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How to Prepare for the Exam
COURSES 21 BOOKS 22 PRACTICE 22
The Board certification is an essential part of every neu- rologist’s credit, particularly in view of the HMO and insurance companies’ requirements.
From the standpoint of preparation, this exam is not different from any other exam, as your chances of passing will be much greater if you have done your homework in a thoughtful and reasonably organized fashion. Con- versely, presenting yourself after a hurried and haphazard preparation sets the stage for a painful failure. Time after time, when candidates look back on what they could have done better, appropriate preparation is one of the most frequently mentioned responses. A good training and consistent studying throughout the residency do not guar- antee you success either, considering all the variables that play a role in a positive outcome of the test.
While nobody has the magic formula for the Board preparation, a few steps and strategies have been known to be of use. But before we address them, we will briefly discuss getting information on the test from your col- leagues who have already taken it. This is by all accounts a natural thing to do given the importance of the exam, the yearning for information to supplement what the Board gives and the mystique that the exam has acquired over the years as a terrifying rite of passage that has shat- tered countless reputations and self-esteem. Other than slightly and temporarily decreasing your anxiety about the test, however, the information you get from your col- leagues may be less than useful, if not confusing, at times.
This is due to a variety of reasons, such as:
1. The colleague giving you a distorted account of his or her perception of the exam or rationalizations for a poor performance.
2. The colleague may be reluctant to share much infor- mation and only provide conflicting and unhelpful bits and pieces of the experience. It is not unusual for peo- ple to hide having failed the Board once or more.
3. Every exam has a life of its own and it is hard to generalize.
4. Multiple variables, such as anxiety and poor prepara- tion, may have contributed to the candidate’s negative experience of the process.
5. Some of the stories you hear may have no factual basis at all (such as tales on where the exam is easier).
Thus, our advice is to take whatever your colleagues say about the Board with a grain of salt so that it will not influence your performance negatively, and focus on ad- vice that can help build your preparation realistically.
As for when you should take this exam, the answer is simple: As soon as possible.
You should apply for the oral part as soon as you hear about the positive outcome of part 1. Waiting or procras- tinating will only decrease your chances of getting to the exam optimally prepared, as it would further take you away from your residency, thus decreasing the impact of a good training on your preparedness. On the other hand, major events in one’s life may distract from preparation and it would be counterproductive for you to present yourself for the exam with only limited preparation. This is a difficult decision as one has to balance one’s assessed preparation against the risk of getting seriously burned after a resounding failure. If you have been out of the residency for a few years, your preparation might take a longer time and require a longer practice. This book is intended to help this group especially, since it may be problematic for these candidates to obtain accurate information.
Some of the tools candidates have used to prepare for the exam are discussed below.
Courses
Basically there are two types of courses:
1. The first type is a review of material in a lecture format with few hints about the oral part. Therefore, these courses are more geared toward the part 1 of the exam.
22 4. How to Prepare for the Exam
2. The second type tries to simulate the three sections of the oral Board, providing suggestions on presentation, preparation, and how to approach the different parts.
The ABPN does not recommend or recognize any preparation courses. There are, indeed, very few available and they have received mixed reviews from candidates as they are known to be expensive and not live up to expectations. Some candidates enthusiastically praise a course because it may contribute to lessening their anxi- ety about the exam itself. Here is what one candidate stated about a course he took:
The course was very expensive and did not help my prepa- ration. I was able to get a few hints about what the oral boards would be about. However I became gradually dis- couraged by hearing some stories of exams by other candi- dates. One disappointing aspect of the course was the pe- diatric part. It was poorly structured and the teachers seemed poorly informed about this section and did not seem to have significant information about it. In the end I passed this part, but I am unsure about how much of my passing was do to instructions I got from my taking the course.
This is only one opinion. So, our suggestion is, before you embark on a major expenditure of money, energy, and time, you should consider other methods of prepa- ration, such as books and practice.
Books
By and large, what you are going to need is one book of general neurology, one book of differential diagnosis, one of treatment, and one of pediatric neurology. The best way to bring yourself up to date on the latest news in the field is by poring over the major neurology journals is- sued over the past three to four years. This is the best way to fill the gap in recent knowledge that most text- books suffer from.
This is particularly valid for certain issues regarding treatment, such as
• Therapy of multiple sclerosis.
• Therapy of epilepsy with the new anticonvulsants and new treatment options, such as vagus nerve stimulation and surgical intervention.
• Therapy of Parkinson’s disease.
• Headache treatment.
• Stroke therapy.
Below are some titles of books that can help in your preparation. Our suggestions do not mean that these book are necessary or sufficient to pass the test.
• Victor and Adams, Textbook of Neurology.
• J. Biller, Practical Neurology.
• G.M. Fenichel, Clinical Pediatric Neurology: A Sign and Symptom Approach.
• R.T. Johnson and J.W. Griffin, Current Therapy in Neurologic Disease.
• Some good review journals: Seminars in neurology, Continuum, etc.
In addition, many candidates find very helpful the courses on CD ROM by the American Academy of Neu- rology on the most recent meetings, where the most re- cent diagnostic and therapeutic options are presented.
The time spent on the review books is subjective, de- pending on your work and training schedule. Some can- didates prefer to wait for the results of part 1 before com- mitting to a new experience of studying for part 2. There are usually 45 days or more between knowing the results of part 1 and the part 2 exam. Therefore, if you know how to prepare and what your weak points are, it will save you a great deal of time.
Definitely, a large portion of this time needs to be spent on the pediatric neurology preparation.
Again the ABPN does not suggest any specific book.
Having passed part 1, candidates have already re- viewed a great deal of clinical and theoretical material.
Practice
Practice is an excellent way to lessen your anxiety about the exam and to learn what your deficiencies are. Some residency training programs offer sessions that simulate the oral Board examination but often you will have to take the initiative and ask colleagues or teachers to be your examiner.
For the live patient examination, you can practice at the bedside or in your office on different neurological cases, timing yourself so that in 30 minutes you have completed a good history and neurological evaluation.
If you are fortunate, you will have a colleague or teacher supervising you on your history taking, neurolog- ical examination, summary, and differential diagnosis.
The advantage in this case is to have someone who can give you feedback on your performance, highlighting weaknesses and strengths. If alone, practice standing in front of imaginary examiners while you present the case, keeping in mind the most important points related to his- tory and neurological exam.
Practice at least once every day. If you do not have a patient, practice on a friend or family member while you become accustomed to the 30-minute time frame, which, over time, will become automatic.
Practice is an excellent way to lessen your anxiety about the exam and to learn where your deficiencies are.
Some programs offer sessions for their residents but most often you will have to take the initiative and ask someone to be your examiner. By and large, a few general princi- ples apply to planning for a productive session:
Practice 23
1. Select well-prepared examiners who might have taught courses on the topic or might be well known for interviewing and diagnostic skills. It also helps to be examined by colleagues who have recently passed the exam.
2. Unless you know they will be impartial, you should avoid selecting previous supervisors whom you know well and who have a tendency to be overly supportive.
3. You examiner should be someone who is completely free to highlight the areas you need to work on, with- out neglecting to mention the areas in which you dem- onstrated good preparation. Possibly, it should be someone you don’t know very well.
4. Ask your examiner to elaborate on weaknesses and to offer suggestions on technique.
5. Do as many practicing sessions as possible, each time trying to work on the weaknesses your examiner ad- dressed the previous time.
6. In addition to live patient examinations, you should do some dry runs with vignettes. Ask your colleagues to provide some vignettes or use some of the vignettes in this book.
7. It is important to choose patients and vignettes with a wide range of neurological problems so that you can be ready to deal with a variety of clinical and thera- peutic situations.
