge base
-not put off boards review until after graduation
-most importantly: I would've actively sought out conferences and better conference attendance. This frankly would've given me the confidence to say I'd extracted more from residency, instead of cramming and then wondering if "I had done enough"

Very best regards to everyone studying for the boards. If you're interested in making the most of yourself and the least of your social life by becoming a pediatric cardiologist, you can also reply to this or send a message.
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10+ Year Member
Jul 6, 2006
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Since there's a lot of advice going around the forums, I'll give my $0.02 as well.

My background: I scored below the mean on Step 1, then blew Step 2 out of the park. My ITE score intern year was okay, and then I 'passed' both second and third year (over 180, which is the score to pass boards). I'm a chief now with a fairly heavy clinical load (we do about 25% clinical time), and our program's board pass rate is below the national average.

During intern year, I focused on staying afloat. I did some Hopkins modules (required by our program), and some Peds in Review reading along with the occasional question when it was slow on nights, but didn't do any firm studying.

Our program provides MedStudy flashcards and books our second year, and Laughing Your Way Through the Boards in third year. During my electives in second year, I would read more about whatever specialty I was in, and do more PREP questions. I completed each year of PREP before they expired off my account, but didn't focus much on the more recent years. After I got my books, I started reading through the sections of the rotations I was on (Endo when I was on Endocrine, etc). I continued this and added some flashcard studying during third year.

I wasn't a huge fan of Laughing, so I didn't use it at all during residency. During the second half of third year, I increased the amount of questions I did, so I was probably doing an average of 5 or so per day. By the end of July after graduation, I had read through all of the MedStudy books, and been through the flashcards at least once. Then I started watching the MedStudy videos and taking extensive notes on them. I finished all the videos about 2 weeks before the exam. I continued doing lots of questions. In the end, I got through 2012, 2013, 2016, and 2017 in the few months before the boards, with 2015 being completed while I was still in residency. I went back through and did the questions I missed as well.

In the two weeks leading up to the exam, I started skimming through Laughing. It's a great refresher, and I remembered a few tidbits I read in there when it came to the exam. I took the ABP practice test during this time too, and got a pretty good score on it, so I relaxed the 3 or so days leading up to my exam.

The exam itself seemed much easier than I expected it to be, but the topics were not necessarily what I studied (there was a lot of child abuse questions on our exam). I passed by a comfortable margin, and our class pass rate seems to be better than our previous program pass rate (though we don't have the final report yet).

I think the key is to figure out how you learn best, and focus your study there. For me, that was questions and writing things down, so the videos and PREP banks were very useful to me. The other chiefs in my program both used the MedStudy questions and loved them, but I chose to focus on PREP because I liked the complexity of the responses.
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2+ Year Member
Jul 20, 2016
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  2. Attending Physician
Just to preface- my step 1 score was below average, step 2 was slightly above average. My ITE were consistently the best in my program and I was projected to pass the boards any my 3rd year. I passed on first attempt by a comfortable margin, slightly above average. My residency program has consistently scored below the national average.

I did not directed studying until my 3rd year. I did what most residents do- read about my patients, partipate in noon conference and just show up to work. By third year I purchased the medstudy books with q&a, and started using the PREP qs. I took for grant that I was the highest scorer on the ITE.

By 3rd year Medstudy was too much. I tried to read it in sections depending on my elective schedule but I don’t think I hit a dent in that series. I lat r focused on areas I knew I need it like vaccinations and ID. I did about 5 questions a week in prep during the second half of my 3rd year inconsistently but by the time I graduated I hadn’t even completed one exam.

I started fellowship and my time to study was nil. I only studied in the weekend doing medstudy questions by topic and randomly doing prep questions. I studied every explanation and wrote it into LYW. LYW became my notebook. I don’t like LYW- it is by no means conplete but at least I had a baseline with must know facts. I completed 3 years of prep by the week before the exam scoring between 50-70%. I never finished the medstudy questions but like I said I used it for topic studying starting with high yield. I did the APB exam and scored about 82%.
After everything, I didn’t think I was prepared. I regret not putting more time in sooner and saving me the stress. I thought the boards were rather easy and fair with lots of straight forward questions on topics I recognize but not necessarily remembered with confidence. Because it was so easy I was nervous my peers would do better which does not seem to be the case.

If I could do it all again I wouldn’t invest in the medstudy series- just the qbank. I tried to read the book series but it would have been more useful to if I used it during my training. Don’t depend on LYW. The additional qbooks that come with it are not worth it either. I still have them wrapped in shrink wrap
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