Preparing for Oral Boards

The anesthesiology boards have two parts, a written examination and an oral examination. While this used to be the case with most specialties, many have done away with the oral part. For anesthesiology, I think it is here to stay. The written test focuses on medical knowledge, understanding of physiology, pharmacology, and disease states, interpretation of data, and textbook facts. However, a critical part of being a safe and effective anesthesiologist is the medical decision making in what we do. Since so much of anesthesia is real-time, we don't always have the luxury to break open the textbook, look up information, or consult our colleagues. The oral exam assesses our thought processes, response to changing situations, and clinical reasoning, It probes the grey area of medicine, the weighing of risk and benefit, the approach to uncertainty, and the situations which have no right answer. I think in this respect, it is an exam that is here to stay.

Of course, the process isn't the easiest. It's time-consuming and expensive. Over the last year (and again in the next year), every few weeks, hundreds of newly minted anesthesiologists fly across the country, stay at a hotel, and take this standardized exam. Dozens of examiners, well-established professors and community practitioners, also fly across the country to administer the test. It's a little mind-boggling how much goes into this. (One wonders whether someday it'll be digitized).

We are all nerves and stress while we take this test, just over an hour of examination time. We get two patient scenarios, and for each one, two examiners proceed with rapid-fire questions trying to befuddle and stump us. The scenarios never go smoothly; part of the test is to assess how we manage surgical and anesthetic complications. You never know when you get the right answer since the virtual patient will always do poorly. The examiners also probe in increasing depth, asking question after question until all you have is, "I don't know." They want to see how candidates do under stress, and it's fair, because real life anesthesiology is stressful. The good examiners reveal nothing, and an hour and a half later, we are ushered out, dazed and shocked. At least that's how I imagine the experience to be.

I have been studying quite a bit; the exam can cover any aspect of anesthesiology, including areas I don't currently practice such as neonatal anesthesia, cardiac bypass, and pain management. But since it's more than just medical knowledge, I am working on how I present myself, my communication, and my thinking under time pressure. I'll probably take a break from the blog in a few weeks as I get closer to the test.