Thursday, March 13, 2014

MiM Mail: Navigating oral boards (and not going insane)

I am a 31 year old Ob/Gyn in the North East and have two small children, ages 1 and 3, as well as a wonderful husband. I am one and a half years out from residency, am becoming a partner in a small private practice, and am preparing for my oral boards. I have a 90 lb labradoodle that eats all my socks and throws them up in the middle of the night in the corner of my room. I have loans, bills, chores, family responsibility, and the list goes on and on. Basically, I could lose it at any given moment.

Typically I am very relaxed about life. I am calm under pressure and actually enjoy that adrenaline rush during an emergency.  I have rushed a mother to c-section in minutes without breaking a sweat and then came home to quickly throw together a home cooked meal.  All while dealing with my three year old in his second time out and holding the 1 year old who just won't let me put her down.   I honestly felt like I could handle just about anything...Until now.  Preparing my case list for the oral boards has been nothing short of miserable.  After a few days of chest pain and frequent trips to the bathroom from anxiety, I am writing this to ask for help.

I am hopeful I can find a few others out there like myself who had this same experience. I thought that the worst part was going to be in Dallas where I will sit on the "hot seat" for three hours and get baraged with questions. And maybe it will be.  Oh God, what if it is worse then this!!!! Breathe, just breathe.   Let me explain the root of my troubles.  I am currently compiling my case list, which means entering in every delivery and surgery I have done in the last year. Thus I am forced to relive and reanalyze each one.  As I am entering in a case, I remember it all clearly and at first think that yes, I did everything just as I should. Warm fuzzy feelings wash over me as I remember how I helped that woman and improved her life or placed a new life into her arms.  Quickly, feelings of doubt and fear wash over me as I panic. Was that the best way to approach her problem? Did I do the most evidence based treatment? Did she have a readmission for  a postop complication that I am not aware of? Do I actually know what I am doing? How did they ever let me graduate!?!

I tried to explain myself to my husband, and of course he is supportive. Reminding me that most young new graduates undoubtedly feel this way too. But do they? That is where I need your help.  I am certain you have all been in my shoes. Struggling to balance motherhood and medicine. Feeling guilty for not reading all the latest journal artricles and at the same time feeling even more guilty for not reading Goodnight Moon that third time because you just needed your kids to be in bed so you could have a moment to yourself.  Wanting to give your husband attention and wanting to sleep.   My identity is both physician and mother/wife. I am where I am and who I am because of my experiences. I love my job and even more I love my family.  I feel truly blessed to  be where I am, and also slightly terrified.  It seems like just yesterday I was graduating from college with big dreams to become a doctor. Big dreams to one day be married with a family. And all of a sudden here it all is in front of me, and all I can do is panic and want to hide under the covers.

So, I am sending this out into the great internet void to get some clarity and advice. How do I continue to "do it all" and not lose my mind in the process? Is there a secret to navigating the oral boards? I need your help.

6 comments:

  1. I've never taken oral boards, so can't give you any insight into that process, but I have lately experienced life as a full time working mom along with being a single parent of sorts to 3 kids, one of whom is an infant. My husband recently started an online master's program along with a part time job in addition to his usual job from home, and so I've been left with 3 kids and almost all the housework. It's taken some getting used to, but I definitely had to give up things e.g. not cooking and baking as much as I want, not doing activities with the kids unless I can cope with 3 kids at the same time, not celebrating our religious holidays in as much pomp as I usually orchestrate. And even at work I know that I'm losing touch with some of the stuff I should be good at - procedures, more serious inpatient type conditions, babies. I work outpatient only and am glad for the time it gives me to spend with my family support my husband, but I know my skills and knowledge take a hit.
    Good luck to you on your oral boards and as you figure out how to keep your mind through this madness. It's pass, and then you'll feel more in control of your life.

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  2. KC, as soon as I started reading your post, I couldn't help but think how similar we are in this stage of our life! I also have been out of residency since June 2012, on a partnership track, 3 kids (4, 2, and 6 mo), a loving husband (who started grad school after our 2nd kid), and yes the preparing for the oral boards. I too have an extremely relaxed and easy going personality that is not really associated with a stereotypical obgyn :) people always ask me how I chose to became an obgyn haha. Anyway, yes this oral board process has given me some grey hairs but I feel much better after talking with a couple people who have passed the boards in the recent years and also after registering for the exampro oral board prep. I never took a prep course in my life including the written board, but with the lack of time to really study and from other ppl's reviews/experiences, i think this will be a good investment, although it is rather pricey. I bought their caselist construction software and it's been really easy to log in my cases on any computer or on my iphone. This way I don't feel too overwhelmed about missing any cases. I will have to go back later and fill in all the little details but at least I will have a list of patients already logged. By the way, I will probably have a shorter case list since I was on maternity leave for a lil more than 3 months this year (but was approved to sit for the boards) so I am a little nervous about that but just want to get this over with! I also frequently email the ABOG about what to include in the caselist because I still am not 100% sure. They are great about answering ur emails!
    Anyway, we should keep in touch! Good luck with all your prep and maybe we will meet each other in Dallas!

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  3. I completely understand! I am also an Ob/Gyn and in the 6 months prior to my oral boards I had my second child and also interviewed for fellowship. The process leading up to the oral boards was very stressful. I would have been very disappointed if I failed after spending so much time away from my babies. But let me tell you, it can be done!

    Please know that the actual test really isn't as bad as it seems. Yes, it has taken on a reputation of epic proportions. Somehow we have all been led to believe that the testers are ruthless and the case list will make or break you. We all spend hours agonizing over this list. My advice is pick a style and be consistent. I chose the limited info version. For example, a med list may say antibiotic or antihypertensive, not a specific name; an annual exam receives age appropriate testing. This kept me from painting myself into a corner with the list. That way, during the test you don't have to remember so many specifics about each patient, but provide your standard of care answer. Does that make sense? Others choose the more detailed version. Both are completely fine, just be consistent. (but the less detailed way may alleviate one of your stresses). The other thing to know is that once your case list is accepted, the testers sitting in front of you are instructed to quiz you on content, not form a pass/fail opinion based on the list itself. Once you are sitting at the test, you are in the driver's seat.

    It is also very helpful to have someone give you practice orals. There are likely people in your residency program that would be happy to do this if your current partners aren't as prepared to do this. Don't be afraid to reach out. These people may also review your case list for you. I know I have done it for many friends over the years.

    I did take a board review course (the 8 day Columbus course), though that was probably overkill. I would give one word of caution on courses now -- be sure to read the ABOG statement about review courses. They have really been cracking down on them and I think you now have to sign some sort of honor statement prior to the test? Check the website. They have stated that in certain circumstances they can invalidate your certification. I really don't say this to fear monger, but this is a change in the last year that would make me be very careful in what courses I chose, etc.

    I could go on and on about this test. If you want more info, let me know. The bottom line, don't stress as much about the case list, put some energy towards studying your weak spots, and walk in there with some confidence. And maybe a beta blocker. That worked for me :)

    And in 2 years when I am headed back for my MFM orals, remind me I said it wasn't so bad!!

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  4. I agree with above. The key is practicing ! Have someone intimidating quiz you. We are all nervous, but the more prepared you are the more confident you will be. I also took a review course that was awesome (Exampro). This was about 7 years ago, so I don't know anything about the waiver??? but if this course is allowed then it is well worth the time and money. Put mommy guilt on hold for the next few months and just study. Focus on the standard of care don't worry about zebras. When they start asking you crazy questions, that means you've already passed and they just want to see how much you know. Good luck. Life does get a little smoother when the kiddos get a little older!

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  5. I just passed my oral boards in 2013...I have a 2 year old and was 24 weeks pregnant the day I took exam! You are not crazy to be so stressed and have anxiety regarding patient care...you are still learning and growing. One of my good friends ended up in therapy during her studying because it put such a strain on her marriage and caused her so much anxiety (she also passed and is now doing great)! I took the exampro definitive board prep course and used their software to log cases...I would highly recommend them. I took the course in August even though I did not test until end of January...I felt like this helped me tremendously...even though I really didn't start studying until december...I was able to feel calm because I knew what my study plan was and had their materials available. I also did 2 mock oral exams with other attendings at my hospital, as others have recommended...well worth it.
    I am lucky enough to be part time OBGYN hospitalist so had a little more time to study...but my friends in private practice all found their way and did great as well.
    Good luck!!!

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  6. I agree with what everyone else says. Don't stress too much about the case list, take a prep course, etc. In particular, don't worry about complications on your case list. If you're really working, you will have a complication from time to time, and the examiners know this. They aren't testing whether or not all of your cases were textbook; they want to know if you understand the speciality, are actually working enough so that they can feel confident that you are keeping up with your skills, and can handle complications as they arise.

    The one additional thing that I wanted to recommend is that if you are feeling super stressed about this, take some time to talk with a therapist. The reality is that the re-hashing of your cases, complications, etc. isn't going to go away once you pass your boards. As a group, we all are conscientious and self-critical, which are good qualities, but they can drive us crazy because we also are human and are inevitably going to make mistakes at some point. People--least of all doctors themselves--don't like to admit that doctors are fallible. If it's really eating you up, it helps to have an outlet to discuss it. We spend SO much time as OB/GYN's listening to other people vent about the stress of life, we deserve to have someone available to listen to our own stresses!

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