Tox Boards Round 2

[noshie]

Well, I guess I am going to be the first one to post about this since I couldn't locate any other threads about failing the medical toxicology boards...

I took the med tox boards in 2020, and I got a 70 on my test. Unfortunately, a 72 was passing. I will be retaking the exam in October 2022.

Last year, a new 2021 core content for the boards was released (Hendrickson et al, The 2021 core content of medical toxicology. J Med Toxicol). They have mentioned that they will remove very old historic chemicals and regulatory facts.

The passing score this time has not been determined yet, so this may also change. The ABEM site mentions that they will determine the passing score after the 2022 exams are over. This can either be a good thing, or a bad thing... Either the passing score will drop or it will increase making it harder to pass.

The first time I took the exam, I studied really hard. I had taken 2 ACMT board review courses (in fellowship and right before the exam), and I had a study group that virtually met to discuss chapters at least 1-2 times a week for 4 months. In the end though, the test was not what I felt I had studied for, and there was one Goldfranks chapter that I wished I could have gotten to before that test. A literal handful of questions stood between me and a passing score.

For the last 2 years, this exam failure has PLAGUED ME. Little things like... I have been hesitant to start a family for fear that getting pregnant would ruin my ability to study or to take the exam (Im almost 40, which is why this is a big deal for me). I have had so much anxiety about failing again, and as it gets closer to the exam, I realize that I need to make a plan. The problem is that I do not know what I could have done better last time. Other than one GF chapter that I identified as being possibly my downfall for the last exam, I am not sure how to tackle this upcoming test.

For those of you that do not know me or haven't seen the link in my signature at the bottom... I have a hard time with exams. I took the MCAT 5 times, and eventually overcame that. I have not had any other significant issues with tests since then (I know I need to study my a** off twice as hard as most). In order to overcome the MCAT, I had to go back to the basics and essentially start over. I just don't know how to start over for this exam.

If any of you have taken the med tox boards more than once, I would love to hear any advice or insight you have into how you changed things up the second time around or what your strategy was. Or any advice in general is welcome!

1/4 of people that take this exam fail (pass rate 76%), so I know there are more of you out there! Please help and give me hope!

---

Members don't see this ad.

 

[DeadCactus]

Hopefully someone chimes. For what it's worth, my observation has been that people who struggle with similar multiple choice exams make the mistake of trying to learn medicine (and often do know the actual medicine extremely well). The problem is that these exams are closer to a game than anything else and studying a textbook or the literature or the actual day-to-day practice doesn't prepare you to play the game. It's like learning to play the guitar to be tested on Guitar Hero.

What does that mean on a practical level? Don't touch a textbook when studying for a standardized test. You're not trying to learn about everything they could ask you; the questions are not evenly distributed throughout the textbook material. Your goal is to master the large chunk of the test made up by the topics constantly reiterated and explored in more depth in review courses and practice questions. The topics most likely to be asked about. The goal is to know that subset of topics by muscle memory: to see the prompt and immediately recognize what they are trying to test, what to look for in the stem, and what the answer is. That get's you a right answer on a large chunk of the test. The rest of the test you can narrow down answer choices, guess, and get enough right to cross the passing threshold. But you can't afford to miss predictable give-me questions because you tried to prepare for every esoteric question about a table or a footnote in the textbook.

 

[southerndoc]

A good friend of mine had to take it twice, and he is incredibly intelligent. He definitely knows his tox stuff. Sometimes it's just the luck of the draw. Certainly don't beat yourself up for it.

 

[noshie]

Just wanted to update this post in case anyone has been looking for some hope after taking the 2024 Medical Toxicology Boards last week. 🙂

Even though I failed the medical toxicology exam in 2020 and it felt like the end of the world, I took the exam again in 2022 and I passed.

My study strategy changed slightly. I was able to go more deeply into the material the second time around. I really learned the mechanisms behind the toxins, and recategorized them in multiple ways. For example, I categorized toxins by system such as looking at renal toxins and how they cause toxicity at the cellular level, or by random manifestations in the body like hearing loss. My advice is to take the ACMT board course, buy the "Medical Toxicology Review: Pearls of Wisdom" book (written by Robert Hendrickson), and study your butt off.

Goldfranks will be an essential resource as well. However, I am going to say something controversial, though hopefully it will change your view of the exam for the better. The people writing the exam are "seasoned" (I dare say older individuals). They trained with a Goldfranks edition that was straight forward (basically any Goldfranks edition from #9 and prior was more straight forward in my opinion, and yes I have editions from the 7th-11th on my shelf). For these reasons, the exam may not have newer tidbits from the Goldfranks 11th edition in it... Also, some of the older editions have study questions that can be used to test yourself. You can likely find these very old editions (circa 2000s or prior) from eBay or used bookstores.


Just to give anyone reading this some hard cold facts about the exam starting in 2022 forward and how it has changed... From the "scoring FAQ" that were released after the 2020 and 2022 test (I saved those PDFs after the test), the test changed in the following ways, and I have commented below on how this changed things for me and hopefully will change things for others taking the test in the future:

2020 - The passing score was 72, and the pass rate was 78% in first time test takers.
My score was a 70, so I failed even though I got a C on this exam... Needless to say I was not happy about that. But as you can see, almost 1/4 of people failed in 2020. In other words, 1 out of 4 people entering the test came out failing. Every other year, about 100 people take this exam for the first time based on the number of people that graduate at the 28 fellowships around the country. That means that somewhere around 22 people failed in 2020. That number was just way too high. It was unacceptable, and luckily the toxicologists in charge of the exam knew it.

2022 - The passing score was 64, and the pass rate was 92% in first time test takers.
My score was a 77, which meant I would have passed on either test administration since I was over the passing score for either test, but the exam itself was also more reasonable starting in 2022. If you read the "2021 Core Content of Medical Toxicology", you will note that they "removed chemicals that had been banned or unavailable in the US for the at least 50 years". This meant all the historical irrelevant toxins were removed. Therefore, the test had more reasonable content AND the passing score was lowered to allow more people to pass the first time.


Taking it twice was actually helpful for me in the long run, so I am less upset about it now. Especially after I found out later that so many established toxicologists had to take it more than once and it didn't hinder their career at all. I have even heard of a toxicologist that is relatively well known and an amazing human being that failed it a few times and then decided not to retake it. They never got board certified, but it didn't change how much they have influenced medical toxicology over the last several decades.

Do not get it wrong however, the medical toxicology board exam is still challenging. There is a lot to learn, and slacking is not an option! However, it is manageable, and for those that do not pass, it is going to be ok. You will retake the exam in another 2 years and chances are that you will pass because you have become a more seasoned medical toxicologist. Studying for the exam twice is not the end of the world, and like me, you may feel like a more solid medical toxicologist for taking that grueling exam twice.