March 2016 Tip of the Month

Tara Budinetz, DO, FACOG

Dr. Budinetz obtained her BS in Biology, while on a soccer scholarship, and graduated magna cum laude from Elizabethton College. She then went to medical school at the Philadelphia College of Osteopathic Medicine. She completed her OB/GYN residency at Geisinger Medical Center. She then subspecialized in REI and completed her fellowship at University of Connecticut.
Dr. Budinetz poured her heart and soul into preparing for her oral exam and is anxious to pass along her tried and true tips.

ABOG Maintenance of Certification (MOC) Candidates

By now, you should have received your sticker for your frame verifying that you are re-credentialed through 2015. 

For those of you who are wondering why you can’t access your articles, it’s because you have to reapply every year. You can now access the articles via a link, which makes it so much easier by eliminating the librarian middle man to obtain the articles. So you can scratch that off your list of excuses.

Speaking of excuses, 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? If so, get back on track. You should have completed at least ¼ of your articles.

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 December 15, 2016, or you can opt out if you’ve averaged 86% on your articles over the last 5 years. The exam is only 100 questions and you answer two “books” of fifty questions each. Generalists get to choose 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. You get a total of five attempts to pass. The only way you won’t pass is if you procrastinate and run out of time. But back to your question: if you fail to pass your exam by December 15, 2016, your certificate expires and you must pass a written re-entry test to reinstate your Board certification. Please don’t go there …

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 2016 articles. No rest for the weary!

Test Taking Tip:
For those of you in MOC Year 6, you can take the exam anytime until November 15th. For you generalists who have truly read, not skimmed, the MOC articles, we recommend you take the exam right away. Heck! If you pass, you get to prop your feet up and start reading the 2016 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 they save you oodles of time.  If you don’t want to take any chances, come to our April 13-17 review course to fill in all gaps. Since MOC implemented the mandate in 2013, 100% of those who attended our review course 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 Skills Workshop being offered at our April course.


For ABOG & AOBOG 2016 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, as a weekend workshop or evening webinar simply cannot 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 from April 13-17. Historically, our course covers 90% of exam topics! Our faculty is especially knowledgeable in written board exam trends and each lecture concludes with written questions.

You must be candid as to what you can/cannot accomplish within 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. For you do-it-yourselfers, our Written Exam Webinar archives is designed to perfectly complement the April course. We will blast you with written exam questions based on those high yield subjects, and it includes the answer discussion led by our esteem faculty mentors. Additionally, our Written Question Manuals provide another 900+ questions. Since the test is computerized, ideally you should practice with tests in 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 your 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 if that were the case. It’s typically a processing problem. The Jolley’s have a brilliantly simple and effective PROCESS with proven success. Their Test Taking Skills Workshop is offered during the April review 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 cookies. 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 a score of 200 or more predicts passing your boards. If you didn’t’ score this minimum of 200, you must get crackin’.
Secondly, the report 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 you must start focusing on your weaknesses!
Practice makes perfect. You are taking a written exam after all, so you must follow each topic review with written questions. Here are some samples from our Written Questions Manuals (WQM). Check the answers in next month’s advisor.

FPM WQM (from Fecal Incontinence)

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 includes 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:

  1. 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 (from AUB #2)

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

REI WQM (Embryology #1)

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 2016 ORAL Exam Candidates

Your application, copy of your current medical license, and application fee of $840 is due by March 15, 2016. Don’t overlook this menial, but necessary, administrative task. Just in case you’re tempted to delay, if you wait until April 15th or April 30th, you incur a $345 and $825 late fee, respectively.

We strongly recommend our April 13-17 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, which 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’ll be 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, in each of the last FOUR years, we have covered 99% of exam topics! Every lecture concludes with Oral Exam Tips, 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 Marc Jean-Giles will spend 1-2 hours weekly on high yield core topics and show you exactly how to prepare for an oral exam. This webinar started in February and covers 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, you should complete the hard copy of the case list form. The clock is ticking. You must now enter cases no later than EVERY WEEK.

You should have half of the 40 office categories collected and 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 that 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 our Case List Construction Workshop. In just one day, we’ll show you how to raise your case list to a level that is head and shoulders above the rest. Our flagship workshop is April 12 in Charlotte, NC, the day before the course. For those who are OCD, order your copy of the best-selling guide, Pass Your Oral Ob/Gyn Board Exam by Dr. Das for a complete step-by-step guide.

Case List Construction Tip:
One of the hottest topics in GYN is the emerging concept that ovarian cancer originates in the fimbria of the fallopian tube. In January, 2015, ACOG launched their Committee Opinion #620, Salpingectomy for Ovarian Cancer Prevention. This is timely, as this has been a hot topic for the last couple of years in several of the mandatory ABOG MOC articles.  ACOG recommends that women at average risk for ovarian cancer be counseled about these benefits when undergoing hysterectomy or sterilization. So wouldn’t it be fitting to have your case list demonstrate this contemporary understanding? You still have time to collect GYN patients for hysterectomy, bilateral salpingectomy. Also, instead of just a PPTL, how about a postpartum salpingectomy? Or instead of a LTL, a laparoscopic salpingectomy or fimbriectomy? Obviously, you could also demonstrate this on the OB list with a Cesarean delivery, bilateral fimbriectomy, but I doubt the MFM OB examiner is going to be as up-to-date. It might catch his eye as being odd and if he inquires, you’ll look cool- as long as you do it politely. Typically, it’s not advisable to try to one-up the examiner.


For AOBOG 2016 ORAL Exam Candidates

Applications for the September 30th and October 1st, 2016 exam, along with the $3275 exam fee, are due by April 1st, 2015. However, don’t procrastinate. Since AOBOG implemented an exam cap of 45 candidates, the cap has been reached within a couple of months.

For those preparing for their April 29th & 30th exams, the exam is less than 2 months away – 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 the core topics AND invites each participant to interact. Since its debut in 2011, 99% 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.

In 2015, AOBOG expanded beyond the traditional ten core topics. Now you’re accountable for a wide range of topics. We recommend our April 13-17 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.

This is an oral exam. You must practice out loud. Pull it all together with our Structured Cases CDs, based just on the core topics. Finally, let our faculty challenge you with private Mock Oral Exams by telephone and/or in person at the course. Get all the exam willies out of the way, so you can explode out of the starting block on your big day.

Did we already mention that 99% of our course participants have passed their exam since 2011?

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. Therefore, make sure to hold onto that residency log!

Refer to the ABOG Bulletin as to 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 notes, pathology reports, and discharge summaries. For the OB patients, keep a file of the prenatal forms, delivery notes, discharge summaries and postpartum notes. Don’t worry at all about the office patients, at all, as you may compile these 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, cease and subsist and “go fish” for another.

Case List Construction Tip:
For many candidates, urogynecology is a love/hate relationship. Commonly, many don’t 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.


Planning for their 2016 ABOG General Oral Board Exam

You can now sit for your general oral boards anytime during your fellowship. You will be shocked at how quickly you lose recall of your off-specialty subjects. Hence, I advise you take your general oral boards as early as possible.

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 excellent step-by-step guides.

Case List Construction Tip:
For many candidates, urogynecology is a love/hate relationship. Commonly, many don’t 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 advice, as it will be easier to retain or relearn these topics if you have a specific patient prototype. Better to have you in control of choosing the patient, rather than the examiner having free rein to introduce a hypothetical patient of his choice.


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

The examination is now offered only once a year at the ACOOG Annual Convention in the Spring. This is not an exam to walk into unprepared. 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%

You poor subspecialists are accountable for general OB/GYN, so this will be a real challenge to recapture your off-specialty topics. Don’t you generalists be naïve and think this is going to be a walk in the park. Very quickly, most “generalists” begin to narrow the scope of their practice and appropriately refer to the subspecialists for infertility, oncology, urogynecology, high risk obstetrics, etc. So I don’t see how anyone can walk into this exam without preparation. Come to our April 13-17 course to launch your review or one of our fall courses, September 14-18 or November 16-20 to buckle down

Back to blog

Leave a comment

Please note, comments need to be approved before they are published.