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Preparing for Oral Boards

This guide provides tips and strategies for successfully preparing for and taking oral board examinations in the field of medicine and anesthesia. Learn how to effectively convey your knowledge, judgment, and adaptability during the examination.

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Preparing for Oral Boards

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  1. Preparing for Oral Boards E. Steele, M.D. May 2006

  2. Overview • Pass Written • Application for Orals automatically mailed to you • Given in April & October • You don’t get to choose • But you can call and ask for a particular day

  3. The Big Day • You are assigned and day and time to report to an orientation room • Orientation last about 20 minutes • You get Question No. 1 here • Approx. 10 minutes to work on your outline • March to your assigned examination room

  4. Examination Room • Suite-type hotel room • Two examiners: one senior, one junior and possibly an observer who sits behind you • Small desk with pad of paper and pen and a glass of water

  5. Format of examination • Main stem: intra-op and post-op OR intra-op and pre-op • Senior examiner begins • Junior examiner jumps in later • All the time they are filling out a scantron sheet (what does it mean?!) • After they finish grilling you, they begin grab-bag questions

  6. Grab bag questions • You don’t see it before they ask it • Brief clinical scenario and what would you do? • Child comes for PE tubes and mom says he has a hole in his heart. Do you proceed?

  7. A busy week • Each day there are about 5 sessions, each session has several orientation rooms, each orientation rooms has about 20 applicants for five days in a row. This means 900 to 1000 people are taking oral examinations the same week as you! • Lots of nervous people in the lobby • Lots of anxious people leaving the lobby

  8. Scoring the exam • Two rooms are separate • Not all questions or examiners are created equally • Statistical analysis and conversion factor for difficulty of question and examiner • It takes awhile to do all this

  9. What are the trying to assess? • Written exam: knowledge of general medicine and anesthesia • Oral exam: • Soundness of judgment and rationality of thought in making and applying decisions • Ability to assimilate and analyze data so as to arrive at a rational treatment plan • Ability to define the priorities in the care of a patient • Ability to recognize complications and to respond appropriately to them; adaptability as evidenced by the ability to respond to changing clinical conditions • Ability to communicate effectively about those issues of specific relevance to anesthesia care and also those topics of general medicine which are crucial to the care of patients with diverse diseases.

  10. In summary • Judgment • Application of knowledge • Clarity of expression • Adaptability to changing, sometimes unexpected, circumstances • Your job: to convey verbally an organized, rational approach to safely anesthetizing patients and managing complications and developments

  11. Pitfalls • PPPPPP • prior planning… • You must practice OUT LOUD!!!

  12. Problems as listed by the ABA • Superficial knowledge • If you don’t know it, you can’t discuss it • Inability to apply knowledge to a clinical situation • How abnormal PFTs might change your management • Inability to adapt to changing clinical conditions • Routine case: I got it! Managing hypoxemia during thoracotomy: how do I do that? Hmmm….

  13. More problems • Inability to express ideas or defend a point of view in a convincing manner • Well I could do this, or this, or whatever • Faulty judgment • Don’t choose the risky option • Transmittal of insufficient information because of excessively slow and deliberate knowledge • Not enough time to convince them that you know something

  14. Problems from Board Stiff Too, UW Dept of Anesthesia • Failure to prepare • Getting rattled early on and never getting back on track • Trying to cater to the examiner • Getting mad • Not doing first things first (H&P/airway) • Not showing proper urgency • Not stating pros and cons, not indicating if a choice is controversial

  15. Pigeon-holing the question too early • Not getting consultations for specific problems • Asking questions of examiners • Slow pace with excessive lists • Tangential answer (answer the question- repeat if necessary to remind yourself) • Airway • Unfamiliar with common technique • Not asking surgeon for alternatives to planned surgery

  16. Cookbook approach • Using unfamiliar techniques • Not calling neonatalogist at beginning of difficult OB case • Forgetting Abx for heart lesions

  17. How do I actually take the exam • How to dissect the question or what to do with your ten minute allotment • Brainstorm! • Write down as much as you can about the case. You’ll want to refer to your notes later.

  18. Timing • Emergency – just go with it and manage! • Urgent – time for a few studies? Labs? But prob. Needs to go today • Elective – Do all you want

  19. What are they getting at? • Why is this an oral boards question? • Multi-organ systems involved • Conflicting interests • A case everyone should be able to manage? • Difficult airway!

  20. Anesthetic planning • Preoperative assessment • Pre-op preparation: organ systems • Premeds • Monitors • Choice of technique • Induction • Maintenance • Emergence/Extubation • Post-op

  21. Pre-op assessment • History and physical • Labs • Consults • Studies: invasive and non-invasive

  22. Organ systems • Patient’s comorbidities • Expected and anticipated problems • Management

  23. Monitoring • Standard monitors • Cardiovascular • A line • CVP • PA • Echo • Neurologic • Twitch • ICP • SSEP

  24. Anesthetic technique • Many choices but each patient gets one (in general) • Pick one and defend it • Lay out your reasoning

  25. Induction • Agents • Options • Problems • Propofol may drop CO too much in this frail patient with AS

  26. Maintenance • Not much on how you’re going to maintain: air/iso/remi etc…. • But critical incidents happen here • Hypoxia • Hypotension • Tachycardia

  27. Emergence and extubation • Not waking up? • Life-threatening: hypoxia, hypotension, hypoglycemia, brain bleed • Big hitters: drug, metabolic, neurologic • Not ready to extubate? • Transport issues

  28. Post-op • Pain • Oxygenation/Ventilation • Fluids • Cardiovascular management

  29. Critical Incidents • List from Wright’s handout • Mechanic’s Manual from Board Stiff Too • Know your algorithms! • Expect to see difficult airway and hypoxia

  30. Let’s try it! • 61 year old man scheduled for lumbar lami at 11:30am • PMhx: HTN, DM, MI 4 years ago • Meds: Oral hypoglycemic agent, metoprolol, thiazide diuretic • VS: 80kg, 130/90, P 72, T 37, Hbg 16.5, glucose 130

  31. Case #2 • 62 yo woman s/f thyroidectomy and r.radical neck dissection for thyroid CA • Smoker with long standing chronic, productive cough • Anxious, thin (51kg), cough a lot • 132/80, P 92, coarse rhonci throughout • Hct 52, room air ABG 7.38/34/68 • EKG: r. axis deviation

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