The American education system testing is largely based on multiple choice questions. The ENT Oral Board Examination may seem intimidating, as it differs from the conventional test-taking norms. The unfamiliarity of the examination format, large body of information covered (encompasses 5 years of training), and artificial setting of the examination (a hotel room), are all factors that may increase the test-takers’ anxiety level.
Before you panic, keep in mind:
1. You already know the material, you’ve been learning it for the last 5 years.
2. The test is not structured to make you fail; it is to make sure you are systematic, thorough, logical and are able to explain your actions, analyze the outcomes and manage the complications.
Months before the exam – start using the same routine in the office and hospital setting: chief complaint, relevant history of current presentation, past medical/surgical history (obstetric details in children), medications, allergies, social history, family history, review of systems and vital signs. Then perform a thorough physical examination and highlight the pertinent points. Review available data. Order studies which will either help you establish the diagnosis or change your management. Construct the differential diagnosis list, from most likely to least likely. Formulate the management plan. Same routine every time. Make it a habit.
Weeks before the exam – go over common topics in Otolaryngology (reviewed in a separate section). Be familiar with common surgical complications and management of such. Review radiology images and pathology slides. Interpret audiograms. Be able to provide facial cosmetic analysis. Learn how to draw various flaps. Simulate cases with your contemporaries. Get used to talking and explaining your every question, decision-making step and management actions. Some time in the winter/early spring months you will have to review a rather long list of names and pick out clinicians you have ever interacted with to avoid being tested by familiar individuals.
Days before the exam – get plenty of sleep. Eat well and stay well hydrated. Schedule your arrival at least 1 day prior to the exam and attempt to pack your luggage into a carryon, so that traveling challenges do not add to your stress level. Bring a suit and comfortable dress shoes (there will be a lot of walking).
The day of the exam – have a good meal and arrive on time. You will be separated into groups and receive the list with the order of specialties (plastics, general, head and neck, and otology) and names of the examiners. You will stay with your group for the entire day. You will be guided/courted by 2 proctors and security guards between different locations of the hotel. The examination will take place in a hotel room. The examiner and you will sit across each other at a desk. Each specialty section takes an hour, 4 cases per hour. The examiner will present you with a one-liner about the patient. There is paper and pencils you can use. He/she will keep track of time, so if he/she doesn’t want to go into details of family history, it means it is not important for the sake of time or not contributory. But I urge you to make an attempt to mention every point of the routine mentioned above, unless your patient presents in extremis. You may be given a picture of an imaging study, a pathology slide or a patient’s facial image. Describe what you see, even if you do not know what you are exactly looking at. After the review of clinical presentation and data, summarize your assessment. Present a solid differential diagnosis list, explaining why something is more or less likely. If you feel more information is needed, ask for it, but explain why.
Avoid asking for excessive and unnecessary tests. Narrow your differential and formulate a plan of action. Random things:
- If there is a history of a “mass”, even benign – ask for the pathology report
- If there is a history of otologic or complex head and neck procedure – ask for the operative report and treatment records
- Counsel on smoking cessation
- Do not forget ancillary support – speech and language pathology, dental services, nutrition, social work
- Make sure your patients have proper follow up not only with you, but other specialties if needed (if there is an incidental diagnosis of an autoimmune process, refer the patient to the rheumatology)
- Always employ your reconstructive ladder (healing by secondary intention, primary closure, skin graft, regional flap, free flap)
- Provide proper prophylaxis to your patients (including tetanus)
- Remain calm and systematic, explain every step of your thought process
If you’d like to practice topics, BoardVitals offers a set of free ENT trial questions.