Medical

Tips For The Anesthesiology Standardized Oral Board Examination (SOE)

Anesthesiologists typically take the “oral boards” (standardized oral board examination, or SOE) roughly a year after completing their residency training. Compared to other exams we take over the course of our medical training, the SOE can often times be more daunting since its based on an examinee’s ability to communicate rather than answering multiple choice questions.

I previously wrote about how I used Ultimate Board Prep as my written preparation for vignettes I’m likely to encounter, but in this post, I’ll outline some other tips I’ve garnered over the years and teach the residents I work with:

  • Stay at the hotel the ABA recommends in Raleigh. Yes, it might be a little more expensive, but exam registration takes place there, so you don’t have to worry about being late Ubering in from elsewhere the morning of the exam.
  • You can get every question right and still fail the exam. Why? Because you never got through it. Examiners are under just as much pressure as you to get through the exam. If you don’t know something after a few seconds, move on to the next question. By the same token, if you can convey you’re safe and know what you’re talking about in a few words, the examiners may cut you off and move on to the next question. This can make the exam feel very choppy. However, don’t be flustered because you couldn’t flex your intelligence – you just don’t have time!
  • You are being examined by board-certified anesthesiologists. They don’t need to know every – single – way one can approach a given clinical situation. Commit to a decision. Instead of “Well you could do x, y, and z…”, focus on saying “I will do (insert plan).”
  • If the examiner is throwing you a bone, take it. Testable but clinically rare topics like local anesthetic systemic toxicity (LAST) and malignant hyperthermia (MH) often show up this way. Yes, clinically, you may never see them, but you don’t want to miss them! If a “grab bag question” or vignette-based question involves a patient getting warm on the OR table with increased ETCO2 and a vague family history of unexpected ICU admissions after general anesthesia – yes rule out more common things (hypoventilation, overwarming, etc.), but you have to say you’re considering MH in this case. If this was the examiner’s original point, then you will likely go down the MH pathway (discontinue triggering agents, call for help, cooling blankets, switch to TIVA, flush vent and hyperventilate, 2.5 mg/kg dantrolene, etc.)
  • Be comfortable with awkward moments of silence. If you’re doing a laparoscopic cholecystectomy on a healthy 25 year old and are asked what monitors you will need, “standard ASA monitors” will suffice. Don’t unnecessarily drag out responses. Examiners want you to pass – if they want more information, they’ll ask.
  • Best advice I was given: never say something you wouldn’t actually do in real life. When you are given your short and long form vignettes, imagine that patient is in front of you. Imagine you’re actually taking care of them in the pre-op, intra-op, or post-op settings. What would you actually be doing? What kinds of monitors? What kinds of meds? What kinds of vent settings? If you have an “impossible airway” in a pediatric patient, are you actually going to do a true awake fiberoptic intubation, or would you call for help, have your airway toys in the room, keep them spontaneously breathing with an inhaled induction, and then proceed accordingly?
  • PRACTICE – this is NOT an exam you can prepare for just by reading. Practice mock oral board vignettes with your colleagues, co-fellows, etc. Focus on concise communication. Record yourself and and re-listen to your responses – people are often amazed by all the “ummms” and “likes” they have in conversation.

Drop me a comment below with questions, comments, or your own experience regarding this exam.

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