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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

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 5050 pass on the oral
  • 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 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.

  • 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
  • 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
  • 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.

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

(No Transcript)
Picture of Exam Room
Exam Room
  • Every room is adjusted for equal lighting and
  • 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
  • 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
  • Exam 2.
  • Go home.

  • 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

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.

  • Briefing session
  • 2 parts, 35 minutes each.
  • Part A
  • 10 minutes to look at the information. Take
  • Intra-operative 10 minutes (Senior examiner)
  • Postoperative/ Critical Care 15 minutes (Junior
  • 3 Extra topics 10 minutes (Senior examiner)
  • Dont 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.

  • 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
  • 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
  • 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

Scoring Sheet
Scoring Sheet
Scoring Sheet
Scoring Sheet
Scoring Sheet
Scoring Sheet
Scoring Sheet
Scoring Sheet
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
  • Are you an anesthesia consultant?
  • Can you be a leader of an anesthesia care team?
  • Can you prioritize and organize your
  • 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?

  • 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
  • The score is also related to the difficulty of
    the examiner.

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

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

  • 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

You are asked a question.
  • Listen to the question and answer it.
  • Then immediately justify why that was your
  • 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

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
  • 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
  • Dont 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 dont stress over whether
    it was your fault.

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

Problems candidates have.
  • Superficial knowledge.
  • Good knowledge, but.
  • The inability to apply it or adapt to clinical
  • 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

  • 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.

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