Skip ABPN Part II, or take it and fail?

[twright]

Hoping to get some wisdom from people about the ABPN Part II. I read through some of the previous threads, and saw some nightmare stories from MichaelRack, whopper, etc.

Here is my situation:

1. I am a relatively newly minted psychiatry residency graduate from 2009. Because of some family stuff I had going on, I actually did not take Part I until 2011. Fortunately, I passed Part I and am scheduled to take Part II in 3 weeks (my first testing opportunity).
2. I have paid the $1000+ testing fee but have not paid for the airfare ($400-600) and hotel (say, $400). Money is an issue, but since I have already paid off my medical school debt it is a relatively small issue. I am more concerned about career-type issues (see below).
3. I feel very unprepared to take the exam at this time.

I think my options are: (a) not showing up and de facto getting reassigned to another testing date, (b) calling them to cancel the test and getting reassigned to another testing date, or (c) going ahead with the test but knowing that I am headed for near-certain failure.

If I did option (a) or (b), my plan would be to buy myself some time to study more and to sign up for more moonlighting shifts where I can basically do mock interviews with live patients (except that I am not in a position where I can ask someone to supervise/observe). In addition, I think it would be nice to not have the stain of a Part II failure on my record.

If I did option (c), my intention would be to simply learn from the experience, the stain be damned. My understanding is that boards anxiety causes people to drop a lot of balls that they otherwise would not have dropped -- and I would hope that having gone through the experience might do a little to allay my anxieties the second time around.

Questions for all of you:

1. Which option would you recommend, and why? Is there an option (d)?
2. Is there any difference between (a) and (b)? i.e., should I call and cancel, or should I just not show up?
3. Is it possible that option (a) or (b) may not give me any more time to study? Because of all of my other commitments at the moment, the only reason I would choose (a) or (b) is if that course of action would give me another 6-9 months to prepare. If the ABPN is just going to schedule me for a July 2012 testing date then that would defeat the whole purpose of skipping the exam and then I might as well take the exam and try to learn from the experience.
4. Would it be better to go with (c) and get the learning experience even if the cost is having a failed Part II on my record?

Thank you in advance for any advice!

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[kugel]

I'm not recommending one option or another, but what is the "stain" of a failure, except that you have to take it again? Who would ever know you took it more than once? Or care? I learned a fair amount about the process and about myself from failing the first time - but that's just my experience. And I understand the process is quite different now than when I took it first.

I'm a pretty big fan of the Beat the Boards course. Good review no matter what. I thought it was worth the money. I know others vehemently disagree. Prob still time to sign up if you want.

 

[twright]

I'm not recommending one option or another, but what is the "stain" of a failure, except that you have to take it again? Who would ever know you took it more than once? Or care? I learned a fair amount about the process and about myself from failing the first time - but that's just my experience. And I understand the process is quite different now than when I took it first.

I'm a pretty big fan of the Beat the Boards course. Good review no matter what. I thought it was worth the money. I know others vehemently disagree. Prob still time to sign up if you want.

Actually I guess that was just an assumption of mine. I assumed that if residencies and fellowships know if you failed USMLE, then some type of higher body (e.g., state medical board) would know about ABPN failure. Thanks for the thoughts.

 

[strangeglove]

If money is not an issue, then just take it. Worst case you fail (no stain) and pay the fee again. Best case you pass and all is well. If you postpone, you lose about $1000 in travel expenses and then have to prolong your agony. But what would you gain in this case? Avoidance of anxiety?

 

[OldPsychDoc]

There's no real "stain" from a failed attempt at Part 2.
Why do you feel unprepared? They are fairly artificial situations (one-sided video "exam" and observed patient interview with presentation), but they should be somewhat similar to what you're doing day by day--new patient intakes with folks you've never seen before. I don't know anything about your training program, how much supervision/feedback you were getting, etc., but you may be more prepared than you think. Could you find a helpful attending locally who could watch you on a couple of interviews and have you present them board-style?
I also don't know specifics about how easy it is to call/reschedule or cancel. I'm guessing they still keep all or most of your money anyway--so I'd say "Just Do It".
Also--keep in mind that the 'horror stories' represent a self-selected subpopulation. The majority of first-time takers DO pass. I didn't find it malignant. (Uncomfortable, but not malignant.) It's probably about 80% a matter of managing your own anxiety and 20% just doing your job normally.

(And all of you youngsters can just ignore this whole discussion, since it doesn't apply anymore.)

 

[whopper]

You can only fail it I believe 3x (double check this) before they make you take the written boards all over again. If you miss an exam, it counts as one of those 3 tries unless you what they consider a valid excuse and you have to tell them ahead of time and get their permission to be excused. I know this because my 2nd try exam I had to cancel because it was too close to the anticipated date of delivery of my daughter. I had to get a doctor's note verifying the estimated date.

Personally, IMHO, a portion of the exam is luck. Yes you can prepare for it more than others, and that will increase your odds.

My personal advice is be able to present a nightmare scenario case. That happened to me on my first try, and on my second try I talked to a bunch of people and they told me they too had some very serious cases. One guy told me his interview subject was actually psychotic to the point where he was worried the subject needed to be sent to the ER and was worried that maybe he should be calling 9-1-1 and asked the examiner and the examiner just sat there without telling him what to do--prompting the guy to freak out (IMHO this was completely justified for a guy to freak out) because he didn't know if he should've continued the exam.

Then after the interview portion was over the guy still told the examiner that he believed they should call 9-1-1, and the tester just ignored him and asked him the usual questions, e.g. "Tell me about this person's history" that this guy said he couldn't answer because the subject was so psychotic and disorganized he couldn't answer most of the questions.

This guy I talked to, a buddy of mine told me he failed the exam and he IMHO is smarter than me and a good doctor.

Another thing I noticed, and IMHO this also makes me like this exam even less is a lot of the examiners IMHO ask questions based on their own inferences with the test subject, in other words they want to hear a very specific answer from you. You could give them a right answer but not the answer they're thinking of and therefore might not like your answer.

I passed it the second time but I had the dream person to interview--an organized guy who was in remission for depression and extremely cooperative.

I'd go with what OPD said, the majority pass. I'd practice by running some mental simulations in your head of some tough cases. E.g. a guy who won't talk to you, a guy who is so bad you might literally need to put him in the hospital during the interview, etc, so should this type of thing happen, you'll be mentally prepared. This should reduce a lot of the anxiety. I've seen some very good exam notes provided from some places like Beat the Boards.

My advice, you can't sweat the stuff you can't control. You'll never know what the person will be like until you see that person. Another thing is while you need to be on top of the basic data (e.g. the DSM criteria) the examiners aren't looking for you to get an exact DSM diagnosis but enough to competently diagnose in a clinical sense. Dont' get too bogged down in getting every single detail right. It'll be better for you to cleanly present your case instead of memorizing every detail about the person you interviewed.

 

[michaelrack]

You can only fail it I believe 3x (double check this) before they make you take the written boards all over again. If you miss an exam, it counts as one of those 3 tries unless you what they consider a valid excuse and you have to tell them ahead of time and get their permission to be excused.
.

That's correct. I had to take the written boards again, finally passed the orals on the 5th try. There's no stain in failing as long as you eventually get certified. It only takes a few days to prepare (assuming you have an adequate knowledge base), take a course with mock exams like Beat the Boards. Beat the Boards will teach you how to handle some of the nightmare scenarios described by whopper.

 

[sunlioness]

Are they still doing the live interview? I thought that was phased out already.

 

[OldPsychDoc]

Are they still doing the live interview? I thought that was phased out already.

There are still an unlucky few who started the process before the phase-out date who have to complete it the "old fashioned way".

 

[whopper]

One thing to factor in if you want to take the exam or not is the location. If it's by your area you might want to take it.

Yet another thing I don't like about the exam--they decide for you where your exam is. Yes there could be an exam being done about an hour from where you live and they stick you at an exam location where you have to pay about $1500 for the travel, food, and lodging. Thank God my daughter's expected arrival got me out of an exam on the west coast, would've been two plane flights, 3 days of a hotel stay, a rental car worth of money away, and I was able to have it changed to an area that was about a 2 hour drive away.

If the location is right by where you live, I'd consider taking it even if you didn't feel prepared because you got a lot less to lose.

 

[atsai3]

I echo the previous -- you may be more well prepared than you think you are. The only situation I can think of where a "stain" might declare itself is when you are listing your certifications on your CV. Typically one obtains Part I certification the year of graduation, Part II the following year -- in your case you would simply have your certifications spaced out (and one could reasonably infer that you failed -- although it is also a plausible inference, based on the data presented on your CV, that you simply chose to defer).

If you fail, at least you will have the experience of one exam under your belt. That will help considerably with the anxiety when you take it the second time.

 

[twright]

Thanks so much for the feedback. I guess I'll go ahead and take it then!

 

[OldPsychDoc]

Thanks so much for the feedback. I guess I'll go ahead and take it then!

Knock 'em dead.