Up Against The Boards

Genmedmom here.

It's been ten years since I graduated from residency. I was Med/Peds and not quite sure what I was going to do with my life. So, I took both the Pediatrics and Internal Medicine board exams, within two months of each other. I know I studied, but I don't remember feeling overwhelmed by the material or flummoxed by the practice questions. I was a resident and then a research fellow, so I'm sure I didn't have oodles of free time. Both exams were sit-down, pencil-and-paper, highly regulated, proctored, and extremely lengthy affairs. But, somehow, I passed both tests, with minimal pain. (I'm not saying I passed with the highest scores, but hey, all you need to do is pass.)

Fast forward. I've been a Medicine attending for six years, and I'm due to re-take the medicine boards. I've registered and paid and I've got a date: April 15th.

But this time around, I am struggling. Yes, I have two little kids, and may be sleeping even less than I was as a resident. Yes, I'm purely outpatient and far, far removed from acute, inpatient care. There are scads of specialists in my large, teaching hospital- based clinic, and we frequently refer patients for alot of management issues.

But I'm only studying for the Internal Medicine boards, and I've been in practice for six years. You'd think I'd be more comfortable with this material.

Now, I like to study. I'm a dork that way. In my practice, I look stuff up all the time. I earned three hundred CME credits in the course of a year just by looking things up on our favorite medical search engine (yes, you can earn CME credits that way, if you register and then print out the report). So I figured, boards, no problem.

I got the study books and the audio material in November. I read when I can (after the kids have gone to bed, or late on a weekday workday) and listen to the most BORING medicine lectures during my commute.

But, I'm just struggling. I've reviewed a fraction of the total material. I'm getting killed on the practice questions. There are huge gaps in my knowledge, that is clear.

So I'm trying to get my head around this. The re-cert is about 8 hours of testing, now done electronically in testing centers around the country. Looks like a few hundred questions, from these basic areas:

Cardiovascular Medicine
Dermatology
Endocrinology & Metabolism
Gastroenterology & Hepatology
General Internal Medicine
Hematology & Oncology
Infectious Disease
Nephrology
Neurology
Pulmonary & Critical Care Medicine
Rheumatology

There is alot of potential question material under each discipline. At this point, I won't be able to review it all, to ABSORB all the material. I don't have time.

So I'm cramming questions. I'm doing 25-question blocks, and studying the answers, trying to learn patterns, what are they likely to ask about.

The overall pass rate for the October 2014 Internal Medicine board exam was reported as 72%... Ugh. The pass rates have been steadily declining over the past decade. Why? This is, apparently, a matter of much lively debate. In one fun article from the NEJM website, several hypotheses are presented. One conspiracy-theory hypothesis purports that the people that write the exam and charge us to take it have made it harder so that they can charge us to take it more times. Like, it's a money-maker. Other hypotheses include that we're losing the ability to study effectively, because we CAN look everything up on medical search engines... Oh.

So, I hired a sitter to get me 100% protected time on Saturday afternoons; I registered for a boards review course next week; I slashed my clinic hours to two hours per session for the three weeks leading up to the exam; and I limited my time writing blog posts to about thirty minutes a week total (ha!) so I can CRAM.

How does everyone else study for their boards?