Over Boards.
Understanding and Coping with the Insanity of Testing During Medical Training (and Beyond)
In this house, we are over Boards. (See what I did there?!)
But, great news! My husband is OFFICIALLY done with them. And not JUST Boards. Like, all the tests. DONE. COMPLETED. CHECK. DUNZO.
So yeah, this week marks a pretty EPIC milestone in my husband’s life (OUR lives).
But before we get into how things look differently now, I want to just quickly recap the testing milestones for those unfamiliar with the process.
Undergraduate School
It starts early, friends. In undergrad, the first major testing milestone hits every hopeful doctor in the form of the MCAT. Doing poorly means either 1. No med school at all, or 2. Losing the option to go into a higher ranked program. We weren’t married yet at this point, but I do remember this being a huge stressor and a major life suck at the time!
Medical School
Then, we have Medical School, which delivers the sheer joy of the STEP exams. STEP 1 is a nightmare for everyone. For that doozy, my husband used a dry erase board and documented what he planned to study every. single. day. of the month. This went on for months. It was so intense, because it MATTERED. It mattered significantly to his future because that test, in particular, is a crucial part of the residency application. Then you get to take two MORE STEP exams later in Medical School, but they matter a little less, so I won’t get quite as dramatic about those. However, they’re definitely still a factor.
Residency
Then, once you’ve dominated all these other tests, you move on to Residency, where you are faced with in-training exams that are specific to your specialty. These tests are designed to prepare you for the eventual Board exams you will take after (or at the veeerrrrry end) of Residency. In my husband’s case, in Orthopedic Surgery, he and his co-residents took these in-training exams once a year. These are also a big deal, because low scores are an indicator that you may not be prepared for your written Board exam down the road. Low scores can also mean that the Program Director is probably not super thrilled with your performance and you get put on a “naughty list” of sorts. For some Residency programs, it means you suffer the embarrassment of remediation courses. From my perspective, these in-training exams were intense, as far as the prep went, and important, as far as the weight of the results.
Post-Residency – Board Certification
After Residency, it’s finally time for the Board exams. In order for a physician to call themselves “Board Certified,” it means they’ve taken and passed the major exam(s) required for their specialty. Each specialty has a governing body that is in charge of offering Board Certification, and each governing body has a little bit different of a process. But what all of these governing bodies seem to agree on is that a written exam is important. The written exam is usually required well into or after a Residency program. Everyone we knew took this exam just after Residency ended.
Now, because Orthopedic Surgery always gets “VIP” treatment, the governing board, the American Board of Orthopedic Surgery (ABOS), has granted them the gift of TWO exams. (yay). One that they take right at the end of their Orthopedic Surgery Residency program, and another that they take at least 20 months into practice.
I mean, I’m not crazy when I say that is an INSANE amount of gigantic tests, right?!
Well, thanks for indulging me in that recap.
Hopefully it was helpful!
But now let’s discuss these cute little Board exams in a little more detail.
(And just a note that the info here is specific to Orthopedic Surgery and may not apply to all specialties).
Boards Part 1: The Written Exam
Between Residency and Fellowship, you get a month off (hooray!), BUT, during this time, most folks choose to take the first part of their Boards (boo). It’s a written exam and requires a LOT of preparation. It’s also super expensive, just FYI! The American Board of Orthopedic Surgery gets a LOT of our money (rightfully so, as I can only imagine the time and resources it requires to write and administer and score these tests).
In my husband’s case, his written exam took the better part of a day and was administered at a Prometric Testing Center (anyone else take an exam at one of these? I took the GRE there)!
My husband and I were both a little fuzzy on our recollection of the prep for this exam. But because of the in-training exams he studied for along the way in Residency, he didn’t have to dedicate SUPER insane amounts of time for prepping this one. Just moderately insane. So there’s that.
Boards Part 2: Oral Exam
You have five years after taking (and passing) the written Board exam to take the oral exam, or you have to start back over with applying for the written boards again. My husband took them (this week) at 21 months into his practice as an attending, but there is a window.
The process to take the oral exam is intense.
First, you apply to take the exam. Then you are assigned a collection period, during which you submit a truckload of data on the patients you have seen during that “board collection” period. (All protected health information must be removed). Honestly, my husband had to get some help from office staff to help him gather info on all of his patients that he saw during the Board collection period.
Then, some time later, the Board examiners let you know which patients you may be asked about during your actual oral exam.
Once you have that information, you then submit TONS of additional required information to the Board on all of those patients. You can also then begin studying your care of those patients and practicing presenting those cases to the examiners. You can further study the literature which supports your decision-making for the care of those patients. You can attempt to anticipate what potential questions you may be asked about the patients and try your best to prepare. But you don’t really know what’s going to come up until you’re in the moment. So, because you have to prepare for ALL potential questions, it takes a longgggg time.
All this prep took my husband a cumulative of approximately 200 hours, he estimates.
Then it was showtime.
My husband’s oral exam was in Chicago. Makes sense that these exams would not be offered all over the country because it’s a pretty specialized group of folks needing this exam. His assigned date was Tuesday (of this week), but he flew out on Sunday in order to get settled and prevent any tragedies in the form of flight delays or cancellations. It also gave him some last-minute time to review without being crawled all over by our three kids under five.
The day-of, they had a briefing session first, followed by almost two hours of the actual exam – where the docs defended their patient care decisions to groups of two examiners at a time. Afterwards, there was a de-briefing session (think surveys and questionnaires).
When the hard stuff was over, my husband grabbed a cup of coffee and then jumped on a plane a couple of short hours later. He was back in the house that evening.
And it was done.
Now we are left only to wait for the results, which will come at the end of August.
_________
The Aftermath
My husband was just saying how exhausted he was, even though it’s been a few days since he finished the boards. He wishes he had taken an extra day off work, and I think he could’ve been justified to take a week.
He is cautiously optimistic about his performance, as he felt adequately prepared, and had a sense of peace and confidence throughout the actual exam.
But the gravity of this milestone is not lost on him. On us.
Being done with exams.
There is this tricky part about tests that people don’t talk about enough. Tests, and all the prep that goes along with them, well, it’s all EXTRA. It’s in ADDITION to whatever you’re doing…Med School, insane Residency, a more than full-time work schedule…whatever. So the doc has to pile in the test prep hours on top of the insane demands already required by whatever part of the process they’re currently in.
In the case of the written Board exam, you’re studying while you’re a Chief Resident. Some programs give you time off to study for the Boards, and some programs give no time to study. Sometimes you’re on busy rotations like Trauma at Harborview, and you just had a baby and you still gotta squeeze it in somewhere (just sayin’).
In the case of the oral Board exam, it is prepared for and taken while you are working as an attending. So, those 200 hours of prep I mentioned? They were squeezed in between cases, and on the weekends, and from 7-10pm. I’ve talked about my husband’s hours before in THIS post, “How Many Hours Do Surgeons Work: A Week in the Life of ‘My’ Surgeon.”
So it’s crazy to think that more hours beyond that is a necessity. But it is. It’s another tick in the box of “things normal people don’t choose to do.” It’s another reason why docs are exceptional.
Coping with Exams as the Spouse
When you love someone, it’s hard to see them constantly be pulled away for work. And when “work” comes in the form of “studying,” I’ve seen some spouses have a particularly difficult time, because the physician is now self-directing their studying efforts. When the test-taking doc chooses to be away to study, sometimes that can feel more like a personal slight to the spouse. Like, “You don’t have to be away right now, but you’re choosing to be.”
Those thoughts have crept up but have been promptly squashed in my mind at times. I squash them because what I KNOW to be true, is that my husband WANTS to be with us, his family, far more than he wants to be studying. He is studying because it is necessary in order for him to 1. Provide the best care for his patients, 2. Achieve personal excellence, 3. Meet his goals.
We, as the spouse, want those things for our husbands as well.
So here are some tips for you spouses to make those studying marathons a little more tolerable!
- Give your spouse some grace. This isn’t the time to be resentful of your spouse not doing enough or being around enough. Believe, as I said above, that they want to be there with you as much as you want them to, but they have to put this other annoying thing close to first place for the moment.
- Approach the process as a team. The more you can be united in your goals, the more successful of a couple you will be through the trials of test prep. How could I ever expect my goals and dreams and wishes to be respected if I’m not supportive of his? It doesn’t mean I have to love the process all of the time (trust me when I say that there are times when it is difficult at best). But I understand the personal sacrifice that he is making, and that makes it easier to stomach the personal sacrifice I sometimes feel like I am making, if that makes sense. Obviously, we’re talking about two very different-looking sacrifices here. But sacrifices nonetheless.
- Consider taking some time away by yourself (and/or with the kids). During his last push to prep for the Oral Boards, I took our girls on a vacay without my husband. You can read about my tips for that trip HERE in my post two weeks ago). The trip, though not always easy, was amazing and entertaining, and gave my husband back at home some much needed time to work until midnight most nights, without feeling like he was directly missing out on family time.
- Plan some time for decompression after the exam, if possible. During prep for a test, there is extra pressure on both the test-taking doc and the spouse. You’ve both been burning the candle at both ends. You’ve both been under additional stress. I find this to be especially true now that we have kids. My husband is stressed out from working/studying around the clock. I’m stressed out because I don’t have my tag-team partner available to help with the little people. Both parties can easily get maxed out during an intense process like this. Decompression, like a little (or HUGE) getaway, would benefit everyone, in order to ease back into life as it was. Don’t be surprised if, after a test, they don’t come home doing cartwheels and being instantly happy. It’s an adjustment period for all!
The great news about all of this is that it will, eventually reach an end! We are so happy to be so close to being finished with these tests, and it will be your turn at some point, too. Hang in there.
Wishing you all the best in your test-taking ventures!!! Which ones are you or your spouse facing?!
All the love, as always, ❤️
Honestly,
AM ❤️
More About Me: Hi! I’m Ann Marie, a blogging mama of 3 tiny gals, and a wife to a busy Orthopedic Surgeon. You can find me right here for a weekly smattering of inspiration for your motherhood journey, home, marriage (I see you other medical wives!), style, and beauty. You’ll find me most active on Instagram or Facebook for life between blog posts. And I truly can’t wait to see you there, friend. ❤️💋
To connect, shoot me an email at honestlyannmarie@gmail.com ❤️
