March 2014 ABC Advisor

John Gordon, MD, FACOG

Dr. Gordon graduated Summa Cum Laude with a BA in Biology from Princeton University. He then went to medical school at Duke. Dr. Gordon completed his OB/GYN residency at Stanford University, and then his REI fellowship at UCSF. He is board certified in both general OB/GYN and

Reproductive Endocrinology and Infertility. He is in private practice and a Clinical Professor at George Washington University and VCU/Medical College of Virginia. He has received numerous teaching awards, including the APGO/CREOG National Teaching Award. In 2013, he released his second edition of Reproductive Endocrinology & Infertility, a classic REI guide for both generalists and specialists.

ABOG Maintennance of Certification (MOC) Candidates

You should have received your sticker for your frame verifying that you are recredentialed through 2013 by now.

The list of journal articles for the first quarter came out mid-January. Have you already broken your New Year’s resolution to complete your articles each quarter? Get back on track.

Starting this year, ABOG has shifted the timing for the distribution of articles. They are now January, May, and August. It still wouldn’t be a bad idea to synchronize the deadline with the quarterly tax schedule to stay ahead in the game.

Some of you are wondering why you can’t access your articles. That’s because you have to reapply every year. Furthermore, ABOG is lagging a month behind in verifying your license, so this delays accessing your articles yet another month. So get crackin’!

Welcome and congratulations to those who just passed their oral exam. Thought you could finally rest? Well think again!! New diplomats must enter and start the MOC process this year.

For those of you in MOC Year 6, you must pass a secure written exam by Dec 15, 2014. RELAX, it’s only 100 questions and you answer two books of fifty questions. Generalists get to chose their books or “selectives” for each exam. Subspecialists must take the first book based upon their designated subspecialty. They then have to choose a second book from the generalist’s selectives.

Generalist Selective Exam A & B (50 questions)
Subspecialists:Selective Exam A (50 questions)
        I have more bad news for those of you in MOC Year 6. In addition to passing your written exam, you still have to read the 2014 articles. No rest for the weary.  We’re getting panic phone calls already inquiring about what happens if you don’t pass your written exam. You get a total of five attempts to pass. The only way you couldn’t pass, is if you procrastinate and run out of time. But to still answer your question, if you fail to pass your exam by December 15, 2014 then your certificate expires and you must pass a written re-entry test to reinstate your Board certification. Please don’t go there …


Test Taking Tip

For those of you in MOC Year 6, you can take the exam anytime starting January 1. For you generalists who have truly read, not skimmed, the MOC articles, we recommend you take the exam right away. Heck if you pass, then you get to prop your feet up and start reading the 2013 articles.If you don’t pass, there is no financial penalty to retake the exam. Actually,you can retake the exam up to four times if necessary. However now you need to study. Our Annual MOC Manuals, summarize each of the articles, so it will save you oodles of time.

Lucky for you we have a one day MOC Written Exam Workshop May 4 the day before our five day review course or June 7. Come for just that day if time is tight, but better yet, stay for the May 5-9 review course to fill in all gaps. 100% who attended either the MOC Workshop and/or our review course in 2013 passed their exam!  Additionally, if you’re feeling a bit rusty or you had to repeat your primary written exam, our education specialists, Martin and Jane Jolley specialize in standardized written exams and have created a program just for those taking their written board exam. Sign up for their test taking workshop at our May course.


For ABOG & AOBOG 2014 WRITTEN Exam Candidates

The exam is in just TWO and THREE  months. Your free time to study will be usurped by end of year stuff as you finish your residency. So you must take advantage of MARCH and APRIL to “kick butt” and crank out the rest of the topics on your study plan.

We strongly advise taking a BOARD review course. A weekend workshop or evening webinar can’t provide the content. No matter how many questions you go through, you simply can’t answer them well if you lack the foundation. It’s like trying to build a brick wall with only the bricks and not the mortar.

We recognize that there is precious little time to wade through the volumes of material. That’s why we provide an exam focused review in accordance with the latest ACOG  clinical guidelines. We will review 82 subjects in 44 hours over five days May 5-9, which historically covers 90% of exam topics! Our faculty are especially knowledgeable in written board exam trends and conclude each lecture with written questions.

You must be candid as to what you can/cannot accomplish on your study plan. Have you finished the MUST KNOW topics? Our Test Topics Manual  is a great resource, as it lists high yield topics and the expected test questions. We suggest you shift to those topics that we don’t have time to cover at the course. These include statistics, ethics, genetics, safety, practice and liability management.

Don’t forget YOU MUST PRACTICE WITH WRITTEN questions at the end of EACH study topic. Our Written Exam Webinar, is designed to perfectly complement the April course. We will blast you with written exam questions based on those high yield subjects with the answer discussion led by our esteem faculty mentors. For you do-it –yourselfers, then our Written Question Manuals provide an additional 700+ questions. Since the test is computerized, ideally practice with tests of this same format. ABC, in collaboration with Jolley Test Prep Services offers computerized diagnostic tests.

For those who have traditionally struggled with written exams, failed the written board exam, or did not score at least 200 on your CREOG in-service exam, you cannot continue with modus operandi. It didn’t work before, so why set yourself up for the same outcome? We have found that knowledge is rarely the problem. You couldn’t have made it this far is that was the case. It’s typically a processing problem. The Jolley’s  have a brilliantly simply and effective PROCESS with proven success. Their test taking workshop is offered at our May course.


Test Taking Technique

ABOG set a precedent in 2010 exam by not relinquishing the board exam scores, so candidates received only a pass or fail grade. Thus the only parameter to gauge or predict Board exam performance is the CREOG in-service-training exam.

This month you received your CREOG results. Don’t cry over spilled milk; rather let’s add some yummy chocolate. This report has two pieces of helpful information. One is your raw score. In the past there was little incentive to correlate board and CREOG performance, so there are only a few studies. However we believe 200 or more predicts passing your boards. If you didn’t’ score this minimum then you must get crackin’

Secondly, the reports gives a fantastic itemization of your strengths and weaknesses per topic. What’s that old saying? “trick me once, shame on you, trick me twice shame on me”. So TODAY start focusing on your weaknesses!

Practice makes perfect. You are taking a written exam afterall, so you must follow each topic review with written questions. Here are some samples from our Written Questions Manuals (WQM). Check the answers in our next month’s advisor.

A 33 year old mulitgravida patient presents complaining of dyspareunia and “feeling loose” during intercourse.  Obstetrical history includes that of an episiotomy with a 4th degree extension during her last delivery several years ago.  Review of Systems include rare symptoms of stress urinary incontinence, but no complaints of fecal incontinence.  Pelvic examination is significant for a widened genital hiatus, scarred posterior fourchette, positive dovetail sign and a tender perineal body that is <0.3cm.  The most likely reason that the patient has no symptoms of fecal incontinence is:
A)  The external anal sphincter is mostly intact
B) The internal anal sphincter is mostly intact
C) The rectoanal inhibitory reflex is normal
D) The anorectal angle is less acute
E) The dependency on the puborectalis muscle is increased
Gynecologic & Oncologic Surgery WQM
A 13 year old G0 presents to the ER several months after menarche with acute, heavy vaginal bleeding.  She has a diagnosis of type 2 diabetes.  On H&P, you also note hirsuitism and a BMI of 40.  She also has a sister with von Willebrand disease. The best initial treatment is:
    1. Hysteroscopy
    2. D&C
    3. Desmopressin
    4. IV estrogen
    5. Progesterone
A teen has primary amenorrhea, normal external genitalia, but a blind ending vagina. What would be the most helpful to differentiate androgen insensitivity syndrome from mullerian agenesis?
  1. Absent uterus
  2. Café au lait spots
  3. Urinary tract abnormalities
  4. Increase serum testosterone
  5. Normal LH

For ABOG 2014 ORAL Exam Candidates

Your application, copy of your current medical license, and application fee of $840 is due on March 15, 2014. Don’t overlook this menial, but necessary administrative task. Just in case you’re tempted to delay, if you wait until April 15 or April 30, then you incur a $345 and $825 late fee, respectively.

We strongly recommend our May 5-9 Board Review Course. This is the ideal time as you will be all consumed with finishing your case list from June to August. You have to assume that your exam could be the first round in November. Thus that only gives you two months to prepare after you turn in your case list. Taking a review course in the spring puts you in a PROactive mode; whereas, if you procrastinate until the fall, you’re now in a REACTIVE tailspin.

We provide an exam focused review in accordance with the latest ACOG  clinical guidelines. We will review 82 subjects in 44 hours over five days. Incredibly, the last FOUR years we have covered 99% of exam topics! Every lecture concludes with Board Answers, a script for articulating each subject in an oral exam format.

Another way to catapult your studying is with our Oral Exam Webinar. Drs. Diane Evans and Chetanna Okasi will spend 1 1/2 hours weekly on each of ten high yield topic and show you exactly how to prepare for an oral exam. It started in February and covers ten core topics in just three months. Sign up for one, two or all three sessions. They are strategically divided into OB, GYN, and Oncology/Urogynecology. Don’t worry, all sessions are archived. The lessons learned from the webinar will empower you now to tackle the rest of the topics.

Only THREE months LEFT to complete your collection of cases. At this point, you must be up-to-date with all of your past OB and GYN entries. Ideally, right after you dictate your operative or delivery notes, then complete the hard copy of the case list form The clock is ticking. You must enter cases no later than EVERY WEEK now.

You should have half of the 40 office categories collected. You want to complete ¾ of your list by the end of April. Show your clinical depth by having at least 30 categories.

If you have been using the ABOG case list software, chances are you are now appreciating why your predecessors grumble they would have never used it. Don’t fret – it was helpful to at least get you familiar with the process. However, if you want to take full control over the optimal construction, we’ll show you how to wrestle this alligator or even help you customize your own software.

Rest assured, this is really pretty easy. Come to one of our case list construction workshops . We’ll show you how to raise your case list head and shoulders above the rest in just one day. Our flagship workshop is May 4 in Baltimore, MD just before the course. Our satellite workshops are scattered throughout the country in April and May. Our April workshops are in Greenville, SC and Orange County, CA.  Our May workshops are in Baltimore, Atlanta, New York City, Indianapolis, Memphis, New Orleans, and Fargo, ND. For those who are OCD, order your copy of the best selling guide, Pass Oral Ob/Gyn Board Exam by Dr. Das for a complete step-by-step guide.


Case list Construction Tip

The office case list is the only one in which you get to choose the patients. Take advantage of this! There are 40 categories and you may list no more than two patients per category. So at a miniumum, you must use half of the categories.

However all 40 categories are fair game. Since this is an open book test, then it would be ideal if you could use all 40 categories. I have yet to see anyone pull this off; however, use as many categories as possible, so at least 25-30 categories.

Strategically pick some categories that you traditionally struggle with; for me that would be those awful REI categories of hirsuitism, hyperprolactinemia, primary amenorrhea, etc. If you chose a representative patient, then you have a legal cheat sheet, which you can freely refer to during the exam. Better yet, the fact that you put it right on the table, gives the impression that you already know how to work up and manage these patients and may totally spare you the torture of defending them. Sweet!

So don’t just slop your office case list together at the last minute. On the contrary, this can become one of your greatest assets. Take the ball and run!


For AOBOG 2014 ORAL Exam Candidates

Applications for the Oct 25 and 26, 2014 exam, along with the $750 application fee are due April 1, 2014.

For those preparing for their May 2 - 3 exams, the exam is in May – YIKES!

Our Osteopathic Oral Exam Webinar,is the only webinar in the country that is designed by an osteopathic physician. Dr. Diane Evans DO, FACOOG goes through EACH of the ten core topics AND invites each participant to interact. Since it’s debut in 2011 100% of webinar participants have passed their exam! It started in February, but don’t worry, you can still jump in and even access those earlier topics in our archives. Each monthly session is strategically grouped into OB, then GYN, then Oncology/Urogynecology.

For those of you preparing for the fall exam, you’ve probably figured out by now, that the “ten” core topics is actually about fifty topics. We recommend our May 5-9 BOARD review course, for an exam focused review. Did you know our syllabus is highlighted with EACH CORE TOPIC? We also spend an evening dissecting EACH core topic and trying to predict every possible question.

Wonder what that surprise topic is going to be? There is precious little time to wade through volumes of material to figure out what to prioritize. We’ll get right to the point. Each lecture is in accordance with the latest ACOG clinical guidelines, which is after all the answer guide for your test.

This is an oral exam. You must practice out loud. Pull it all together withour Structured Cases CDs based just on the core topics. Finally let our faculty challenge you with private mock oral exams, both by telephone or at the course. Get all the exam willies out of the way, so you can explode out of the blocks on your big day. Did we already mention, that 99% of our course participants have passed their exam since 2011.


Test Taking Tip

            Time for damage control. The examiners will drive you to the nth degree. Fill in the blanks NOW for each core topic:

Definition (if applicable)
Pathogenesis & Etiology
          Differential diagnosis
Diagnostic criteria
          Work up
   Laboratory evaluation
      Radiologic studies
Follow up


Chief Residents Planning A Subspecialty Fellowship

Subspecialty fellows are permitted to select 20 patients from their Chief resident year for their off specialty case list. In other words, GYN Oncologists, REI and Urogynecologists will need an OB list and  MFMs need a GYN list. Thus make sure to hold onto that residency log!

 Refer to the ABOG Bulletin on how those 20 patients are selected. To be on the safe side, we recommend you collect at least 30, so you can strategically select the final 20 later. For those patients, keep a file of the following: for the GYN patients, collect the H&Ps, operative note, pathology report, and discharge summary. For the OB patients, keep a file of the prenatal form, delivery note, discharge summary, and postpartum note. Don’t worry about the office patients at all, as you may compile this only during your fellowship

A word of caution – right now you are at your peak for general OB/GYN knowledge. Believe it or not, two years from now, your knowledge base will regress to that of an intern. Yes it’s true, if you don’t use it, you lose it. So those really cool, esoteric, bizarre, once-in-a career cases now will be a nightmare to defend later. Your greatest allies are your junior residents. If they can’t easily defend that case, then cease and subsist and “go fish” for another.


Test Taking Technique

 For many candidates, urogynecology is a love/hate relationship. Commonly, many don’t even have any urogyn cases on their GYN case list, since many generalists refer the patient to the urologist or urogynecologist. Nonetheless you will be held accountable for urogynecology on your oral exam.

Given you’re in your chief year, urogynecology is practically second nature for you, so make sure to choose some cases for your case list if you will be using your chief log for your GYN case list. Just go with the bread and butter cases, such as stress urinary incontinence and prolapse. You can sneak in some office management, such as pessaries or OAB meds by stating the patient failed these in your preoperative diagnosis. Don’t mention complex urodynamics in the work up, as the generalist only needs to know simple cystometrics. You’ll be glad you did, as it will be easier to retain or relearn these topics two or more years from now.


Subspecialty Fellows Planning for their 2014 ABOG General Oral Board Exam

You cannot sit for your general oral boards until at least your second year of your fellowship. Furthermore, you can only take the general oral boards once during your fellowship. If you neglected to collect cases in your off specialty from your chief year, you must get back to your residency institution to gather those cases AND enter them into your software. GYN Oncologists, REI and Urogynecologists will need an OB list and  MFMs need a GYN list. If you currently have to take call for these off services, you can use those cases.

If you are retrospectively collecting cases, go with your comfort zone. Dang, how could you have forgotten so much in such a short time? Unfortunately it’s true, if you don’t use it, you lose it. Go with the bread-and-butter cases. Remember this is your general boards. We recommend you chose those cases that reflect high-yield topics. Our Test Topics Manual  and the #1 guide, Pass Your Oral Ob/Gyn Board Exam by Dr. Das  will be an excellent step-by-step guide. 


Test Taking Technique

For many candidates, urogynecology is a love/hate relationship. Commonly, many don’t even have any urogyn cases on their GYN case list, since many generalists refer the patient to the urologist or urogynecologist. Nonetheless you will be held accountable for urogynecology on your oral exam.

If you will be using cases from your chief residency log for your GYN case list, make sure to choose some urogynecology cases, otherwise, out of sight, out of mind. Just go with the bread and butter cases, such as stress urinary incontinence and prolapse. Don’t mention complex urodynamics in the work up, as the generalist only needs to know simple cystometrics, and anything you put on your case list is fair game.

I know, it’s like bad indigestion coming back to haunt you. Here’s a spoonful of sugar to help it go down easier. Later you’ll be glad you heeded this advise, as it will be easier to retain or relearn these topics if you have a specific patient prototype. Better to have you in control in chosing the patient, rather than the examiner with free reins to introduce a hypothetical patient of his choice.


AOBOG Recertification Written Exam, Osteopathic Continuous Certification in Obstetrics & Gynecology (OCC)

The examination is offered annually, during the  ACOOG Annual Convention in the Spring. This exam is usually a walk in the park for generalists both obstetrics & gynecology. The breakdown of the OCC exam is as follows: 

  • General Obstetrics                              25%
  • Maternal Fetal Medicine                      10%
  • Gynecology (office and surgery)         40%
  • Reproductive Endocrinology               10%
  • Gynecologic Oncology                        10%
  •  Miscellaneous                                      5%



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