Top Doctors 2022

The Most Intimidating Test I've Ever Taken: The Anesthesia Oral Boards

Anesthesiology resident Max Feinstein, MD, discusses his experience taking the anesthesia oral boards and gives tips to those about to take them.

Following is a transcript of this video; note that errors are possible.

Feinstein: All of the major exams to become a physician in the United States are the same kind of untrue-to-life, multiple-choice test that's taken at a computer terminal. But the intensity of the exam that I just took to become a board-certified anesthesiologist, it actually makes the drama in "Grey's Anatomy" seem realistic for once.

Examiner 1: You'll be rated on your ability to diagnose, manage treatment, handle the unexpected, basically the strength of your constitution in crisis.

Feinstein: In the United States, to become board-certified as an anesthesiologist or a number of other specialties, you have to take what are called oral boards, which, as the name implies, is a verbally administered examination. But it's not just any examiner who administers the test; it's a number of board-certified physicians in that specialty who take turns grilling you on topics in your field.

I'm sad to say that I have watched most of "Grey's Anatomy," and I can assure you that the vast majority of what's in that show has been dramatized for entertainment purposes and doesn't correspond with reality. But I got to hand it to them. The way that they portray the oral boards is actually pretty realistic. Handling the unexpected and quickly dealing with life-or-death issues is a fundamental aspect of being an anesthesiologist and this is what they test you on the oral boards.

So how do they do that exactly? The exam starts with getting some information about a given patient scenario. Any topic in anesthesiology is fair game. Despite the fact that I'm going into pediatric anesthesiology, I could be asked questions about cardiac anesthesia, OB anesthesia, pain management, critical care medicine, and so forth.

The exam questions start out basically the same for all examinees. "Dr. Feinstein, which preoperative labs would you like in addition to what you already see here?"

But where it gets tricky is the fact that subsequent questions will depend on your answer to prior questions.

"How does that lab change your management?"

"The lab result will take 2 hours. Will you delay the case or will you proceed without it?"

"Doctor, if you don't even need this lab to proceed to surgery, then why did you bother sticking the patient with a needle if you're not even going to wait for the result?"

But the dynamic format of the exam isn't even the most intimidating aspect about it, it's the psychology of the exam. The oral boards are essentially a race against the clock because the examiners have a ton of questions to rush you through and so they'll often cut you off before you even get to the end of a given answer.

"What will be your anesthetic plan for this patient?"

"I would administer general anesthesia with an endotracheal tube and prior to that I would place one IV in..."

"What medications will you administer to induce anesthesia?"

"I'd first bolus fentanyl followed by lidocaine, then propofol and rocuronium. Subsequently I would man..."

"The patient has an allergy to rocuronium. How will this change your approach?"

If you get cut off as you are giving your answer, does that mean that you were going down the right path and they were satisfied so they just stopped asking? Or you were barking up the wrong tree, so they just cut you off and moved on?

"How is remifentanil metabolized?"

"It's a..."

"Should you like this video and subscribe to the channel if you're enjoying it?"

"Yeah, that one I'm not sure about."

On top of that, the examiners will routinely start down a line of inquiry and ask you questions until you get a question wrong, so no matter how smart you are, you're eventually going to get questions wrong and that's going to feel bad. For this reason, many people walk out of this exam feeling like they failed because they know that they got questions wrong. They just don't know whether they got enough correct, or the right ones correct to actually pass the exam.

Intuitively, you can imagine that examiners commonly pounce on uncertainty, but would you have imagined that they would also pounce on confidence? There is nothing quite as disarming as delivering your answer with confidence only to be met by the examiner asking you, "You're sure that's the best approach for this situation?" In the back of your mind, you know that, despite however much time you spent studying this material, the examiner sitting in front of you has been in practice for years, possibly decades.

Examiner 2: Precisely my question, Dr. Yang.

Cristina Yang: I've treated this condition a dozen times.

Examiner 2: And I a thousand times.

Feinstein: Sometimes the examiners may try to rattle you, but picking a fight with an examiner is definitely a recipe for disaster. After all, keeping your cool in the operating room is of practical importance when things around you can get pretty stressful. Knowing that this exam is the one thing that stands between you and full board certification adds a certain level of stress to this test. My heart rate was literally 120 beats per minute as I was walking down the hall to enter the first portion of my exam. One former examiner told me a story about an examinee who had actually vomited on the table in between the examiners and the examinee during the test.

Examiner 3: A 40-year-old man presents with a suspicious lesion on his left temple sent in by...

Meredith Grey: [THROWS UP]

Feinstein: I'll reluctantly give another point to "Grey's Anatomy" for this one.

Then to top all of this off, you have to wait 3 weeks in order to get your results. Let me assure you that I did not record this video during the 3-week waiting period because I'm superstitious enough to know that had I recorded this video during that waiting time, it would have caused me to fail, so I waited until after I got my score back, which fortunately was a passing score, and then sat down to record this video.

So what happens if you fail? Well, you have to wait a year to take it again and then you have to fly back to Raleigh, North Carolina, which is the only city in the United States where the American Board of Anesthesiology offers their oral board exam. You also have to pay the multi-thousand registration fee again and, of course, put yourself up in a hotel and pay your travel expenses to get there.

While the prospect of failing this exam is extremely anxiety-inducing, I will remind you of one thing, which is the worst thing that can happen if you go and fail your board exam is that you have to retake it, shell out a bunch of money, and go back to North Carolina. The worst thing that can happen in the hospital on any given day of being at work as an anesthesiologist is that there is a bad outcome and the patient dies.

Watch the video above for more.

Max Feinstein, MD, is a PGY-4 anesthesiology resident at Mount Sinai Hospital in New York City, where he is also chief resident of teaching. His YouTube channel focuses on perioperative medicine, especially the role of the anesthesiologist.

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Students With Disabilities Match With Physician Residency Programs At Lower Rates

Medical students who report having a disability are less likely to match into a residency program, according to a new Yale study involving residency programs across the United States.

The findings, researchers say, suggest students with disabilities may experience barriers to training and career opportunities, particularly in certain medical specialties.

"Physicians with disabilities are underrepresented in the medical field," said Mytien Nguyen, an M.D.-Ph.D. Student at Yale School of Medicine and lead author of the study. "Lower match rates could contribute to that disparity, which ultimately has negative impacts on the field and patient care."

For the study, published n the journal JAMA, the researchers used data from the National Resident Matching Program, which matches applicants to residency programs in the United States. They analyzed match outcomes for individuals applying to residency programs in 2022 and 2023.

Of the nearly 70,000 people who applied for residencies during that time period, 5.9% reported having a disability, answering "yes" to the application question "Are you a person with disability (e.G., ADHD, learning, psychological, chronic health, mobility, hearing, vision,etc.)?"

After evaluating match rates for those reporting and not reporting a disability, the researchers found a small but significant difference in match rates, with 83.2% of those not reporting disabilities successfully matching to residency programs compared with 81.8% of applicants who reported a disability.

When researchers then looked at rates across medical specialties, they found several where match rates were not significantly different between the two groups. In others, however, including otolaryngology, neurology, physical medicine and rehabilitation, dermatology, pediatrics, internal medicine, and emergency medicine, match rates were higher for applicants with a disability.

Driving the overall lower match rates for students with disabilities were the rates for general surgery—65.5% compared with 76.2% for students not reporting disabilities—and orthopedic surgery—58.6% versus 73.3%.

During the matching process, students apply to specific programs, interview, and then rank programs in order of preference. Programs rank their applicants as well and the National Resident Matching Program uses an algorithm to determine matches based on the two sets of rankings.

The match rate variability across specialties, researchers say, may reflect differences in specialty culture or their applicant assessment practices, with biases--whether conscious or unconscious--affecting match rates.

"With this gap, I think it's important for each specialty, not just surgical specialty, to think about their processes and incorporate disability as a metric to examine in addition to race, ethnicity, and sex when they're evaluating their program's diversity," said Nguyen.

The differences across specialties may also point to positive approaches that others can adopt or build from, said senior author Dowin Boatright, who is now vice chair of research in the Department of Emergency Medicine at New York University Grossman School of Medicine and began this line of research while at Yale School of Medicine.

"Looking at specialties with higher match rates for applicants with disabilities may uncover successful strategies for equitable evaluation," he said.

Organizations like the Accreditation Council for Graduate Medical Education, which evaluates medical residency and internship programs, play a role as well, said Nguyen, noting the work the body is already doing to promote awareness and support for learners with disabilities.

"And of course the number of applicants with disabilities in our study was very low, which speaks to disparities that may exist earlier in the training pathway and need to be addressed as well," she said.

More information: Mytien Nguyen et al, Outcomes of the Main Residency Match for Applicants With Disability, JAMA (2024). DOI: 10.1001/jama.2024.5000

Citation: Students with disabilities match with physician residency programs at lower rates (2024, April 17) retrieved 24 April 2024 from https://medicalxpress.Com/news/2024-04-students-disabilities-physician-residency.Html

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Medical Resident Shares One Symptom That Led To Her Metastatic Sarcoma Diagnosis — Now She Inspires Others (Exclusive)

Kimberly Nix was well into her journey to become a doctor when life threw a wrench at her: She was diagnosed with metastatic sarcoma in 2021.

At the time, Dr. Nix was only 28 years old and in the third and final year of her internal medicine core residency. Even then, the Canadian resident didn't let the sad news dull her spirits. Instead, she leaned on her family and friends, decided to continue her studies and now uses her journey to inspire others.

"When I was first diagnosed, I was also studying for my specialty licensing exam (which I fortunately passed!) and working full time as a resident," Nix tells PEOPLE exclusively.

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"I was disappointed about the news, but between frequently meeting with friends to study, my supportive family (including my now husband), and working with a licensed cancer counselor, I kept my spirits high, which helped me immensely with the sarcoma cancer journey."

Nix was initially diagnosed with extra-skeletal osteosarcoma, but later found out she actually has undifferentiated pleomorphic sarcoma as "having an evolving diagnosis is common in sarcoma because there are over 100 subtypes," she explains.

According to the National Cancer Institute, undifferentiated pleomorphic sarcoma typically forms in the soft tissue (though it can also form in bone) and usually occurs in the legs, arms or back of the abdomen. For Nix, it started with a lump in her leg.

"Symptoms of sarcoma are so important because there is no screening test. My symptom was the most common symptom in soft tissue sarcoma. [Everything was] completely normal — including all my lab values — except for a small, but rapidly growing lump in my left leg," she reveals.

"Mine changed rapidly, which led me to see my doctor right away. It went from the size of a pea to the size of a golf ball in just over a week."

To treat her cancer, Nix takes a targeted chemotherapy pill every day. Outside of lowering her immune system and preventing her from eating the spicy foods she used to love, Nix says she goes about her life as normally as she can.

She's currently going forward with her studies at the Cumming School of Medicine, University of Calgary, where she is sub-specializing in general internal medicine while simultaneously partaking in the Clinician Investigator Program, "which allows resident doctors extra training time to study in a Master's Program, for me epidemiology," she says.

She likes to travel, try new foods and spend time with her cute pets. Additionally, she's also managing her growing social media platforms, where she shares her journey with admirers, fellow sarcoma patients and of course, her loved ones.

Beginning in 2021, Nix started sharing her sarcoma journey on Instagram and TikTok. And while she could have chosen to showcase the downsides of living with sarcoma, she opted to go the positive route, showing her followers how she continues to live life to the fullest, despite the diagnosis.

Nix has shared videos from her 2023 wedding; her February bucket list trip to New York (which was put together by her loved ones); her life as a dog and cat mom, among many other videos and photos. The best of the content are her short and sweet gratitude videos, in which she simply cites a thing, event or person she's grateful for that day.

"I only have one thing in my life that is tough or hard right now. Yes, it is serious, but [it's] just one thing," Nix affirms. "Life is so much more. It's friends, family, pets, your career, the perfect temperature first sip of tea, the beautiful snow-tipped mountains."

She continues, "So many people go through so much more with so much less to be thankful for. Seeing the beautiful parts of life each day helps me stay grounded and focused on what's most important to me, and keep pressing forward with more treatment."

And even though the process of sharing her journey isn't always easy, she's already seen the benefits of opening up, as fellow sarcoma patients, other young adults with cancer and people with experience living with metastatic cancer have reached out to champion her and show solidarity.

Nix plans on continuing her studies. Her husband, Michael MacIsaac, also bought her a new ring light recently, which means there'll be more content coming soon.

As for what she wants people to know about sarcoma, Nix has this to say: "The most important thing to know about sarcoma cancers is that being seen at a high-volume sarcoma center can save lives," she urges.

"My team here in Calgary is excellent, and they collaborate on my care with other centers here in Canada and the USA too. A list of high-volume sarcoma centers is available through the Sarcoma Alliance website, which is a patient-facing organization."

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