Oral Board Examination Pearls

By Lisa Reaves, MD

1. Relax: 85-90% pass.
2. You’ve gone through an accredited ophthalmology residency program, practiced for probably at least a year, and passed your written boards. Be confident; these are three great accomplishments.
3. You don’t have to get every single question right. You can fail part of a section and still pass the exam.
4. Practice your “spiels” for typical patient scenarios. Although you may have all the knowledge in your head, you still need to practice communicating this knowledge to the examiner in a clear, concise and intelligible manner.
5. You may still get points even if you’re not sure. You can usually describe the picture, or come up with a reasonable differential. If the examiner picks a diagnosis and you are able to competently answer how you would manage the patient if they had that diagnosis, you will still get a lot of points even if the diagnosis is wrong. However, if you are completely stumped and in danger of getting yourself into dangerous waters ask to move on to the next question.
6. Have a routine way of describing a picture, e.g., fluoresceins. It sounds a lot more professional if you can say, “This is a fluorescein angiogram photograph taken during the early arterio-venous phase in which the optic nerve looks normal, there is no abnormality in the flow through the vessels and no evidence of abnormal hyper or hypofluroescence.” I don’t think they care how you do it, so long as it is rational, follows a pattern and is right.
7. Avoid verbal diarrhea. If you’re not sure about a certain aspect of the case, don’t mention it. You will have to back up everything you say.
8. The examiners are not supposed to help you. They have been trained to say little; however, if you seem to be really close, they might ask pointed questions to get you to mention the specific point they want. Listen carefully to their questions and try to guess where they are going with them.
9. Know the basics very well. Expect cases on diabetes, glaucoma, uveitis, strabismus, amblyopia, and anisocoria and be prepared to present typical symptoms, signs, differential diagnosis and management. Optics, although worrisome to many applicants, is not heavily emphasized and the questions are clinically correlated. The “unhappy glasses patient” is a classic example.
10. Don’t kill or blind a patient. You may do brilliantly on the whole test, but if you mishandle a retinoblastoma patient and the patient dies, you probably will fail.
11. Be conservative. If you are a retina guru and know all the latest details of cutting edge treatment, avoid the temptation to flaunt your expertise. The cases on the oral board exam are based on the standard of care as presently expected. Don’t try to teach the examiners; they will smile and then flunk you. I’ve heard of retinal fellows failing the retina section for this reason.
12. Don’t worry about zebras. There won’t be any. You can include zebras in your differential, but most pictures and cases are basic. They want to see how you manage common diseases.
13. Be professional in dress and comportment. Be polite, but not chatty; you don’t have the time. Men should wear suits. Women, professional business dress, but try to wear a comfortable outfit as you will have to stand and walk around a lot. Sleep well the night before and remember to eat.
14. Should you fail, it isn’t the end of the world. Everyone can have a bad day. Things happen and you shouldn’t let one test make one iota of difference in your self-confidence. I will pass along some advice I received from an instructor at the Osler Board Review course: “You are a wonderful physician, have a great fund of knowledge and make a great difference in the lives of your patients every day!”

Good luck to everyone!