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The Things I Do For the Residents May 8, 2008 Jessica

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Title: The Things I Do For the Residents May 8, 2008 Jessica


1
The Things I Do For the Residents
  • May 8, 2008
  • Jessica Lovich-Sapola MD

2
Hotel
3
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.

4
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.

5
Written exam as a predictor.
  • Certain written scores 100 pass rate.
  • Barely pass written exam 5050 pass on the oral
    boards.
  • Side Note
  • Dr. Gravlee, chair of the written exam,
    recommends Hall question book for studying.

6
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 ABAs 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.

7
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.

8
Dress Code
  • Men Coat and tie
  • Women Office attire
  • I recommend a black suit.
  • Most women also wear a black pants suit.

9
Dress Code
YES NO
10
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.
  • Dont play with your pen, jewelry, etc.
  • Look the examiners in the eye and talk with them
    like a colleague.

11
What to bring to the exam.
  • Basically nothing.
  • You cant bring anything into the room.
  • You can bring a pen and your ID.

12
(No Transcript)
13
Picture of Exam Room
14
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.

15
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.

16
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.

17
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.

18
Who Writes the Exam?
  • Practicing anesthesiologists who serve as
    examiners submit the cases.
  • The ABA takes care to ensure reasonable content
    sampling.

19
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.

20
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)
  • Dont waste time on preoperative questions.

21
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)

22
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.

23
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.

24
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.

25
What the Examiners Know About You
  • Your name.
  • That is it!!!

26
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.

27
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.

28
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.

29
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-examiners rating and
    matching those ratings.
  • Fretting over a split with a co-examiner leading
    to failure to concentrate on the next
    examination.

30
Scoring Sheet
31
Scoring Sheet
32
Scoring Sheet
33
Scoring Sheet
34
Scoring Sheet
35
Scoring Sheet
36
Scoring Sheet
37
Scoring Sheet
38
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.

39
Grading Cont.
  • 2. Judgment
  • Soundness of judgment in making decisions and
    applying decisions.

40
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.

41
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?

42
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?

43
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.

44
Scoring
  • Scaled score
  • Based on the exam and the examiner
  • Multifaceted analysis
  • Consistent 20 failure rate.
  • One examiner cant fail you!!!!

45
Be able to answer.
  • Why?
  • Why not?
  • Why not something else?
  • There is NO right or wrong answer!
  • Dont be so regimented.
  • It is OK to say you are not comfortable with a
    certain technique, but you must know that it is
    possible.

46
Questions?
  • Just answer the question.
  • Do not ask questions. They dont have any more
    information than they have told you.
  • You can ask for a clarification if you really
    dont 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.

47
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 dont 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 dont
    know anesthesia.
  • The explanation is more important than the
    answer.

48
More Tips
  • Imagine yourself in the OR. Only do things that
    you would normally do.
  • Dont 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 dont
    remember at this time. Dont ever make up
    answers.
  • Dont quote a book or article unless you are
    prepared to have a detailed discussion.
  • Always keep the patient safe!!!!!

49
Sh-- Happens
  • Bad things are going to happen, no matter how
    good you are.
  • They are written into the script.
  • Treat the problem, and dont stress over whether
    it was your fault.

50
So you realize you made a mistake
  • They dont want you to be wishy-washy, so stick
    to your guns.
  • But, dont go down with the sinking ship.
  • If you realize that you made a big, killing
    mistake, say
  • I am sorry, but I

51
Problems candidates have.
  • Superficial knowledge.
  • Good knowledge, but.
  • The inability to apply it or adapt to clinical
    conditions
  • Cant 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.
  • Doesnt take the test seriously, and are not
    prepared.

52
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.

53
Bibliography
  • 2008 ABA non-examiner workshop.
  • Fort Lauderdale, FL
  • April 14-15, 2008
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