On the verge of crying at the oral boards

[Twoeyes2020]

The oral boards. There were good times and bad times. The good times where when the ball was hit out of the ballpark.

However, there were the bad times. One question, I could not make head or tails out of it. Skip it? Or try it?

"I'm sorry, but this is blurry to me". (it is blurry) "I see ....(this), (or this), (or that) [describing 3 different structures in the eye].

I just have named 3 structures in the eye so 2 of them are wrong. It's as if I said "I see either a spleen, pancreas, or stomach, but I can't tell which"

Tears are about to flow....I am DOOMED!

What I did was, in 4-5 sentences, describe the implications of if it were each of the 3 structures. The examiner moved on. Did I get a zero? Or maybe a 2 of 10 because one of the scenarios I mentioned was correct? However, no follow-up questions were asked (such as "suppose you're looking at a lens.") The board doesn't tell you what is passing, whether it's a percentage or cumulative score. For example, are you supposed to get 60 points with a maximum of 10 points per case meaning you need six 10's or eight cases and score between 7 and 8? Or just overall impression to pass and scoring if there's a dispute among examiners?

The board also doesn't say if you need to pass 5 rooms (they say you can flunk 1 room) or if you just need a total score, which might be achieved by a very high score in 4 rooms. If the later is the case, I am not doomed. If you have to pass at least 5 rooms, I could be doomed because this question could cause a failure in a second room.

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[Twoeyes2020]

Too bad it's not like that Jason Bourne movie where Alicia Vikander, the CIA cyber chief, see a photo on the screen and yells "ENHANCE!" causing the blurry face to clearly be Nikki Parsons, Jason Bourne's colleague

 

[4ophtho]

Initial reaction - if you can’t keep your emotions together at oral boards, how are you going to keep your composure when a surgery goes south and you’re on your own in practice?
Secondly, what makes you think you’re so special that sharing your experience in this public forum helps anyone?

If you’re going to be out there on your own, with a board certification, you’ve got some growing up to do.

 

[increscence]

4ophtho, your response was callous and insensitive. We have been trained to handle issues during surgery. We are not trained for the oral boards. The test and grading rubric are opaque to us, and we are never really sure what the test is going to be like; the grading is inherently subjective; someone is sitting in front of us and judging us; we are in an unfamiliar city in a hotel; the stakes are high; and it cost a ton of time and money to be there. It is understandable that people's nerves are high and people are stressed to their breaking point on the day of the exam. It sounds totally reasonable that an examinee could be pushed to the brink of tears, and it says NOTHING about their capability as a physician or as a surgeon.

Twoeyes2020, your recent posts here have suggested that you prepared well for the exam. I think you are going to do great. Even in the very unlikely event that you get an unfavorable test result in a couple of months, you will STILL be a board-eligible ophthalmologist and you can STILL pass the next time. Remember that the Spring 2019 oral boards pass rate was 86% per the ABO website!!

But your recent posts also suggest that you were really stressed going into the test. I do wonder if you are a high-strung person in general. Would you say so? If so, it may be amplifying your feelings in response to the orals.

We ALL felt terrible coming out of the test this weekend. From what I can tell, it's pretty common. I think you are going to great. I wish you the best.

 

[4ophtho]

When you really think about it, we HAVE been trained for oral boards and the skill set for performing well during oral boards is not all that different from surgery.

Both require critical thinking on your feet and good judgement. Naming three unrelated parts of the eye shows poor critical thinking and bad judgement.
Both require the ability to self-regulate your stress and emotions. The surge of stress hormones and the sympathetic system has to be controlled when facing your exam proctor and when you encounter a surprise during surgery. Nearly breaking into tears during the exam is does not demonstrate good self-regulation.
Both require the discipline and self motivation to prepare well to achieve the best possible outcome. Everyone knows that the boards are difficult and despite the best preparation, you may encounter a surprise, same with surgery. These surprises are much more difficult to manage if you aren't well prepared.

Sounds like you just want to vent so that someone can pat you on the back and tell you everything is going to be OK. That may not be the best feedback for you to hear.

 

[Twoeyes2020]

Not quite. I expected someone to say that they were confident but failed or they were shaky and passed.

The difference between the oral boards and a surgical complication is that action is possible in the OR but in the oral boards, you are subject to the whims of the question writer and the whims of the examiners, some of which I am sure are very fair and some less according to rumor.

One problem with assessing the orals is you can not know something and think you know it (like nurse practitioners). Another issue that after the exam, I thought of some questions for just a moment and was able to come up with much more organized, more relevant information and smoother answers. A problem with the oral boards is that it is a race and a sprint. I heard that the Canadian boards (FRCSC) are less of a race and they expect more detailed answers and allow more time to talk. Their pass rates are over 96%, higher than the ABO.

Insight to grading might be obtained from an examiner or former examiner, which is not likely. Another insight might be from someone who passed and can critically assess their performance.

Another major reason for stress is that one important hospital doesn't budge. Not board certified and you are kicked out. Some insurance companies are like that, too.

 

[Twoeyes2020]

I could have been better prepared but I did, not only practice, but made up by own "like-Pemberton" book by adding many, many more questions than that book. One of my hypothetical questions actually was similar to that on the orals. My answer was superb. In retrospect, I would have been able to add a little more but I think my answer was probably one of the best that day compared to others. However, that's just one question. If all questions/cases are weighed equally, then hard questions are balanced by easier ones. If you have to pass each room, then some questions are more heavily weighted, especially in the rooms that you do less well and fewer questions.

 

[LightBox]

You worry too much. Just wait for the test result. Most people are pleasantly surprised. And those that fail end up passing it the 2nd time.

 

[dantt]

You worry too much. Just wait for the test result. Most people are pleasantly surprised. And those that fail end up passing it the 2nd time.

60-80% of those that fail end up passing it the 2nd time.

 

[hurdlepup]

Kinda harsh. I don’t agree with what you said nor how you said it.

OP, take a deep breath, the sun will come up tomorrow and you will go back to work and be OK.

When you really think about it, we HAVE been trained for oral boards and the skill set for performing well during oral boards is not all that different from surgery.

Both require critical thinking on your feet and good judgement. Naming three unrelated parts of the eye shows poor critical thinking and bad judgement.
Both require the ability to self-regulate your stress and emotions. The surge of stress hormones and the sympathetic system has to be controlled when facing your exam proctor and when you encounter a surprise during surgery. Nearly breaking into tears during the exam is does not demonstrate good self-regulation.
Both require the discipline and self motivation to prepare well to achieve the best possible outcome. Everyone knows that the boards are difficult and despite the best preparation, you may encounter a surprise, same with surgery. These surprises are much more difficult to manage if you aren't well prepared.

Sounds like you just want to vent so that someone can pat you on the back and tell you everything is going to be OK. That may not be the best feedback for you to hear.

 

[TheLesPaul]

When you really think about it, we HAVE been trained for oral boards and the skill set for performing well during oral boards is not all that different from surgery.

Both require critical thinking on your feet and good judgement. Naming three unrelated parts of the eye shows poor critical thinking and bad judgement.
Both require the ability to self-regulate your stress and emotions. The surge of stress hormones and the sympathetic system has to be controlled when facing your exam proctor and when you encounter a surprise during surgery. Nearly breaking into tears during the exam is does not demonstrate good self-regulation.
Both require the discipline and self motivation to prepare well to achieve the best possible outcome. Everyone knows that the boards are difficult and despite the best preparation, you may encounter a surprise, same with surgery. These surprises are much more difficult to manage if you aren't well prepared.

Sounds like you just want to vent so that someone can pat you on the back and tell you everything is going to be OK. That may not be the best feedback for you to hear.

The oral boards are a contrived exercise that having NOTHING to do with real life. In real life, if you need to make a decision during surgery or clinic, you can obtain more information via physical exam, history, etc. In the orals, you have a grainy photo taken in 1970 with helpful or characteristic findings purposely obfuscated. Moreover, it needlessly expensive. I'd rather pay $500 and have it administered at the Holiday Inn Express.

 

[Slide]

I failed the first time but passed the second time. Chin up, not the end of the world if you don't get the outcome you want.

If you don't get good news, this is my feedback for you.

 

[MstaKing10]

Any idea what the pass rate is these days? Just curious

 

[Slide]

Any idea what the pass rate is these days? Just curious

It was recently at a high of 86%, but I believe there was a protest going on outside the hotel during the event that caused disruption, so I suspect the curve was shifted to reflect it.

In the past few years, it's ranged from 70 to 80%. I did the math and based on the statistics, for every 100 recent graduates, only roughly 60-70 graduates would pass both the written and orals on the first try.

 

[TheLesPaul]

It was recently at a high of 86%, but I believe there was a protest going on outside the hotel during the event that caused disruption, so I suspect the curve was shifted to reflect it.

In the past few years, it's ranged from 70 to 80%. I did the math and based on the statistics, for every 100 recent graduates, only roughly 60-70 graduates would pass both the written and orals on the first try.

Which is absurd. If only 70% of graduates are capable of passing the boards, either the boards are ridiculous, or 30% of residencies are woefully inadequate.

 

[Twoeyes2020]

In contrast, in Canada, the FRCSC credential is tough, not a piece of cake. Yet the pass rate for first timers is 98.1%

The Royal College of Physicians and Surgeons of Canada :: Exam pass rate percentages

Less crying.

 

[MstaKing10]

A test with a 98% pass rate is just about useless. I’ve always thought these things are essentially a money grab by the board. Same with Maintenance of certification.

Perhaps the lower pass rates here reflect international grads?

 

[Twoeyes2020]

A test with a 98% pass rate is just about useless. I’ve always thought these things are essentially a money grab by the board. Same with Maintenance of certification.

Perhaps the lower pass rates here reflect international grads?

I know of a few people who have failed and are trying or eventually passed. From my small sample size, they were born in the US and went to a US medical school. Getting into an ophthalmology residency is competitive enough so there are few foreign medical school graduates. It's very rare to find one who went to medical school at Ross or Grenada. Of course, maybe some of them were born in another country and came here as a kid or teen.

I think the pass rate should be 98-100% for first timers. In ophthalmology, that won't cause slackers because in Canada, those residents are not slackers. They study hard. They can be found at the review courses sitting next to each other eating poutine and saying "eh". OK, I made up the part about the poutine and "eh"

 

[MstaKing10]

100%? What’s the purpose of the test then?

 

[Twoeyes2020]

100%? What’s the purpose of the test then?

The purpose would be so you can have hospital privileges and be in-network for insurance companies.

The purpose of medical school is that 100% of graduates get a residency, not 80% and 20% go to medical school then have to work as a retail store clerk or whatever college graduates do.

 

[hello lady!]

Which is absurd. If only 70% of graduates are capable of passing the boards, either the boards are ridiculous, or 30% of residencies are woefully inadequate.

Honestly there's enough people who land their residency spot through connections rather than qualifications that this statistic doesn't seem that far off. Did you not have any coresidents who were questionable? No coresidents who didn't put hard work into their learning/training?

I can tell who they are in practice. They end up practicing like an air traffic controller and just refer the patient everywhere for any little thing.

 

[TheLesPaul]

I'm not sure I have met any ophthalmology residents who were truly questionable in intellect. Certainly in work ethics, subjective morality, etc. But true ability to master the material? It's vanishingly rare to get this far, COMPLETE RESIDENCY, and still be unfit to practice ophthalmology.

Are you insisting that a full 20-30% of residents are just "air traffic controllers"? Air traffic controllers are incredibly safe by the way, if all they do is just follow the guidelines strictly. I think such "by-the-book" people have a much easier time with the boards then those who really like to think and innovate.

I don't see why board exams shouldn't replace the OKAP during the last year of residency and be rolled into the residency certificate. It is a meaningless MOC cash grab.

 

[EyeGuy15]

The test is a nonsensical scam. See a picture and vomit information. That is not how the real world works. My guess is once the old clowns on the board who are in charge of this nonsense die off, the millennials will either get rid of the orals or drastically change the way it is administered.

 

[Twoeyes2020]

The test is a nonsensical scam. See a picture and vomit information. That is not how the real world works. My guess is once the old clowns on the board who are in charge of this nonsense die off, the millennials will either get rid of the orals or drastically change the way it is administered.

Unlikely. The board tries to develop a relationship with the examiners and the ones that share the current board's philosophy get promoted to be on the board of directors. This is not a criticism but a way to prolong institutional memory. The board gives the examiners free neckties, very good food, and thanks them a lot for coming.

The ABO is actually less money minded than some specialty boards which shamelessly try to make money for themselves.

 

[airplanes]

So did you pass?

 

[EyeGuy15]

The ABO is a scam.
Once these old clowns are dead and gone the younger generation of ophthalmologists will drastically revamp the oral boards.
See a picture. Vomit information.
That isn't medicine.

 

[hello lady!]

The ABO is a scam.
Once these old clowns are dead and gone the younger generation of ophthalmologists will drastically revamp the oral boards.
See a picture. Vomit information.
That isn't medicine.

lol oh come on. it's not that bad.

 

[airplanes]

The ABO is a scam.
Once these old clowns are dead and gone the younger generation of ophthalmologists will drastically revamp the oral boards.
See a picture. Vomit information.
That isn't medicine.

Alright then. Now tell us how you really feel.

 

[EyeGuy15]

lol. It really makes no sense. No proper ophthalmologist functions like this. Other surgical based oral boards are panel/discussion. I firmly believe once the old incompetent ophthalmologist are gone, it will be revamped. I didn't say the test was hard. I just said it literally is the absolute wrong way to test someones critical thinking when presented with a case. I have taught for Osler, and I make it a point to stress "Don't think, just vomit key words. The more you try to think and evaluate the case, the worse you will do." Facts are facts.

Plus the fact that older ophthalmologists don't have to re-certify is absolute garbage. In my opinion, older private practice ophthalmologists are the ones who are the laziest in regards to keeping up with the most updated information on the evaluation and management of eye diseases.

 

[estes8000]

Hmmm. I certainly am no expert in how other oral board exams are given but feel that I have some familiarity with the ophthalmic exam. So I looked over the otolaryngology video that discusses how their oral exam is given. It seems extraordinarily similar to the ophthalmic exam. I'd like to hear more from EyeGuy15 as to how other specialty oral exams differ from the oph or oto exams. Do other exams use statistical analysis of each exam question to judge both the fairness and the difficulty of the question as the ABO does? I do agree that the written qualifying exam is probably an inappropriate test of the average candidate.

 

[EyeGuy15]

For example.
As a person who values critical thinking and properly evaluating a patient etc, I feel this is more of a proper "discussion" and less stressful. As opposed to opthalmology oral boards which are rapid fire "Here is a picture and one sentence HPI, GO!".

I do not know if the video will work.



But go to youtube and search "General Surgery Mock Oral Demonstration" and you'll see what I am talking about.

Either way the argument "Other people do it, so it must be right", is useless.

If you can not see how this is a more logical way to give an oral exam to an ophthalmologist, then I guess we just disagree on how to properly evaluate someones ability to properly evaluate an ocular condition. Ten pictures rapid fire just does not seem to make sense to me. The more you study and read, the more you can discuss the range of possibilities of diagnosis and treatment based off a seemingly easy picture. I agree a time limit is necessary for obvious reasons, but giving someone 2-3 minutes to speak intelligently about a case just doesn't seem to make sense. It's a "catch-phrase" exam in my opinion. Say the catch-phrases and pass the exam.

Also, I am not sure how the scheduling is now, but the fact that even with taking the written as soon as possible, you can end up taking the oral exam 2 years after graduating residency, which is absurd. After doing a 2 year retina fellowship and devoting all my time to retina/uveitis, having to go back and re-acquaint myself with the other fields (2 years after graduation from residency) was just annoying and nonsensical (notably optics/refractive, pediatrics). The fact that this was the scheduling just a couple years ago, makes me seriously question the intelligence of the ABO. The Pemberton book is a classic example. People say that book is "all you need". I am sure the oral boards were a joke 20 years ago but the field of ophthalmology has come a long way in a myriad of ways (MIGs, Refractive Surgery, Anti-Vegf Indications, IMT etc.), and I don't think the ABO understands this.

Like I said once the older doctors are gone, things will change. I firmly believe that.

 

[hello lady!]

For example.
As a person who values critical thinking and properly evaluating a patient etc, I feel this is more of a proper "discussion" and less stressful. As opposed to opthalmology oral boards which are rapid fire "Here is a picture and one sentence HPI, GO!".

I do not know if the video will work.



But go to youtube and search "General Surgery Mock Oral Demonstration" and you'll see what I am talking about.

Either way the argument "Other people do it, so it must be right", is useless.

If you can not see how this is a more logical way to give an oral exam to an ophthalmologist, then I guess we just disagree on how to properly evaluate someones ability to properly evaluate an ocular condition. Ten pictures rapid fire just does not seem to make sense to me. The more you study and read, the more you can discuss the range of possibilities of diagnosis and treatment based off a seemingly easy picture. I agree a time limit is necessary for obvious reasons, but giving someone 2-3 minutes to speak intelligently about a case just doesn't seem to make sense. It's a "catch-phrase" exam in my opinion. Say the catch-phrases and pass the exam.

Also, I am not sure how the scheduling is now, but the fact that even with taking the written as soon as possible, you can end up taking the oral exam 2 years after graduating residency, which is absurd. After doing a 2 year retina fellowship and devoting all my time to retina/uveitis, having to go back and re-acquaint myself with the other fields (2 years after graduation from residency) was just annoying and nonsensical (notably optics/refractive, pediatrics). The fact that this was the scheduling just a couple years ago, makes me seriously question the intelligence of the ABO. The Pemberton book is a classic example. People say that book is "all you need". I am sure the oral boards were a joke 20 years ago but the field of ophthalmology has come a long way in a myriad of ways (MIGs, Refractive Surgery, Anti-Vegf Indications, IMT etc.), and I don't think the ABO understands this.

Like I said once the older doctors are gone, things will change. I firmly believe that.

Your approach to the test is wrong. I don't understand how seeing a clinical exam finding or getting a patient history and asking you to reason through your approach to the history "I would ask about these symptoms", the exam "I would look for these on slit lamp exam", and management (they tell you what the physical exam and history results are); "I would send off for this test and treat with this or refer here." Once you adequately describe your approach they prompt the next picture.

Do you really do your clinic differently for undiagnosed or unknown entities?

If your management is off base they will stick on the subject to give you a chance to get it. If you really don't know what to do for a new submacular hemorrhage spewing out word salad isn't going to help you.

Although it now makes sense though why you have this attitude. Stirring up fear/angst/anger among potential test takers is potential revenue flow to the Osler Course system. The Osler course wants everyone to think that the ABO is unreasonable so you'll pay them the grand or whatever they're overcharging these days.

 

[EyeGuy15]

I don't care about making money off Osler. Relax. The teachers don't make much of anything off it. The money is nothing compared to the time and energy spent doing it. I did it simply because I want to emphasize how to pass and I firmly believe the test is incredibly stupid.

I just think maybe you dont understand what I am saying. I apologize if you got lost in my logic. I am retina/uveitis trained. There is not a single case that has pathology that would be a 3 minute discussion (especially uveitis) that I am presented with. The more someone reads journal articles and keeps up to date the more they can say on a topic. That is common sense and that is how someone can be potentially tripped up. If you can see a patient with uveitis and think a 3 minute statement on evaluation/diagnosis/management/side effects of management etc. is sufficient then I am sorry that you are just under educated on the topic and thats a shame.

That is my point. There is SO MUCH information now available on the myriad of ocular diseases and people who take pride and are aggressive about staying up to date on ophthalmology can get burned because they may waste time overthinking and speaking "too much" on a topic. Believe me, there ARE definitely proctors who won't move on to the next case if someone is going to in depth on a topic (even if correct on what they are saying).

"Anything else?"

I heard that phrase a lot and I found myself having to be like "no". However, someone intelligent (and nervous, confused etc.) could literally never stop talking (and making very valid statements) because some clown keeps asking "Anything else?" and get burned.

In the real world over-thinking is actually a good thing so you don't miss the "zebras" that are potentially blinding (or fatal if associated with a systemic disease) if missed. For the exam, they just want to hear the key words, which does not really test if someone truly understands the case.

My point is 10 cases rapid fire doesn't make sense. Medicine isn't rapid fire. It is much more complicated than that and much more proper thinking is involved. This is a catch-phrase test. Plain and simple. You don't have to know why you're saying what youre saying, just say it and get the points.

 

[estes8000]

I finally got around to finding and looking at the YouTube video that you posted. I'm not sure what to make of the video or of your opinion of it. Do you think that the video shows a fair exam? I don't think so. The way the exam is given makes me worried that it is done arbitrarily and without strict and specific guidelines for the examiner to follow. You haven't answered my question about whether other oral board exams are statistically analyzed for fairness and degree of difficulty of each question. Are the examiners themselves graded? Does the board know the relative statistics of each examiner with regard to their rate of giving passing or failing scores on the sum total of questions asked? You and I could easily construct an oral exam that would be better, in our minds, with the opportunity to talk at great length about each situation, but can we create a test that can be reproduced simultaneously in 20 different exam rooms by 20 different examiners to 20 different candidates and attempt to be fairly and similarly presented to each candidate in those 20 rooms? Not so easy.

I would agree that many uveitis patients seen in our clinics have complex situations that can hardly be compressed to a three minute discussion. I don't think that such situations appear on the ophthalmology oral boards. Frankly, many questions presented can be easily and completely answered in two or three minutes. How long does it take to discuss a queston about a macular hole succinctly?