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TRIPLE BOARDING

Link to General Tips

Link to Pediatrics

Link to General Psychiatry

Link to Child and Adolescent Psychiatry

General Tips

Triple board residents are eligible to take board examinations in pediatrics, general psychiatry, and child and adolescent psychiatry. Triple Board graduates from most of the Triple Board programs have contributed to these “boarding” tips. While there are no guarantees, these residents wanted to share their collective experiences.

By the time you prepare to start the triple boarding process, you’ve taken lots of tests and done well on them. Regardless of what anyone tells you, you will not need to reinvent yourself to take the board exams. Use the skills that got you here. Since the anxiety and costs that accompany these tests may be higher than with other tests, here are a few tips to start the process.

  • Take each board as soon as you are eligible if life circumstances allow it. The most successful triple board graduate will take 3-4 years to complete the process and the sooner you start, the closer you are to remembering the zebras.

  • Talk to other triple boarders about board strategies. It is particularly useful to know how people in your program generally do. While not everyone is willing to share this information, both passing and failing experiences can be helpful in tailoring your studying to your program’s patterns.

  • Plan ahead to have your application including a letter from your training director in on time. Each board has a strict late penalty, which can cost up to $500 dollars.

  • Boards are expensive. Keep this in mind while negotiating a salary- sometimes, the cost of the boards can be negotiated as part of salary. Board certification can translate into a higher salary, raise, or bonus. Board certification costs a lot, but is also highly valued in the medical world.

  • You must have an unrestricted license to sit for the boards. Depending on the state, obtaining an unrestricted license can take up to 9 months.

Typical schedule for residents who started residency before July 1, 2007

4th year Fall

Register for pediatrics boards

Register for full license if necessary

Spring Start planning study schedule
5th year Summer Study for pediatric boards
October

Take boards

Celebrate!

January Receive Results
June Graduate!
First year out October Deadline for ABP exam
June General Psychiatry Exam Part I
winter, spring, summer, fall Oral examination (scheduled by ABP)
Second or Third year out December Register for Child Exam Part I
Spring Child Exam Part I
Winter Child Exam Part II (oral)

Residents who start training after July 1, 2007 will complete clinical skills verification during training and will only take a written examination for General Psychiatry and Child and Adolescent Psychiatry Board exams.

Pediatric Boards

www.abp.org

Application is online and during a specific registration period, usually December-February before the examination date in October. This is usually in the 4th year of triple board training Recertification has been required every 7 years, but will change to every 10 years. The examination is a closed book exam at an on-site computer testing center. Recertification also requires evidence of ongoing self-assessment, continuing medical education, and an approved quality improvement project. Triple boarders are required to take the general pediatric recertification rather than subspecialty exam.

Scheduling:

  • Triple boarders are eligible in the fall of the fifth year as long as all pediatric training other than continuity clinic has been completed at that time.

Content/Preparation

  • ABP officials say that the best preparation for the boards is residency training. While for some, that may be reassuring and sufficient, most of us feel like there is a little more to it than that. 5 years of Pediatrics in Review and PREP question content cover the content of the recertification examination and likely represents content important for the certification examination too.

  • Pace yourself and don’t start too late! This is the exam with the broadest content and fairly high level of details.

    • Keep all the PREP issues and the content specification books that come with the binder at the end of the year.

    • Regular reading throughout residency! The Independent Learning Programs (ILP) now required by the Pediatric RRC can be a useful external motivator. Including some regular reading goals in the ILP is a good way to maintain pediatric knowledge. The PREP Content Specifications each year help identify topics worth reading (you’ll know them because they give you a pit in your stomach!).

    • Most people start focused studying sometime in the end of 4th year or the beginning of 5th year.

  • Some triple boarders have taken board review courses, particularly if they did 2 years of pediatrics as a block in the beginning of their training. These courses cannot teach all of the content, but are sufficiently frightening to initiate a rigorous study plan and provide organized review materials. The counter balancing issue is the cost.

Resources

  • Most people use 2 main “study” resources

  • The PREP system:

    • Self-assessment questions are a great way to practice doing multiple choice questions and also target further reading.

    • Pediatrics in Review is probably one of the most commonly used reading sources and it reflects topics the board feels important.

  • Atlas of Pediatric Physical Diagnosis by Zitelli and Davis is great for the visual questions. In addition, the text can be useful, although the level of detail is not sufficient for studying for the boards.

  • Laughing your way to passing the pediatric boards by Stu Silverstein can provide useful pneumonics, although some triple boarders have found some errors in the book’s content.

Tips

(Caution: these are collected from triple boarders who have taken (and passed) the boards and are completely anecdotal!)

  • Talk to people from your program to have a sense of the program’s pattern of success.

  • Use your results from the Pediatric In-Service exams to target your own strengths and areas for further review.

  • Memorizing fine motor and social developmental achievements of infants and preschoolers (how many blocks can a 3 year old stack?) is high yield. These questions appear on each of the 3 boards and are “gimmes.” Syndromes and dysmorphology show up on all 3 boards and may also get you some easy points.

  • Another high yield, easy point area is epidemiology/study design. Know types of prevention, sensitivity/specificity, and cross-sectional vs cohort studies.

  • Each year the higher frequency topics change a little. Talk to people who have taken the exam recently, including your pediatric cohort class who generally takes it the year before you do.

  • During the test- don’t overthink the behavioral questions. Remember, you’ve had a lot more training around these issues than general pediatricians have.

  • After the test- write down the things you thought were highly represented to share with next year’s class!

General Psychiatry

www.abpn.com

Scheduling:

Triple boarders are eligible after completion of residency.

Part I: 1 day multiple choice questions in computer centers (starting 2006). There are a few choices of dates in the fall. Application deadline usually around February.

Part II: Weekend extravaganza of registration and oral examinations, scheduled by the ABPN in different cities around the country. You do not chose your location or exam date and most people will travel to take the exam. The exam includes 1 “live patient” interview and four 15 minute sessions consisting of vignettes and one video clip with focused questions. The resident changes rooms and goes to four “test stations” for these vignettes/videos.

Recertification: Recertification is every 10 years.

Resources

Part I

  • Keep PRITE exams from each year as practice tests!

  • The ABPN will send you a booklet which describes topics that may be included on the exam. Take a look at it to be sure there are no big surprises.

  • Many people use the Massachusetts General Hospital Psychiatry Update and Board Preparation (John Herman editor, 2000). The book includes an over-view of the test, detailed chapters on major psychiatric disorders and treatment. Keep in mind that a book published in 2000 may be out of date, particularly in the psychopharmacology areas. There are questions at the end of the book, but not enough for people who like to practice. So, the same group published a book of 1000 questions in 2004. Also useful, especially for psychotherapy theory is the Kaplan and Sadock synopsis.

  • Neurology: Makes up 40% of the Part I exam. For people who feel like the Mass General book doesn’t give them enough confidence, can use Clinical Neurology for Psychiatrists (Kaufman, 2001) or Neurology For The Psychiatry Specialist Board (Weisburg, 1998). Using neurology board review books is overkill.

  • The APA also publishes treatment guidelines, which can be useful.

Tips

(Caution: these are collected from triple boarders who have taken the boards and are completely anecdotal!)

  • Again, developmental milestones (pesky toddlers building towers of blocks) come in handy, as do epidemiological constructs (e.g. sensitivity/specificity, study design, prevention).

  • There will be some brain images on the written exam, so prepare a little so they won’t scare you when you get to them. Knowing CVA’s, MS, and basic neuroanatomy may prove useful.

Part II (oral)

Resources

  • PRACTICE! Successful triple board examinees have recommended anywhere from 1-4 practice examinations with attendings. Asking the attendings you respect or fear the most is probably the best way to simulate the sympathetic activation that you’ll have at the boards! Use your own comfort level as a guide to how many of these you do.

  • The DSM-IV! Learn the criteria for most major disorders (including Axis II) will help your comfort level going into the boards. Things you know cold will almost always seem a little shakier during the real exam.

Tips

(Caution: these are collected from triple boarders who have taken the boards and are completely anecdotal!)

  • The official exam hotel will be full of people studying and sometimes stressing. Some people prefer to get a little distance from the exam by staying nearby. (Often, you can get better rates at nearby hotels anyway).

  • Anxious co-examinees will start talking about the failure rate right in the waiting room. Ignore them.

  • The primary goal of the examination is to determine if you are a safe psychiatrist and that you have an adequate you take a thorough history, you know how to access help when you need it, and you are aware of the risks of treatments and withholding of treatment.

  • Raport building goes a long way. Try not to let your basic skills disappear because of the exam (introductions, eye contact…)

  • Never say something that you don’t know to be true. It’s ok to say what you think and describe how you would look it up or confirm. The corollary to this is to spend time saying what you know to be true. If you know a subject really well, talk about it.

  • The examiners know that this setting does not show your very best work, and they are instructed to keep that in mind.

  • Being interrupted does not mean that you are doing something wrong. The examiners feel their own time pressure to check a wide range of areas (physician-patient interaction, conduct of the clinical examination, capacity to elicit clinical data, formulation, differential diagnosis and prognosis, therapeutic management, and knowledge of therapies, according to the website) so once they know you know how to do a MSE, for example, they will have you move on.

  • It’s easiest way to show that you know what a bio-psycho-social formulation is by saying those exact words. (e.g. “the biological factors influencing this patient’s presentation may include…”) Don’t make the examiner have to work figure out that you know what bio-psycho-social means! For the most common diagnoses, you may want to think ahead of time what bio-psycho-social factors you would identify for the diagnosis.

Child and Adolescent Psychiatry

http://www.abpn.com

Schedule

Register in December for Part I written examination in June in computer centers. Part II is scheduled in November if you pass Part I. Part II includes a 1 hour patient interview and discussion and a 1 hour 15 min exam based on a video clip and then a written vignette. After you register, you will be told exactly when your exam will end, so you can arrange your travel.

Resources

Part I

  • The ABPN website includes a list of core competencies.

  • Keep Child Prite exams from each year as practice tests!

  • The ABPN will send you a booklet that describes topics that may be included on the exam. Take a look at it to be sure there are no big surprises.

  • Skimming Concise Guide to Child and Adolescent Psychiatry (Dulcan et al) is a good way to make sure you have thought about most topics.

  • Last few years of JAACAP 10 year review articles and practice parameters (keep in mind that some may be out of date)

Part II (very similar to General Psychiatry)

  • PRACTICE! Do 1 or two practice board interviews with attendings.

  • The DSM-IV – memorizing criteria for most major disorders (including Axis II) will help your comfort level going into the boards. Things you know cold will almost always seem a little shakier in the real thing.

  • JAACAP Practice Parameters are the gold standard treatment guidelines. It’s worth looking at the recent parameters (including drafts from the year you are taking the exam).

Tips:

(Caution: these are collected from triple boarders who have taken the boards and are completely anecdotal!)

  • It is possible to over-study for this exam, especially if you are practicing CAP.

  • All the same issues as the General Psych exam apply here except that the written examination doesn’t have nearly as much neurology and has no images.

SEE THE TIPS AS FOR GENERAL PSYCHIATRY ORAL EXAMINATION

Good Luck!

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