April 2019 Tip of the Month

For ABOG & AOBOG 2019 WRITTEN Exam Candidates

The AOBOG exam is THIS month and the ABOG exam is in just TWO months – YIKES! For those of you finishing your residency, the end of year stuff - projects and deadlines will really kick in next month. So this is probably your last month for hardcore studying. Don’t let it slip away. For the ABOG exam, it is your responsibility to schedule a seat with the Pearson- VUE testing center. Seats are released after March 25th, but may not be scheduled after June 3rd. Seats are limited and assigned on a “first come, first served” basis. We strongly advise taking a BOARD review course. A weekend workshop or evening webinar simply cannot provide enough 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 but not the mortar. We recognize that there is precious little time for you to wade through the volumes of material. That’s why our April 24-28 Board Review Course provides an exam focused review in accordance with the latest ACOG clinical guidelines.  You will be taught not only content but also how to take a written test. At the course, you will practice those skills daily in a simulated exam environment.  When your real test day arrives, it will feel like just another practice day! You will walk into the exam with confidence 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 suggested test questions. We recommend you shift to those topics that we don’t have time to cover at the course. These include statistics, ethics, genetics, safety and practice, and liability management. Don’t forget YOU MUST PRACTICE WITH WRITTEN questions at the end of EACH study topic. We have a number of products designed to perfectly complement your content review. Our Written Question Manuals provide over 1700+ questions available in printed format or online. 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 if that were the case. It’s typically a processing problem. Our Test Taking Skills Course is now available online.  Dr. Krishna Das and Martin & Jane Jolley have joined forces to give you their expertise.  The Jolleys give you the theory and will help you identify possible error patterns in your processing of questions. They have a brilliantly simple and effective PROCESS with proven success. We are the only review course whose method is peer reviewed!  Dr. Das will provide the strategy and guidance right up until your written exam.  

Test Taking Technique:
Make sure you carefully note the qualifiers in the stem question, such as EXCEPT, LEAST/MOST likely, BEST, etc. The ABOG written board is known for their NEGATIVELY worded questions, and these are especially challenging. For example, if I say, “DON’T think of the clear turquoise water of the Caribbean.” What do you think of? Yeah, the clear, cool, sparkling, blue waters of the Caribbean, plus warm breezes, bikinis, etc. Here’s a strategy on how to not succumb to their trap. Change a negative stem to a positive one BEFORE you begin to find the best answer.
  1. Circle the negative word in the stem
  2. Omit the negative word and read the stem as a positive statement
  3. Mark each alternative with T, F, or ? (so all but one will be true)
  4. Select the false answer
Which of the following is not a component of the levator ani?
  1. Coccygeus
  2. Iliococcygeus
  3. Puborectalis
  4. Pubococcygeus
Step 1: Which of the following is NOT a component of the levator ani?
  1. Coccygeus
  2. Iliococcygeus
  3. Puborectalis
  4. Pubococcygeus
Step 2: Which of the following ARE components of the levator ani?
  1. Coccygeus
  2. Iliococcygeus
  3. Puborectalis
  4. Pubococcygeus
Step 3: Which of the following ARE components of the levator ani?
  1. Coccygeus - false
  2. Iliococcygeus - true
  3. Puborectalis - true
  4. Pubococcygeus - true
Step 4: Which of the following is NOT a component of the levator ani?
  2. Iliococcygeus
  3. Puborectalis
  4. Pubococcygeus
Try using Dr. Das’ technique on the following question.
Office & Primary Care:
    A 53 year old Caucasian female presents for an annual exam with a blood pressure of 145/90. Her diabetes mellitus type 2 is well controlled with Metformin.  The patient returns the next week with a blood pressure of 155/95.  What is the best management choice?

    1. Initiate antihypertensive therapy with ACE Inhibitor
    2. Initiate antihypertensive therapy with Angiotensin Receptor Blocker (ARB)
    3. Initiate antihypertensive therapy with hydrochlorothiazide
    4. Recommend checking blood pressures at home
    5. Recommend initiating lifestyle changes and recheck blood pressure in 2 months 
       Answer:  A - Initiate antihypertensive therapy with ACE inhibitor
      This patient is hypertensive with two recorded blood pressures above 140/90.  The JNC 8 guidelines recommend treatment of patients aged <60 years old with blood pressure greater than 140/90.  In patients 60 years old and older, treatment should be reserved for patients with blood pressure >150/90.  In African-American patients, treatment should be initiated with either a thiazide-type diuretic or calcium channel blocker.  However, non-black patients may be started on a thiazide-type diuretic, calcium channel blocker, ACE inhibitor or angiotensin receptor blocker (ARB). Diabetic patients and patients with renal disease should be given an ACE inhibitor or ARB for hypertension treatment.
      James PA, et al. 2014 Evidence-based Guideline for the Management of High Blood Pressure in Adults, Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA, Published online Dec 18, 2013.

        In patients affected by Androgen Insensitivity Syndrome, when is removal of the gonads recommended?  
          1. after child-bearing completed
          2. after puberty
          3. at diagnosis, regardless of age
          4. not recommended
           Answer:  B - after puberty
          Patients with Androgen Insensitivity Syndrome have a karyotype of 46 XY.  The testes are typically intra-abdominal. After puberty, the testis may display immature tubular development.  The incidence of malignancy is 5-22%, but is rare before the age of 20 years. Delaying gonadectomy until after puberty is complete allows the individual to attain normal female secondary sexual characteristics due to testosterone production and aromatization to estrogen. Speroff L, Fritz MA.  Clinical Gynecologic Endocrinology and Infertility, 7th Edition
          FPMRS- Fistulas
          In the developed world, what is the most common cause of vesicovaginal fistula?  
          Answer:  Pelvic surgery (eg hysterectomy)
          How is cervical cancer staged?
          Answer:  Clinically


          For ABOG 2019 ORAL Exam Candidates

          Where do you start in your exam preparation?  Our Ultimate Package pretty much has it all for those who have no idea what they need to prepare for their oral exam.  It provides everything, from content in our 5-day review course, case list construction and defense, mock orals and a Case List Review with one of our faculty. The Case List Workshop is included in the review course and will help you artfully and strategically compose a sure-fire PASS product. The Oral Exam Workshop, conducted the day prior to the September or November review courses, provides strategies specific to the ABOG oral exam.  The application, copy of your current medical license and application fee of $840 was due on March 30th, 2019. If you overlooked this menial, but necessary, administrative task, you can still turn it in, but of course, now you’ll have to pay a late fee of $360 If you wait beyond 30, 2019 there is an even steeper late fee of $840. No applications are accepted after May 15, 2019. Surely you already have your case list software, but if you do not, stop everything and order it now from the ABOG website. Only TWO MONTHS left to complete your collection of cases. At this point, you must be up-to-date with all of your past entries. The clock is ticking. You must now enter cases no less than EVERY WEEK. Ideally, right after you dictate your operative or delivery notes, complete the hard copy of the case list form. Once a week, enter these cases online. At this point, you should have half of your office patients selected. Plan to complete all 40 categories by the end of May. Remember - you can include only one or two patients per category. You should now have three binders – one for each of the three sections: OB, GYN, and Office. For each GYN patient, compile their case list sheet, H&P, operative notes, pathology reports and discharge summaries.  For all OB patients, keep a file of the prenatal forms, delivery notes, discharge summaries, and postpartum notes. For the Office patients, file the case list sheet, appropriate copies of the office visit(s) and supporting labs, imaging studies, etc. A well-constructed case list makes all the difference in its defense. This is especially important since you must enter your cases online. Although the entry of cases has changed, the strategy has not. Come to our Case List Construction Workshop April 23rd in Charlotte. We’ll show you how to raise your case list to a level head and shoulders above the other candidates. For those who are OCD, order your copy of Pass Your Oral Ob/Gyn Board Exam, 5th edition, written by Dr. Das. This book provides a complete step-by-step guide. The ideal time to take your review course is in the spring, as you will be all consumed with constructing your case list from June to August. You won’t find out the month of your exam until July, so you have to assume it could be as early as November. If that’s the case, you only have two months to study. YIKES! We recommend our April 23-28 Board Review Course for an exam focused review. There is precious little time to wade through the volumes of material to figure out what to prioritize. Our faculty members have extensive speaking experience and their lectures are based on ACOG clinical guidelines – duh! the answer guide for the test. They are especially knowledgeable regarding the oral exam, and every lecture concludes with our signature oral exam defense tips. Ideally, complement the content covered at the review course with a workshop devoted to the strategic construction of your case list.

          Case List Construction Tip:
          For your OB and GYN case lists, try to use as many of the applied categories as possible.  This will show more depth and breadth to your mode of practice. Carefully look at each case to ponder which category to use. For example, did you know there are 18 possible categories to list a hysterectomy?


          For AOBOG 2019 ORAL Exam Candidates

          Applications for September 20-21, 2019, along with the $3275 exam fee, are due by June 17, 2019. However, don’t procrastinate. Since AOBOG implemented an exam cap of 54 the cap can and has been, reached within a couple of months. For those preparing for their April 12-13 exam, time is short. 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 AOBOG core topics. Since its debut in 2011, 99% of webinar participants have passed their exam! It just ended, but don’t worry, the archives are the next best thing. Each session is strategically grouped into OB, then GYN, then Oncology/Urogynecology.  2019 webinar archives are available for last minute study and strategy. If you’re trying to launch your prep for your fall exam, you should attend either our April 24-28 BOARD Review Course, for an exam focused review. In 2015, AOBOG expanded beyond the traditional ten core topics. Now you’re accountable for a wider range of topics. 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.
          Regardless, you MUST do some mock oral exams. Face-to-face is best, and these are offered at each of the review courses. However, keep that momentum going by scheduling a Telephone Mock Oral exam with one of our seasoned ABC faculty. We only use practicing DO's to prepare you for your AOBOG exam.  You can also challenge yourself with our set of 85, 45 or 20 Structured Cases, which are based on just the core topics.  Newly designed and handpicked cases just for AOBOG candidates.
          Can’t attend our April or September review course?  We designed several Home Study Packages just for the AOBOG oral exam candidate  All three packages include mock orals, structured cases, and Dr. Das’ strategy videos and 44 hrs of online course lectures.  You can access all of the lectures online, practice articulation with our AOBOG topic structured cases and then schedule your mock orals with our DO faculty. 

          Test Taking Technique:  
          Just remember 70%. That’s all you need to pass the exam.  You do not need, nor will you likely get, 100% of the questions correct.
          The questions will come at you in rapid fire. Often times the examiner will push you until you finally don’t know the answer. Don’t misinterpret this as failing the question. On the contrary, you probably passed it long before, but the examiner may simply want to explore the depth of your knowledge or at least reassure himself that you will acknowledge your limitations.
          Let the last question go and focus on the question at hand. Do not let worrying about whether or not you got the last question correct distract you and thereby compromise the opportunity to get a sure pass question correct.
          Remember, just 70%!

          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. Start collecting those cases NOW, while you still have easy access to patient records. 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, as you may compile these cases 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 desist and “go fish” for another case.

          Test Taking Technique:
          Print out the Bulletin for the “Oral Exam for Basic Certification” from abog.org. Go to Publications > Bulletin and peruse the categories. Most generalists don’t have any Oncology and Urogyn cases since they appropriately refer them. But you have the luxury to pick and choose. You want to appear well rounded and balanced. Make sure to include some bread and butter Oncology cases (uterine, ovarian, cervical cancer), Urogyn (prolapse, slings) and for heaven’s sake – at least 3 vaginal hysterectomies!  Also choose some cases on topics that you’ll totally forget about PID, endometriosis, infertility, fibroids. Finally, include some with complications – wound, GU and/or GI injury and some perioperative challenges (Thromboembolism, DM, cardiac, etc.)


          Subspecialty Fellows Planning for their 2019 ABOG General Oral Board Exam

          You can now sit for your general oral boards anytime during your fellowship; however, you can only take them once while a fellow. 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 FPMs 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 Examwritten by Dr. Das, will both provide excellent step-by-step guidance.

          AOBOG Osteopathic Continuous Certification (OCC) Written Exam

          This exam is usually a walk in the park for generalists practicing 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%

          For those preparing for the 2019 OCC exam, take the bull by the horn and come to one of our review courses. 

          ABOG Maintenance of Certification (MOC) Candidates

          You’re working on your taxes, right? That means the first quarter is over. Are you finished with your first quarter articles? Didn’t you make a New Year’s resolution that you weren’t going to procrastinate this year? Promise yourself to get those finished before the second quarter list comes out. For those of you in MOC Year 6, you must pass a written exam by December 16th, 2019. If you’ve never cut corners before, then our five day Board Review Courses, April 24-28, September 18-22 and November 20-24, are perfect for you. This is not the same type of review course as in the past. Just as you’ve evolved and practice evidence-based medicine, our course is designed for the adult learner, is exam-focused and all lectures follow the national ACOG guidelinesHeck, you’ll walk away with loads of everyday practice tips, too. If you’re feeling a bit rusty or you had to repeat your primary written exam, sign up for our Test Taking Skills Course now offered online. Oh, and just in case you think you’re coasting after you pass your written exam, think again. You still have to read the 2019 articles. No rest for the weary!

          Test Taking Tip:
          The written 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 generalists’ selectives.
           Generalist Selective Exam A & B (50 questions)
          1. Obstetrics and Gynecology and Office Practice & Women’s Health
          2. Obstetrics only
          3. Gynecology only (tends to have more Surgical GYN focus)
          4. Office Practice and Women’s Health only (primary care, office GYN & family planning focus)
          Subspecialists: Selective Exam A (50 questions)
          1. Gynecologic Oncology
          2. Maternal Fetal Medicine
          3. Reproductive Endocrinology & Infertility
          4. Female Pelvic Medicine & Reconstructive Surgery (starting 2019)
          SELECTIVE A
          SELECTIVE B
          Generalist – OB&GYN
          Option 1, 2, 3, or 4
          Option 1, 2, 3, or 4
          Generalist – GYN Only
          Option 3
          Option 3 or 4
          Generalist – Family Planning
          Option 4
          Option 4
          Generalist – Laborist
          Option 2
          Option 2
          Option 3 or 4
          Option 3 or 4
          Option 2
          GYN Oncologist
          Gynecologic Oncology
          Option 3
          Option 3 or 4
          Option 3
          Option 3

          Royal Canadian College 2019 Exam Candidates

          This year’s written examination is April 30-May 1st at your local Centre.
          The oral examination is May 30th. Therefore, do not wait until after the written examination to start practicing for the oral exam!!!

          Helpful Hints for Single Answer Questions (SAQs):

          • Make sure your handwriting is legible.
          • Pay attention to the number of questions and the time allotted for the examination. Manage your time wisely. The examination is long and time is short. You can choose to skip over questions and go back later.
          • Choose answers that are concise and direct (do not write an essay!).
          • Don’t write more than asked for (if they ask for 3, write 3 answers!)

          Helpful Hints for Multiple Choice Questions (MCQs):

          • If you don’t know, take a guess… no penalty.
          • Manage your time wisely, you have about 1minute per question.
          • If you change your answer, erase the answer COMPLETELY, as the sheet is read by an optical scanner…
          • Frequently go back to ensure that the question number and the circle you are filling in are the same. You don’t want to be off by one question, all your answers will be wrong…
          Test Taking Tips
          If you’re looking for a good source for questions, the ABC Written Question Manuals are arranged by subjects AND they even include SBAs! Can you believe they changed their manuals just for us Canadians?  You can now purchase a 1 mo & 3 mo subscription to our Written Questions Online.  Over 20% of the 1,700 questions are one-liners

          Subspecialists taking their 2019 ORAL Exam 

          A great way to pull it all together, or salvage what’s left if you procrastinated, is to take advantage of our Do or Die in Dallas service. We’re bringing our best, so you can be at your best. Course director, Drs. Stephanie Martin – MFM will be in Dallas from 7-9.  Dr. Amos Adelowo, FPMRS Course Director is available for telephone mock orals on your case list or thesis reviews on the defense side.  They can warm you up for your big day with last-minute polishing (or cramming for some) through private sessions on whatever you need … mock orals, structured cases, etc.

          Test Taking Technique:
          Just remember 70%. That’s all you need to pass the exam.  You do not need, nor will you likely get, 100% of the questions correct. The questions will come at you in rapid fire. Often times, the examiner will push you until you finally don’t know the answer. Don’t misinterpret this as failing the question. On the contrary, you probably passed it long before, but the examiner may simply want to explore the depth of your knowledge or at least reassure himself that you will acknowledge your limitations. Let the last question go and focus on the question at hand. Do not let worrying about whether or not you got the last question correct distract you, and thereby compromise you getting a sure pass question correct. Remember, just 70%!

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