Preparing for the Neurocritical care boards

[Smashingdude]

Alright folks, time to post after a long time. Hope everyone has been doing well and it's good to be back.

I recently took the NCC boards and want to share my thoughts on how to go about the exam. I am not sure if this is the right place or if this post should serve better under Neurology, but I will let the moderators decide. Part of the reason for this post is because of the radio silence on the internet regarding this exam. Lack of resources, experience as well as guides is the reason I am posting this in the hopes of helping a fellow friend like you. Perhaps the moderators can pin this thread for easier indexing and finding.

My background, and reasons for taking the exam:

• IM+PCCM trained, working in a community setting for 3 years now. My ICU is a combined hodgepodge of everything but we are a comprehensive stroke center and deal with a lot of Neuro patients. I went via the practice pathway which is open till 2026. You have to work certain hours in a Neuro ICU and get a letter from the director which you then send to the ABIM/ABPN. Pretty easy process and please refer to the ABIM/ABPN official website for the details.
• Now was it necessary to take the exam? No. In fact, my partners are not planning on taking and they can manage all of those patients as comfortably as I can. I just wanted to learn something new and hence took on this journey. Moreover, being in a community practice makes you stop reading or being up-to-date and this was a chance to refresh some of my memory and get back to reading and learning.
• Will it add to my compensation? Hell no. I don't think the hospital or my practice group cares about the number of board certifications and that is what I've learned from my seniors who have been in the field for decades. It's all about productivity and how many patients you can see and bill. That is why seeing 2 critical care patients is worth more than spending half an hour putting a complicated CVL. Unless your field is procedure-heavy like interventional cardiology, there are not a whole lot of ways to generate more revenue in critical care.
• Do you have to be a neurologist? I don't think so. The exam tests mostly the critical care aspects. You do need some understanding of common neurological pathologies and their presentations.

Resources:
There are many books and courses but none is concise enough. Some are too long, and some are not geared towards CC. I did not know how to go about the exam. Should you study like a neurologist geared for critical care? Or as a critical care geared towards some deeper aspects of neurology? One of my colleagues who took the exam favored the former approach but frankly, you can go either way. I think if you try to study like a Neurologist, you will be lost in the complex and convoluted world of Neurology and will lose sight of the critical care portion that is tested on this exam. One thing is clear after I took the exam - they DO NOT test general neurology. It's all critical care based so you can be relaxed.

These are the resources I ended up using, and my thoughts on them, followed by my recommendations if I were to do the exam again. They appear a lot but rest assured, I did NOT finish or read everything in them back to back. Many I just opened for one specific chapter and so forth.

1. SCCM Neurocritical Care Review: This is a lecture series and I think I used an older edition. Some topics are well presented, and some are just too basic. The quality was just okay and SCCM can surely do better. The associated PDF had like 100 questions which were just okay. The videos are short and you can finish all of them in like 2-3 days so I do recommend going over them once
2. Neurocritical Care Society book 200 QBank + Book + Oncall: This was $900 and you get NCC book with 200 online questions. The questions were high yield and I do recommend them. The book is boring and I barely read it. Moreover its big and you won't have time to finish it. The same goes for the Oncall section. The quality of these videos is much better than SCCM and you should go over their videos if you get a chance.
3. ENLS certification by NCCS: I think being ENLS certified helps and if you get a chance I do recommend going over there quizzes and videos/algorithms. Its not a must for the exam though.
4. CHEST Critical Care - Neurology portion: I had my videos from the time I prepared for CC boards and they were a good refreshes. You don't have to do them.
5. SEEK - Critical Care - Neurology portion: I saved my flashcards when I prepared for the CC boards. They have 47 questions, and some good concepts but not necessary.
6. Neurology for Non-Neurologists 2022: Another good series. I only viewed the lectures that were my weaknesses like NM disorders and EEG. You don't have to watch all of the videos and frankly can skip these series
7. Asma Zakaria NCC Qbank 2nd edition: This had some good content and I do recommend it. You can skip all the calculations as the exam is NOT going to test your formula skills. Heck, the exam does NOT even have a calculator! This book does have some outdated content (like the whole brain death testing was updated in 2023) so be sure you know the latest guidelines
8. Zachary David Levy Absolutely NCC 2023: This book is structured like 2 practice exams with 5 blocks each. I think this was a good book to exercise your flow and stamina for the exam. A few good concepts but most of it was heavy on recall of factoids and the numerous scores used in NCC.
9. Neuro ICU board review Saef Izzy, David Lerner review: Only was able to do 1-2 chapters. This is from 2019 so has outdated content. The quality of the questions was good and good explanations.
10. Neurocritical Qbank by Statpearls: They have 600 questions online. The content though is very Neurology heavy, and there are only a handful of critical care questions. Moreover, many questions are written/submitted by residents! Hence, take these with a grain of salt.
11. Critical Care EEG Basics by Neville and Kyle: A concise and quick read for EEG's. Highly recommend it. You can skip the quantitative EEG portion
12. The only Neurology book you will ever need by Alison and Malcolm: This is a good and easy read and a refresher for important concepts in neurology. Again, I didn't have time to read everything but read on the neurological exam, pupillary defects, and so forth.
13. Clinical Neuroanatomy made ridiculously simple by Goldberg: An old book, and a quick read. Good to refresh your neuroanatomy skills
14. First Aid for USMLE Step 1 2024: I referenced it for the brainstem strokes, and pupillary pathways and lesions. Also refreshed stats.
15. YouTube: Yes, YouTube has great videos on CT head, MRI brain, Vascular anatomy, EEG basics, etc. I watched a lot of those videos here and there.
16. MKSAP Neurology: These questions were not for critical care, but I used them to review NM, MS, and Parkinson's diseases.

What I recommend:
If I were to do the exam prep all over again, I would do the following:

• Do the SCCM course x1. Make important notes of core concepts. Do the associated questions
• Read Critical Care EEG basics by Neville and Kyle. The exam tests your EEG reading skills. But the EEG's were very straightforward on the exam. They will NOT test complex EEG's
• Imaging: This is by far the most difficult portion for us non-neurologists and I recommend spending some time.
  • You need to have good reading skills of CT head, MRI brain. SCCM radiology lecture is a good start, and the presenter mentions some free online resources. I ended up using YouTube to look at common pathologies on CT head and MRI brain. The exam had a fair mix of imaging questions and you should be able to identify common lesions and pathologies
  • You also need a decent understanding of CT perfusion and TCD's. Questions on the exams were straightforward
  • Only a handful of angiograms and MRA. You should be able to point to simple aneurysms, occlusions, and dissections.
• The Only Neurology Book - Read the portion on neurological exams, brainstem strokes, and eye disorders.
• NCC Qbank - High yield so I do recommend them.
• Asma Qbank - Skip the calculations. Focus on the NCC portion of the book (i.e. the first half). Skip the second half.
• Practice stamina with Zachary Absolute NCC 2 days before the exam by simulating the exam.
• Memorize the common scores used in NCC. You should know GCS, Hunt Hess, ICH, ABCD2, ASIA etc and be able to calculate them based on the information provided.

Cost analysis:
As with any board or exam, cost is a major consideration and this exam by far was THE MOST expensive that I took, which is ridiculous! Hence before you embark on the journey, do take into account that you will be spending close to $6000-$7000 on this exam.

• The board exam fee itself was like $2995
• NCC bundle was like $900
• Books were like $300-$500
• SCCM course I think was $1000 or so
• Statpearls I only took for a month for $150

Exam structure:

• The exam is 54 questions separated in 5 blocks over 6 hours as follows:
  • 10 minutes of Tutorials
  • 30 minutes pooled break time
  • 320 minutes to complete the exam
• Unlike other ABIM exams, you are responsible for managing your time. That is, you have to click out of a block and it won't end after a certain time. This proved a bit more challenging but it was doable. I gave myself an hour on each block. Frustratingly, there is just one clock in the corner so it sometimes gets challenging to manage the time. What I did was to write on the piece of paper provided by Prometric the time I must end this block and that made it easier. If the countdown was at 4:10 when I started the block after a break, I just wrote 3:10 and kept going.
• I took a break after every block and that was worth it.
• Overall, I think the exam was well structured and you had enough time to answer the questions.

Exam content/experience:

• Overall, the questions were not as difficult as I was expecting them to be. They were all geared towards critical care. No office setting questions.
• One thing I loved about the exam was that the question stems were very short. Like 2-3 lines. This made it much easier to read and answer. I wish pulmonary boards were similar.
• There is no calculator in this exam FYI. That being said, you don't need it. There are only a few simple acid-base questions. Nothing too hard
• There were no stat questions on my exam.
• Ethics was straightforward
• Lots of questions on TBI. This was my weakest area as our institute does not deal with a lot of TBI.
• Few basic EEG's. Recognize seizures. Localize them to specific regions. Recognize NCSE
• Some tested your recollection of common scores.
• Some difficult MRI tumor questions. Hence, know the basics of MRI.
• Lots of pharmacology. Know commonly used drugs in the ICU like paralytics, sedatives, etc.
• Complications of common neurological procedures like shunt infections and so forth.
• The vent management questions were very simple and straightforward. You can do them in your sleep. The same goes for CC POCUS and hemodynamics.

Final thoughts:
I think this exam is very doable for non-neurologists, and frankly was easier than critical care and pulmonary boards. Having said that, it does need commitment. I studied for 4-5 weeks on and off with work (like 1-2 hours per day), and then took 9 days off before the exam to prepare and that was sufficient. You need very good EEG as well as MRI/CT/CTA/DSA reading skills. That is where I suggest you spend the most time. Also need to be good in TBI diagnosis, management and common complications.

I hope this was useful. Results will be out in 12 weeks. Fingers crossed!

---

Members don't see this ad.

 

[jthedestroyr]

That makes me feel good minus the EEG.

My job is micu-neuro icu split but more heavy neuro ICU, where we in conjunction with neurosurgeons make calls on strokes for CTP/CTA, so I’ve gotten decent at this.

I feel very weak in EEG as I defer this to the epilepsy trained guys reading the EEGs.

Seems very doable exam.

 

[Katheudontas parateroumen]

Has anyone gotten results back from this past exam cycle? ABA portal says it’s gonna be down until Jan 14th. That’s over the 12 week timeframe they had quoted from Oct 7-11 testing range.

 

[Smashingdude]

Has anyone gotten results back from this past exam cycle? ABA portal says it’s gonna be down until Jan 14th. That’s over the 12 week timeframe they had quoted from Oct 7-11 testing range.

Nope. No results yet. This is the strangest exam. Most of the other sub speciality exam results are out. I am not sure why there is such a hold up. Pretty annoying.

 

[Smashingdude]

Got a notification in ABIM portal that says I passed!

They didn’t send score report yet. That will be sent out in 2 weeks. This is the weirdest and the slowest board organization!

But I am glad it’s all well and done behind me. The annoying part is that ABIM is already asking $220 for certification fee for NCC. I mean, what the heck!!!

 

[Katheudontas parateroumen]

Passed as well via ABA. The slowest moving board of all time!

I’ll also add that I barely studied for this exam. Didn’t pass with flying colors and wish I could have studied more of course, but I think just for the purposes of passing the test and practicing, a general CCM fellowship fund of knowledge was enough. Further reiterating a lot of what’s been said that these further sub specialization exams are just for show. Critical care is critical care