Secrets To Passing The ABPS Boards

Ron Raducanu DPM FACFAS

I want you to pass your American Board of Podiatric Surgery (ABPS) boards. I really do. Despite all the conspiracy theorists, we all want you to pass your surgery boards. It can only serve to make our profession stronger.

Sadly, not everyone can pass. That is inherent in board examinations. No one is out to get you. I promise. I have never been an ABPS examiner. I have never actually written questions for the examination or been involved in the ABPS in any way. Despite that, I think that I can say with a reasonable amount of certainty that no one who helps out within the ABPS (many of whom do it with not nearly enough accolades) has a vendetta against you or anyone else in our profession.

Whether you want to believe it or not, all of us go through the same process to become board certified. It is a fair and honest system based on statistical analysis of examination data. The only one who can determine whether you are successful with the process is you. The problem is that many of us are our worst enemies, so I am going to try to help out and give you a blueprint of how to go about things and limit potential mistakes.

I am going to talk mostly about getting through the oral portion of the examination and how I approached it, the mistakes I made, and how you can get there more smoothly. I will also try to help you settle yourself while going through the actual oral examination, although I do understand that things are changing and pretty soon, there will be no face-to-face part of the examination itself. I am hopeful, however, that my advice will carry over regardless.

First things first. To get “board qualified,” you have to pass the written exam. I have a horrible time with test taking but eventually overcame this while I was in college. Just thinking about all those multiple-choice questions makes my stomach churn.

A key thing to understand is that each question is graded individually. If too many people get a question wrong, the examiners could throw out the question. This is important because if you get questions wrong that most people get right, it is not the examination that is faulty. You see?

I have personal experience with this as I was unsuccessful in passing the rearfoot/ankle written examination. I found that I was not exposed to many of the theories that the examination presented, so I had no idea what the correct answers should have been. I also decided not to try again, as I really wasn’t sure what I needed to learn to get the right answers. It was a tough pill to swallow, but I was sure it was me and not the examination.

Once you pass the written portion of the examination, you are board qualified. However, you are not permitted to advertise that you are board qualified. You can only advertise your board status once you are fully certified. You will get the guidelines when you receive your letter of congratulations. Read them. Follow them. Make sure your employer follows them. You get the picture. Bravo!

What To Do Once You Are Board Qualified

On to phase two and a somewhat more complicated experience. That being said, one of the biggest mistakes I made was not starting to keep track of my cases right away. I should have, so this is what I suggest you do.

As soon as you get that notification that you have passed the ABPS written examination, immediately download the ABPS 220 document. This will help you figure out what cases you need, what documentation you need for each case and what you need to properly prepare to submit your cases for the board certification process. Read the ABPS 220 document carefully. Learn it inside and out.

Once you have done that, buy a little notebook and keep track of every case you do along with a small checklist of what you need to get/have so you can submit that case for consideration. Do this. It will avoid you needing to scramble and sweat about what cases you need, wondering if you have all the required information, etc. Easy peasy. If you have questions, call the ABPS. They were very helpful to me during the process. They are an invaluable resource. They have the answers you seek.

The other thing to know is that you have seven years to get this done. Otherwise, you will have to sit for the written examination again. If you do not keep track of this and let time get away from you, you risk losing your board status. This could end your career as a surgeon in some communities. If you let this happen, the only person you have to blame is yourself.

Keep It Simple And Follow The Rules

The one thing that blows me away is that some people think that the rules just don’t apply to them. Some people think they can get away with trying to bend someone else’s rules. Then they cry and moan when they get caught in a situation where they try to bend the rules, and the rules bend back and slap them in the face. Follow the APBS 220 to the letter. There are warnings about situations in which your cases will be rejected all over the document. Don’t take the risk of trying to sneak one through. I promise you that they will pick that case you are trying to sneak through and that one case will end you. Don’t do it.

Your peers are evaluating your cases for a reason. They want to make sure you have your head about you. That’s what they do. It is up to your colleagues in the ABPS. So if you’re submitting your “hero” case in which a patient came to you for a bunion correction and he or she suddenly came out with the bunion/forefoot/rearfoot reconstruction of awesomeness, and you chose to highlight the greatest Evans procedure ever performed in the modern age of podiatry, you may run into a bit of a problem.

Your peers will evaluate everything you submit for clinical relevance. So basically, a 30-year-old female who comes to you with a flatfoot, but complains about a painful bunion and only a painful bunion (according to your notes) should not have an Evans procedure on the radar for submission. The examiners will question this. You are not trying to impress anyone with your brilliance. Submit the basic cases and be done with it.

The KISS (Keep It Simple, Stupid) principle stands. I hear about the rejection of cases and this is what some of them amount to. Most of them amount to just not following the rules. If an ABPS representative reads this and has more or better information, please contribute. That is what I am hoping for.

Now that you are sure you have everything you need for each case, input them as required, press “send” and wait. If memory serves, you then must provide more information on a certain number of cases. However, you have that covered because you did what I suggested and have all your ducks in a row, and the cases you have to submit are squeaky clean and ready to go.

A Few Notes About Preparing For The Oral Examination

Then you breathe a sigh of relief and realize you now have to prepare for an examination where you have to talk to someone about cases you have never seen before. Scary, huh? Well, it is but you can prepare for it. Here is how you do it.

First of all, you shouldn’t be learning anything new when reviewing for this next stage. It should all be stuff you use on a virtually daily basis (or so), especially if you are a busy practitioner. The questions they will ask you are not tricky. They are based on cases we all do. Maybe some will be a little more obscure but after really thinking about things, you will realize that the principles in all situations are what are most important.

Let me give you an example. I graduated with my DPM degree in 1999. I did three years of residency and eventually was certified (foot surgery) in 2008. Do you know how many gunshot wounds I saw in all that time? One. Guess what was one of my oral questions? You guessed it: A question on a gunshot wound. I breezed through it because it’s basically a wound so the principles of basic wound care apply (for the most part).

Even with my extreme test-taking anxiety issues (I still have them but learned how to control them), I got advice from a host of close colleagues that served me very well so I would like to pass that advice along. Don’t go out drinking the night before the test. Eat a good meal. Take in a movie or something. Put the podiatry books down. Get your mind away from tomorrow’s task. Get a really good night’s sleep and the next morning, make sure you eat something light and stay hydrated. You will be a nervous wreck, whether you chose to show it or not. When I am nervous, I don’t do well in crowds so I tried to stay away from all the inevitable chatter.

Stay Focused On The Questions And Key Principles

When it was time to go to the examination area, I made sure I had a plan for each question and repeated it to myself so I would not forget. The most important thing you get when you go into each room for a question, or get to the next computer station is a blank piece of paper and pencil.

As soon as I sat down for each question, I wrote the following on the piece of paper:

SOAP (subjective/objective/assessment/plan)
NLDOCAT (nature, location, duration, onset, course, aggravating/alleviating, treatment)
PMH, PSH, FH, SH, meds, allergies, ROS
LE exam: vasc, derm, neuro, ortho
X-ray/CT/MRI (I reviewed these as if I were in the school clinic when I saw one)
Labs

This gave me a clear path to follow and worked for every single question. You will not forget the process if you write it down every time. Trust me. It works.

Once again, don’t be a “hero.” Answer the question and only the question. If you have ever had the pleasure of being involved in a deposition, the same advice applies. You are not there to impress anyone. Do what you think is required, not what you think the examiner (or computer for that matter) wants to hear. You are not there for a job interview. Many fall into this trap by reciting McGlamry when asked a simple question. Just answer the question.

Also, do not get flustered by what you see or what they give you. Let me give you an example. One of the pillars of our surgical community was examining me during my oral examination. That in and of itself made me beyond nervous. The question concerned a rather simple LisFranc’s dislocation for which I eventually stabilized the first and second metatarsocuneiform joints. When I saw his post-op film, it looked like more metal than bone in there. I must have turned as pale as a ghost because the examiner reassured me that I wasn’t expected to regurgitate what he did for that particular patient, and eventually confided that he should have done it the way I suggested when replying to the examination question. Answer the question. Period.

The other thing to not worry about is what the examiners are writing. They have a checklist and are marking off whether you have touched on points that earn you marks. That is pretty much it. They may write a note here and there, but do not worry about it. They are also there to help you. They want you to pass. They do. Some may do it in more gentle ways than others but ultimately, they want us all to succeed. They are not there to trick you. They want to see that you have your clinical head about you. That is it. I imagine the computer questions are designed around the same principle.

You will miss things that you will kick yourself for later. All of us did. Even those who won’t admit it out in the open have missed things. The one question I blanked on still has me kicking myself even today. “What is the definitive test for osteomyelitis?” Nothing came out. Nothing. I knew the answer but in the fog of my churning stomach, it would not come out. Can you believe it? Neither could I. Don't worry about it. Those kinds of blanks won't fail the test for you as long it is only one or two.

Final Notes

There are a couple of things I hope the ABPS will consider in the future. Those of you who go out on your own have it hard. It is not easy to generate all those cases in the given timeframe if you are on your own. It is tough. Are the requirements fair? Of course they are, but when you are all by yourself without others to help along with your surgical volume, it adds to an already stressful situation.

The other thing that happened was that when I took the computer test, you couldn’t go back to the previous question. That was a little nuts for us so I’m hoping that if that hasn’t changed, it will change. If the test is will only be on computer starting soon, it stands to reason that you should be able to review your previous answer within the same patient/module.

I want input and questions, folks. Let me have it.

Comments

I'd like to add some comments to Ron's blog. I do have the experience of being an examiner for the oral portion of the ABPS examination for many years. First and foremost, Ron is 100% correct. There are no tricks and no one is out to "get you." If you are prepared and know your material, you will pass. If you come to the exam poorly prepared, you have a high chance of failure. Prepared includes knowing the material AND having the ability to communicate what you know.

Ron mentioned that he immediately jotted down tips to stay on track such as NLDOCAT and other items. During my years as an examiner, I watched too many candidates write all that down and not utilize what they had in front of them. They got caught up in the question and didn't follow their own outlines. They wrote down to ask about allergies but never asked, and subsequently gave the fictitious patient a drug he/she was allergic to in the past.

Ron is also correct that examiners may be writing during the exam. We really weren't supposed to in an attempt to not freak out a candidate. But to ensure I was grading accurately, I did take notes or wrote down comments. However, in the silence a few minutes before the exam clock started, I would actually tell the candidate that if I was writing that they should not take it as negative or positive. It's just allowing me to grade accurately. Don't try to "read" the examiner. It takes too much time and effort. Just stay on target and answer the questions and don't try to be a psychologist.

Most important in my opinion is to not over-think. There are no tricks. Treat the case as you would if that patient was sitting in front of you in your office. Proceed logically and methodically as you would in your office.

To digress a little, your life is also easier when preparing if you simply obtain a copy of the op report on all cases you perform and put them in a loose leaf binder for when you are submitting. Also obtain copies of films taken outside of your office and obtain copies of pathology reports. When you have them all in one place, you won't have to chase them or spend weeks in your hospital medical record department.

On a final note, I'm sorry to see that the oral exam is moving to a computer model. I know during my years as an examiner, I did not give away any answers but instead made sure qualified candidates stayed on track by letting them gently steer themselves in the right direction. I never passed anyone who didn't know the material but did make sure those who did know the material were not led down the wrong path. If you knew your stuff, you passed unless you ignored when I said, "Okay, let's move on." If at that point, you kept going down the wrong path, you determined your own fate.

Prepare, know your material, treat the case as if it is a patient in your office and realize it is a fair exam and not a trick, and you'll do great.

The ABPS is a great organization that has moved our profession forward and if you are capable and prepared, you will be certified and proud of your accomplishment.

Same advice goes for the ABPM (American Board of Podiatric Medicine), formerly called the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM)?

I truly think there is a problem with the prometric design of the test. Who determines the difficulty level of the test? As I'm sure you know, once a question is answered, they assume that you have given it your best guess and progress from there. If you get a so-called "easy" question wrong, you do not get the chance to progress to a more difficult question, and have no chance of a higher score.

Also, in my own experience, there are huge gaps in the individual topic results breakdown. No uniformity at all.

Lastly, there is no chance at remediation. How can you ever improve if you never know which questions you got right or wrong?

I agree with you with way the computer test is designed. I had hoped they changed that by now, but it seems they haven't. I'm not sure why the design is that way.

Remediation is an interesting point. I would guess that since there are so many questions, why would you need to know which ones you got right or wrong as you shouldn't encounter the same questions on your next go around. That would be my guess at least. It's also a matter of avoiding "cheating" as how would they give you that feedback? If you got the test back with it "corrected", what's stopping you from circulating your test and creating a "bank" of questions with others and then distribute that as they do with old tests in podiatry school?

It's not that easy to field all of these issues and maintain a fair environment for everyone. The ABPS does a superb job with it in my opinion.

On remediation...here are some of the problems that I see although I do agree with most of your points.

1. It's a matter of checks and balances. I want to personally see what the board decided was the correct answer. If I don't, how can I be sure that there right answer is the best/right answer? For example: Maybe a postoperative course question with answers A.2wks B.4wks C.6wks D.8wks E.10wks. Depending on what you read, all of these answers could be correct. Who decides which person's opinion is correct? Plus, it varies with each and every patient, does it not? I have researched a number of questions and found multiple answers for each. I still to this day do not know what should have been marked for an answer. I can't help feeling that if the questions were all asked to me orally, things would be much different.

2. This is supposed to be a minimum competency exam. I don't feel that the majority of the information that we are being tested on or that we have had to learn is all that difficult. But for whatever reason, we have all of these people graduating from a multiple year residency who are far more than minimally competent that are not passing these exams. These are the same people that have passed many, many exams to get to this point. Some of these people I know to be excellent clinicians, surgeons and teachers. Why do you think that is? General orthopedic surgeons spend far less time training in contrast when considering the entire body and have a higher pass rate. This definitely makes our profession look inadequate.

3. I can assure you that I have seen questions repeated. How many questions can you possibly come up with on such a narrow field of practice? Of course we are going to see repeat questions and, possibly, repeat wrong answers.

To answer all your questions at once, this is the case with every medical specialty. My brother is an anesthesiologist in Canada and hears the same critique about their board exams up there. There has to be minimum competency agreed upon by a panel of our peers. As I said, THEY decide on the questions, answers and what minimum competency should be. This is also quantified by statistics as analyzed by statisticians employed by the ABPS.

Is it really the exact same question? One word can make the difference between what you've been asked AND what you THINK you've been asked. That is exactly part of the process.

It's not a trick. Statistically, the number of people passing is what it should be. I'd love to see the actual data where you claim that orthopedists pass their examination with more frequency. Where is that data available?

I cant help feel that this is becoming argumentative and defensive. That was not my intention. I will concede that "one" word can change a question but that should change the available answers as well (they were the same questions). It still concerns me that our "peers" consider so many of us less than competent.

From the American Board of Orthpaedic Surgeons web site!
Part I Examination Statistics
# 2007 % # 2008% # 2009% # 2010% # 2011%
Examiness 728 715 719 779 832
Passes 641 88% 610 85% 643 89% 628 81% 660 79%
Fails 87 12% 105 15% 76 11% 151 19% 172 21%

Part II Examination Statistics

# 2007% # 2008% # 2009% # 2010% # 2011%
Examinees 662 699 695 680 662
Passes 596 90% 584 87% 621 89% 602 89% 586 89%
Fails 66 10% 85 13% 74 11% 78 11% 76 11%

Here’s the address: https://www.abos.org/

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