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. 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.

Picture of Exam Room

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.

Scoring Sheet

Scoring Sheet

Scoring Sheet

Scoring Sheet

Scoring Sheet

Scoring Sheet

Scoring Sheet

Scoring Sheet

Diplomate Attributes1. 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 ……”

Problems candidates have…. Superficial knowledge. Good knowledge, but….

The inability to apply it or adapt to clinical conditions Can’t express or defend why they do something (“We do it everyday at Metro” does not count.)

A candidate that tries to control the exam. Examples: Asking to many questions, or deliberately slow, halting

responses. The candidate talks a lot, but says nothing. Inability to express ideas or defend a point of view in a

convincing manner. The candidate is indecisive. Faulty judgment. Doesn’t take the test seriously, and are not prepared.

Failure In case you have to retake the exam:

You will never be re-examined by the same people.

The examiners have no way of knowing if this is your 1st or 20th time taking the exam.

Bibliography 2008 ABA non-examiner workshop. Fort Lauderdale, FL April 14-15, 2008