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The Things I Do For the Residents………. May 8, 2008 Jessica Lovich-Sapola MD. Hotel. Criteria of a Board Certified Anesthesiologist. 1. Completion of an approved anesthesia residency accredited by the ACGME. 2. Pass the ABA Written Board Exam. 3. Pass the ABA Oral Board Exam.
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The Things I Do For the Residents……… May 8, 2008 Jessica Lovich-Sapola MD
Criteria of a Board Certified Anesthesiologist • 1. Completion of an approved anesthesia residency accredited by the ACGME. • 2. Pass the ABA Written Board Exam. • 3. Pass the ABA Oral Board Exam. • 4. Have adequate physical and sensory faculties. • 5. Be free from the influence of or dependency on chemical substances. • 6. Must have no felony on your record.
Written Exam • Primarily a test of knowledge. • Used to determine if a candidate has a sufficient fund of knowledge in general medicine and the specialty of anesthesia. • Designed to test the knowledge gained during training in a residency. • Information is what one would expect to be of importance to the delivery of anesthesia care of the highest standard.
Written exam as a predictor…. • Certain written scores = 100% pass rate. • Barely pass written exam= 50:50 pass on the oral boards. • Side Note: • Dr. Gravlee, chair of the written exam, recommends Hall question book for studying.
Oral Exam • Starting Note: • You walk in the door PASSING. • You have 70 minutes to prove them otherwise. • Statistically, your best chance for passing is the 1st time you take it. • The ABA’s general recommendations are: • Study, especially the topics you are the least comfortable with. • Practice daily. Use your daily cases as a chance to talk though your plan. • Read journal articles.
Location • The location is chosen almost 5 years in advance. • They need a city with a big airport. • A hotel that is not super expensive. • A hotel that is large enough to accommodate the exam. • Good weather.
Dress Code • Men: Coat and tie • Women: Office attire • I recommend a black suit. • Most women also wear a black pants suit.
Dress Code YES NO
Behavior • Good eye contact. • Speak up. • Act professional. • Do not argue with the examiners. • Give the examiners a firm handshake at the beginning and the end of the exam, even if you feel that you did poorly. • Avoid slang and informality. • Don’t play with your pen, jewelry, etc. • Look the examiners in the eye and talk with them like a colleague.
What to bring to the exam. • Basically nothing. • You can’t bring anything into the room. • You can bring a pen and your ID.
Exam Room • Every room is adjusted for equal lighting and temperature. • In each room you are given water, a pen, and a piece of paper. • They will verify the case with you. • They will check your wrist band. • The examiners will introduce themselves to you. • At this time you can switch if you feel that you know an examiner. • There may be an observer in the room. They do not grade you.
A day in the life of an examinee…. • You will arrive at the hotel 15 minutes before your set time. You can not go to the assigned room any earlier. • Take the elevator to your assigned room. • Bring your ID, sign in, get a wrist band. • Briefing lasts about 1 hour. • You get the 1st exam to look at for about 10 minutes. • They walk you to your assigned hotel room. • Sit in the chair and continue to read and write down notes about your case. • They get you. • Exam • Knock on the door.
A day in the life of an examinee…. • Sit in the next seat and take the copy of the test off the door. • You get 10 minutes to prepare. • Suck it up between cases! • Relax and take a deep breath before entering the room. • Exam #2. • Go home.
Exam • Based on general knowledge of all anesthesia-related fields. • The examiners follow a strict script. • The scripted format started 10 years ago, with strict enforcement of the scripting within the last 5 years. • The scripts are based solely on rescue scenarios.
Who Writes the Exam? • Practicing anesthesiologists who serve as examiners submit the cases. • The ABA takes care to ensure reasonable content sampling.
What facts do they expect all candidates to know? • 1. In-depth knowledge of all drugs used and their effects on normal and abnormal body functions. • 2. Pathogenesis. • 3. Alternate methods of management. • 4. Mechanism of drug action. • 5. Methods of measurement including routine lab studies and normal measurements. • 6. Be able to anticipate, diagnose, and provide rational therapy for any complications that are likely to arise.
Format • Briefing session • 2 parts, 35 minutes each. • Part A: • 10 minutes to look at the information. Take notes. • Intra-operative: 10 minutes (Senior examiner) • Postoperative/ Critical Care: 15 minutes (Junior examiner) • 3 Extra topics: 10 minutes (Senior examiner) • Don’t waste time on preoperative questions.
Format Continued • Part B: • 10 minutes outside the exam room to look at the case. Take notes. • Preoperative: 10 minutes (Senior) • Intra-operative: 15 minutes (Junior) • 3 Extra cases: 10 minutes (Senior)
Format Continued • The same case is being presented in all of the exam rooms on all 3 floors at the same time. • No case is reused during the week. • You have 2 examiners at each session, 4 for your entire exam. • These examiners also change rooms during each set of exams.
Audits of the Exam • Each exam is scored by the examiner prior to giving the exam. • This score is also used in the final grading.
Examiners • They get the exam the night before. • They are able to look up the general topics. • They are told to not do a lot of research.
What the Examiners Know About You • Your name. • That is it!!!
A day in the life of an examiner….. • The examiners are in a single room for only part A and B of a single exam. They trade rooms. Never the same team throughout the week. • They finish their grading within 1-2 minutes of the completion of the exam. They do not discuss the examinee until they turn in the score sheet.
Audits of Examiners • The examiners are audited a few times during the week. • Strict quality control. • If they have a problem with an examiner, they are asked not to come back. • Each examiner is ranked yearly as being easy, moderate, or a hard examiner.
What the Examiner is Audited For • 1. Questioning • Vague questions • Confusing questions • Asking facts instead of judgment (giving a superficial exam) • Being unprepared to ask another question. • Inappropriate positive or negative reinforcement • Rhetorical questions • Aggressive or threatening manner • Multiple questions without waiting for a response • Pursuing factual minutiae • Whether they keep on time.
Examiners Audit Cont. • Cover all of the script. • Know when to change topics. • Well prepared and informed. • Whether they ask to many yes/no questions. They should ask more open-ended questions. • They should be unemotional and give no feedback. • 2. Evaluating • Not taking into account the difficulty of the question. • Not recognizing non-gradable answers. • Trying to guess the co-examiner’s rating and matching those ratings. • Fretting over a split with a co-examiner leading to failure to concentrate on the next examination.
Diplomate Attributes 1. Application of Knowledge • The primary goal is not the recall of cognitive information, it is to be able to apply the factual knowledge to a clinical scenario. • Show the ability to assimilate and analyze data so as to arrive at a rational treatment plan.
Grading Cont. • 2. Judgment • Soundness of judgment in making decisions and applying decisions.
Grading Cont. • 3. Adaptability • Ability to respond to a change in the patients clinical condition. • Be willing to change your plan in response to a change in the situation or patient condition.
Grading Cont. • 4. Organization and Presentation • Communication with peers, patients, family, and community. • Are you an anesthesia consultant? • Can you be a leader of an anesthesia care team? • Can you prioritize and organize your presentation? • Can you structure you answers? • Are you able to define the priorities in the care of the patient?
Grading Cont. You are also secondarily graded on….. Clinical Skills • Example: It is important to know when and why to insert a PAC and how to interpret the data and not specifically how to place one. Management of critical scenarios • Can you recognize a complication and respond quickly and appropriately?
Scoring • You are not scored on one question. You are scored overall. • In the past, a person may have failed over one missed critical question. This is not true of the current exam. • The score is related to the difficulty of the test. • The score is also related to the difficulty of the examiner.
Scoring • Scaled score • Based on the exam and the examiner • Multifaceted analysis • Consistent 20% failure rate. • One examiner can’t fail you!!!!
Be able to answer……. • Why? • Why not? • Why not something else? • There is NO right or wrong answer! • Don’t be so regimented. • It is OK to say you are not comfortable with a certain technique, but you must know that it is possible.
Questions? • Just answer the question. • Do not ask questions. They don’t have any more information than they have told you. • You can ask for a clarification if you really don’t know what they are asking. • Assume…… • Always “assume” that your patient is healthy, the examiner will let you know if this is not the case.
You are asked a question…. • Listen to the question and answer it. • Then immediately justify why that was your answer. • Say I am doing “X” and this is why. • They don’t want to hear all the things you could do. Pick one! • Say “I would”, not “I could…….” • They expect you to be able to defend your selected plan of management. • They will interrupt when you have said enough. • Explain things to the examiners like they don’t know anesthesia. • The explanation is more important than the answer.
More Tips • Imagine yourself in the OR. Only do things that you would normally do. • Don’t be afraid to “consult” another service or physician. This shows that you know when to ask for help as opposed to compromising the patients safety. • Write down any numbers or labs they give you. • If you do not know the answer, say “I don’t remember at this time”. Don’t ever make up answers. • Don’t quote a book or article unless you are prepared to have a detailed discussion. • Always keep the patient safe!!!!!
Sh-- Happens • Bad things are going to happen, no matter how good you are. • They are written into the script. • Treat the problem, and don’t stress over whether it was your fault.
So you realize you made a mistake… • They don’t want you to be wishy-washy, so stick to your guns. • But, don’t go down with the sinking ship. • If you realize that you made a big, killing mistake, say… • “I am sorry, but I ……”
