March 2018 Tip of the Month

New!  MFM and FPMRS Structured Cases for ABOG Subspecialty Exam

These cases will be exceptionally valuable for you as you become familiar with, and ultimately perfect this mode of the exam, as well as to assess your knowledge of a specific topic. Receive instant access to our online structured cases.  MFM  or FPMRS

ABOG Maintenance of Certification (MOC) Candidates

By now, you should have received your sticker for your frame verifying that you are re-credentialed through 2017. 

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, 2018, 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 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, 2018, 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 2018 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 2018 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 if you don’t want to take any chances, come to our April 11-15 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, then refresh or most likely learn some new techniques with our Online Taking Skills Course. You can teach an old dog new tricks!


For ABOG & AOBOG 2018 WRITTEN Exam Candidates

The exam is in just ONE 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 practice questions you experience, 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 at our BOARD Review Course to be held April 11-15Historically, our course covers 90% of exam topics! Each day is filled with focused didactic sessions on OB, REI, Primary Care, Onc GYN/Office & FPM. You will then test your retention with topic specific questions, learn to analyze your performance, practice written test taking strategy and participate in a facilitated review of the answers.
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, and practice and liability management.
Don’t forget! YOU MUST PRACTICE WITH WRITTEN QUESTIONS at the end of EACH study topic. Our Written Questions Manuals provide 1000+ 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. Our Online Taking Skills Course will give you an evidence-based proven methodology. Adopting this technique improves CREOG scores on average 1 standard deviation! This may be just what you need to boost you over to a pass for your board exam.
In 2018, you AOBOG folk take your exam on the computer. You may have appreciated through your CREOG in-service exam that taking an exam on the computer is very different than on paper. Practice with our computerized written questions. ABC, in collaboration with Jolley Test Prep Services, offers computerized diagnostic tests containing 600+ written exam questions. Each question has a narrative explanation and reference, so it’s a great learning resource as well. Not only will you get your score, but the computer will also analyze why you missed the questions. Better yet, it will search for error patterns and make recommendations for corrective action.
Finally, like any big performance, a dress rehearsal is a must. Our Practice Test simulates your exam. It has 250 questions timed for 3 hours and 45 minutes with 2 breaks.

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 now know that a score of 205 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). 

Gynecologic Surgery WQM
  1. Bowel injury after laparoscopic hysterectomy can have a delayed presentation. Which signs and symptoms would cause the highest suspicion for bowel injury?
a.  Abdominal pain and peritonitis
b.  Constipation and leukocytosis
c.  Fever and leukocytosis
d.  Vaginal discharge and abdominal pain
    Answer: A - Abdominal pain and peritonitis
    Bowel injury after laparoscopic hysterectomy is relatively rare with an incidence of about 1/247 (0.39%).  It carries a high rate of morbidity and mortality so recognition is vital.  Approximately 41% of bowel injuries during gynecologic laparoscopy can be delayed.  The most common presenting signs are abdominal pain, fever, and peritonitis.
    Llarena NC, et al. Bowel Injury in Gynecologic Laparoscopy: A systematic review, Obstet Gynecol June 2015 (MOC Article 2015).
    1. When diagnosing appendicitis, which of the following has the highest sensitivity?
    a.  CT of abdomen
    b.  Leukocytosis
    c.  Physical exam
    d.  Serum amylase
    e.  U/S of abdomen
      Answer: A - CT of abdomen
      While classic surgical teaching suggests that thorough history and physical exam can diagnose acute appendicitis, this method lacks specificity with a historic 20% negative appendectomy rate. More recent data show CT of the abdomen has become the imaging modality of choice for appendicitis with both a sensitivity and specificity of 95-100%.
      Greenfield’s Surgery Scientific Principles and Practice, 5th edition, Chapter 72. 
      OB WQM (one liners)
      1. One dose of 300 mcg anti-D immune globulin can prevent RhD alloimmunizations after exposure to how much Rh D-positive blood?                         
      2. What maternal condition is important to avoid when managing a paraplegic patient in labor?               

      Answer: 1.  30 ml, 2. Autonomic hyperreflexia dystrophy

      For ABOG 2018 ORAL Exam Candidates

      Your application, copy of your current medical license and application fee of $840 is due by March 15, 2018. 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 10-15 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 of the ABOG published exam topics in accordance with the latest ACOG clinical guidelines.  Afternoon small groups will implement and integrate the topics just reviewed. utilizing a structured case format. This format is carefully designed for the seasoned adult learner preparing for an oral exam and will be informative, focused and non-adversarial. 
      Together we’ll construct cases for your case list and then run them by the faculty examiner. If he takes a line of questioning that you don’t want, then we’ll put him in the corner, reconstruct it, and let him try and trip you up this time. HAH! One for me, Zero for the examiner.
      Keeping in mind that this is an oral exam, although months away, we’ll then finish up each session with mock oral exams on structured cases. The faculty will then coach you on verbalizing the correct answers.
      Not sure what you need to prepare for your exam?  Our Ultimate Oral Exam package has it all!  It includes our April workshop & review course, review of your case list prior to submission, and return in the fall for the Oral Exam and Structured Cases Workshops.  It’s also the perfect time to schedule your face to face mock orals with our faculty.  Finally, when you arrive in Dallas, you will have a one hour session with ABC faculty for any last minute help.
      Another way to catapult your studying is with our Oral Exam WebinarDrs. Diane Evans, Stephanie Persondek and Hazem Kanaan 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 February 6th 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.
      In the past, many grumbled about the ABOG case list software. Evidently ABOG heard and now require you to enter the cases online. It’s nice that you can enter your cases through any device with an internet connection. However, you still must have a well-constructed list and their guidelines are still woefully sparse. Don’t fret – come to our one day Case List Construction Workshop being offered on April 10, the day before the review course.  We’ll show you how to raise your case list head and shoulders above the other candidates. For those who are OCD, order your copy of the 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 2018 ORAL Exam Candidates

      Applications for the October 19-20, 2018 exam, along with the $3275 exam fee, are due by July 9, 2018. 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 27-28 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 through our archives. Each monthly session is strategically grouped into OB, then GYN, then Oncology/Urogynecology.
      This is an oral exam. You must practice out loud. Pull it all together with our Structured Cases, 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?

      Oral Exam Technique
      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, 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.


      Subspecialty Fellows Planning for their 2018 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 are excellent step-by-step guides.
      Although it’s precocious, just an FYI that we now offer preparation for your subspecialty boards. We have a FPM webinar Jan to March on structured cases specific to the FPM oral exam. Additionally we have a MFM 3 day interactive review course in November.

      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 at Pearson VUE centers around the United States during the week of March 6-11. 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.
      For those being proactive for 2019, come to one of our 2018 courses this spring April 11-15, or one of our fall courses, September 19-23 or November 14-18. If you’re really a gunner, you can get the archives for this spring’s Oral Exam and OCC webinar taught by DOs for DOs, with Drs. Diane Evans, DO and Hazem Kanaan, DO.

      Test Taking Technique
      If you’ve never taken an exam on the computer, it’s “different” than on paper. Don’t risk your first time to test drive this new format the day of your exam. We strongly urge you to practice first with our computerized questions.

      Royal Canadian College 2018 Exam Candidates

      You have a couple months left and might start feeling out of breath. It is important at some point to slow down for a few days, take a vacation if possible and freshen up. You need a few days of rest in order to attack the last few weeks efficiently. Having your mind and body rested will only benefit you in the grand scheme of things. At this point, you might start feeling that the topic you studied back in early fall are well behind. You could start reviewing some of that theory and do practice questions. We cannot say it enough, practice questions!  Learning to answer questions efficiently is an important skills to have. You should have started that already, at this point I would try to do longer sequences (increase the amount of questions) to practice staying focus for longer periods of time.
      Also, you should have your result back from Canadian Obstetrics and Gynecology Review Program (previously known as “Making a Mark”). Canadian Obstetrics and Gynecology Review Program and at this point, following practice oral and MCQ, you must have a good idea of your area of weakness. I would focus on increasing your strength around those areas, you still have time. Furthermore, it would be a good idea to start practice oral examinations. Don’t wait until after the written, the lapse of time is too short. Both exam are complimentary, and learning the SOGC guidelines will help you with those two parts.
      Finally, at this point, you should have your flight and hotel book for the Ottawa examination. Give yourself enough time for unanticipated delayed and make sure to get to Ottawa a day or two before the examinations.

      Test Taking Tips
      For the MCQ portion of your exam, the ABC Written Question Manuals are a great resource. They cover OB, REI, Oncology, FPM, GYN and Office Practice. Also, these ABC WQMs now include one-liners so you can kill two birds with one stone.

      MFM 2018 ORAL Exam Candidates

      It’s the last month before your exam – take a deep breath, it’s time for the final sprint! By this point you have done all of the hardest work: your thesis is in (didn’t you submit that a million years ago?!), your case lists have been turned in . . . and hopefully you’ve been making time to read and study. With these last 4 weeks before test day, use your time to its full potential. Make a plan for which topics you’re going to cover by reading or using other study methods. Review your notes. The wisest strategy to use this month is mock orals. There’s no better way to check for gaps in your learning than to put your knowledge to the test!  You’ve got this – the finish line is in sight. Dig your heels in and make the most of this month.

      Structured Cases Tip:
      Start working on developing a depth to your differential diagnoses; try to come up with at least three working diagnoses. Also, start with the most logical- when you hear hoof beats, think of a horse before a zebra.  The next question, “How would you work her up?” is dependent upon how you answered the first. Our MFM Structured Cases are now available for purchase and perfect timing in that you are less than 5 weeks away from your exam.


      FPMRS 2018 ORAL Exam Candidates

      We are about a month away from show time and anxiety is likely starting to mount. The key to focus on is trying to maintain focus on the areas you are less comfortable with and doing as many run-throughs with mentors, colleagues and ABC as you can.  Keep your mind on high yield topics and review your case list again to brush up on any specifics that you are not 100% comfortable.  Get a head start with ABC’s FPM Structured Cases. These cases will be exceptionally valuable for you as you become familiar with, and ultimately perfect this mode of the exam, as well as to assess your knowledge of a specific topic. discussing.  You can still sign up for our webinar series and watch archived case presentations.  It is also not too late to sign up for our phone mocks or the Do or Die Mocks in Dallas.  Benefit from the expertise of ABC faculty subspecialists who can focus on specific topics, case list or your thesis.
      Make sure you have everything in order regarding your travel plans so there is no additional last minute stress. Nothing makes a stressful situation worse than a last minute travel glitch.
      Finally, breathe. You really do know the wouldn't have gotten this far if you didn't. The key is organizing your thoughts enough to articulate what a great clinician you are to the examiners!

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