How to excel on part II of the ABPN Boards Exam

Part One (Written)

  • Invest in some study guide books (The American Psychiatric Publishing Textbook of Clinical Psychiatry, Fourth Edition Edited by Robert E. Hales, M.D., M.B.A., and Stuart C. Yudofsky, M.D. With Introduction by Glen O. Gabbard, M.D. and Essentials of Clinical Psychiatry, Second Edition Edited by Robert E. Hales, M.D., M.B.A., and Stuart C. Yudofsky, M.D. are a good choice) or take a course
  • Note that many of the more confusing question formats are no longer part of this exam (eg. there are no "not" questions "which is NOT true, a or b", and there are no "K type" questions (A and B are correct, neither A nor C is correct, etc.)
  • Questions will be clinically oriented, rather than covering basic science
  • Don't second-guess questions. If a question seems too obvious or easy, chances are you have the correct answer. Questions are not written to "trick" you.
  • Your performance on the PRITE (Psychiatric Resident In Training Exam) is a good gauge of how you will do on Part 1 of Boards

Part Two (video and live patient)
  • Practice and organization are the keys to doing well on part two
  • Practice "mock boards" (use videos and/or and practice with colleagues)
  • Practice how to organize information and set an outline. This will give you a framework into which you can to insert information. Practice using that outline many times before the exam
  • Be clear--present to examiners as if they were third year medical students. This will enable you to remember to explain whatever you say, and not assume your examiners know you know things.
  • Be concise--monitor the amount of information you present. The presentation should be more than your "best guess", but less than everything that could possibly be said on the subject
  • Be specific, especially on treatment recommendations (give specific drug, dosage, advice you would give to the patient, etc)
  • Prepare for interruptions from examiners, and be able to quickly recover your train of thought
  • Remember that the goal of the examiners is to make sure you are a safe practitioner
Video (4 tapes, none with straightforward diagnosis)
  • Note that patients with deliberately ambiguous conditions are used
  • Use patients’ words as examples to back up your definitions and terms (eg. "the patient was paranoid, he repeatedly said that people were trying to attack him")
  • Present information about what you did not see – (eg. "I would also ask about this patient’s history with drug abuse…")
  • Pull together the biological, psychological, and social aspects of treatment
  • Don't forget to include the physical aspects of mental illness
  • Present your working diagnosis, ie. your best guess based on the information you have. Mention what other information you would need to be sure (for example, talking to family, etc.)
  • Give differential (2nd and 3rd choice) diagnoses
  • Be specific in your treatment. For medication give brand and dosage. For psychological aspect, specify type of therapy (ie. family therapy, etc)
  • Be reasonable in prescribing treatment--take into account limitations of managed care

Live Patient (Candidates have a 30 minute interview with a psychiatric patient followed by a presentation to two examiners plus a "floating" senior examiner)

  • Expect a broad spectrum/range of patients
  • Establish rapport
  • Control the interview. If the patient begins to ramble, say "I'd like to know more about that, but I am going to change direction…" Organization is key, particularly if patient is disorganized
  • Lay ground rules, explain time limits
  • Finish the exam in 25 minutes, and then summarize to patient ask if wrong/incomplete. Realize in advance that you will not be comfortable with the amount of information you will get from the patient in 30 minutes.
  • Some important questions are worth repeating (history of suicide, etc)
  • Ask about social contacts, what the patient does during the day, where the patient lives. Often, the patient’s lifestyle will help you formulate a treatment plan
  • Be very specific in treatment plans
    • Biological-give very specific drug and amount and plan
    • Social - day program, AA, NA, etc
    • Psychological—family therapy, group therapy, etc
    • Don’t forget to give a prognosis
  • Realize that examiners might try to question your judgement. Remain confident in your presentation
  • Use notes only if they don't intrude on your exam. Resist the temptation to write down every single detail
  • Keep in mind the criteria you will be evaluated on:
    • Doctor-patient relationship
    • Conduct of interview - able to do it, and in a nice way
    • Organization of data
    • Differential diagnosis
    • Treatment and prognosis
  • Practice taking 30 min interviews, and then present to someone
  • Mentor, faculty, fellow resident
  • Focus more on passing exam than on offering a truly therapeutic session for the patient.
  • Learn to manage anxiety if test taking is a problem for you. Practice will lessen anxiety

Reasons for failure

  • IMG - if language is a problem, get a tutor. If you have a strong accent, be sure to tell patient to tell you if they can't understand you
  • Cultural doctor-patient issues – in some cultures doctors are more authoritarian than in the US
  • Avoid making judgmental remarks on lifestyle issues (sexual activity etc.)
  • Smart people fail because of anxiety. Get help for anxiety if you need it (medication, relaxation techniques, etc.)