Wednesday, May 28, 2008

Family Medicine Board Exam 2008 - description, study strategy, results

I'm putting together my plan and resources to prepare for the 2008 Family Medicine re-certification exams. These exams used to be pretty stress free, but that was back when I actually did family medicine!

I'm surprised how scattered the resources are on this topic. I'll list what I've found, and update this post over the next two months. I'm restricting my list to items available through the AAFP, ABFM (board), or "free" (typically pharma or ad supported). Most of these links work only for AAFP members or recert exam registrants.

  • ABFM profile: Home base for exam information.
  • My medical reference page: updated in preparation for the board. Licensed MD/DOs can get everything "free" via MerckMedicus.
  • ABFM Study Guidance: ABFM's guide to preparing for the exam. They don't like lecture classes and they don't like people to focus on practice exams. As a (formerly) ace exam taker, barely one step behind my wife, I thought the advice was meek. Using JFP to study for a recert exam? Pardon?
  • ABFM 2007 In-Training exam and critiques: same question pool as the exams.
  • ABFM Candidate Information (PDFs), includes:
    • Candidate Information Booklets: PDF explains the exam in great detail, including rules of the somewhat harsh company that inflicts the exams.
    • Recert exam description: The only detailed description of the exams I found.
    • Exam content: What topics are covered. I won't spent much study time on the < 3% group.
    • Recert modules: Choose two of these.
  • AAFP Board Review Questions AAFP members can do these practice exams and even earn CME credit at the same time.
  • Online exam tutorial: ABFM tutorial teaching mechanics of their exam software.

For my commute I have a backlog of Audio CME to add to my iPod, but iTunes also has a pretty good listing (though as badly organized as every other Apple item list I've seen). I've also found a UCSF newsletter (pdf) with an article on medical podcasts.

Podcasts:Science and Medicine:Medicine including

  • MedPod 101: Internal medicine review aimed at fourth year med students preparing for board exams. Sponsored by the US Navy, with a very tolerable interstitial ad. I like MedPod. The background music is tasteful, the voices are clear and entertaining and they move through topics very quickly. Their audience has no time to waste on frivolity or slow speech. MedPods 101 is run by an independent group of 3 very young high school students internists who may have mercantile ambitions but appear to be having fun.
  • Surgery ICU (Vanderbilt)
  • Annals of Internal Medicine
  • Pri-Med CME: samples form their commercial products
  • INFOPoems: My old friends from Michigan!
  • Pediatrics from the U of Arizona
  • McGraw Hill ACM Podcasts: samples from a range of McGraw Hill texts
The UCSF newsletter also lists some journal podcasts (ex. JAMA), but those are much less useful for FM board review.

I thought I'd end up working through my cache of unheard Audio Digest reviews, but, of course, they're more aged than I'd realized. The AD reviews are also recorded from typical CME programs, and they tend to move slowly and get caught up in the lecturers personal interests. I think the podcasts may turn out to be a better use of commuting time. I don't care about the CME, I'll get lots of that working through my backlog of American Family Physician.

I'll miss In Our Time, but I can catch up in August.

Update 8/15/08:

I've long had an information-geek's admiration for the printed version of Monthly Prescribing Reference. Despite its evil ad-funded roots, there's a real genius to the density and layout of the content, refined by generations of customer feedback. It also has the virtue (and sin) of being always topical and exceedingly brief.

So I started my review by reading this cover to cover. Each time I come across a medication that's new to me, or a familiar one that unlocks a domain of forgotten knowledge, I add it to my core med review sheet. This sheet is also an interesting overview of what's changed in medicine over the past decade. There was more activity in the treatment of Parkinson's Disease, for example, than I would have guessed. Lots of combo drugs, maybe because of the co-pay effect.

I also note that when a med is introduced it gets a trade name in the second half of the alphabet, but copy-cat meds get names starting with the letters A-D.

From the med review I will identify key topics based on med activity development to review in AFP articles (Parkinson's, for example).

Next I will review my obsolete medical notes to bring old memory banks online. Then to a practice exam to identify high value study areas. From that I will identify the highest yield subtests to take.

I found the podcasts less useful than expected, so I'm dumping my old audio digest material to an MP3/AAC data CD, I can opportunistically sample those while driving.

Incidentally, it appears the ABFM has given up on their over-ambitious board study program -- the old q7y exam will be retained as an option. I think there's a better middle-way and I hope they'll soon find it.

Update 7/15/08b:

I'm making limited use of traditional references, books, and articles. I'm finding it much faster to google on terms and read the NIH/NIND/etc information for professionals. The articles are too wordy.

Update 8/1/08

I'm done with the exam. These exams are much more interesting when one hasn't seen a patient in 10 years! We'll see how I did. In retrospect my study approach was very good; any bad outcome would be due to lack of study time rather than study strategy.

I'll summarize my strategy below. This is a strategy for someone who doesn't do medicine and who needs to recreate a lot of knowledge in a very short period of time, a practicing clinician wouldn't follow this route.

My goal was to resurrect as much old knowledge as I could, while patching in new things.
  1. Read Monthly Prescribing Reference cover to cover to create a core med review document. Don't spend too much time with this reference, the goal is to create the list and update it based on further study. Monthly Prescribing Reference also has about 5-6 useful 1-2 page protocols for care of common conditions. They're a very concise set of reviews, print and use them as reference.
  2. Review empiric antimicrobial therapy in Sanford and make notes. Antimicrobial therapy has changed more than anything else in medicine due to increasing drug resistance.
  3. Review and summarize the most interesting bits of the AAFP's preventive services document.
  4. Find as many of the ABFM 2007 In-Training exams and critiques as you possibly can. The ABFM used to provide links to several years worth of training exams, but now they only provide the last year. The critiques are superb; so try to find friends who have them from the past three years. Do one of the exams cover to cover, but don't get too hung up on the questions. Instead, carefully read the critiques, they're ultra-concise guides to what matter. Unfamiliar topics in critiques are guides to further study.
  5. I tried medical podcasts, but they simply weren't good enough. I had a large collection of Audio Digest CDs that were a few years old, those were better. The best audio resource, however, were my old AAFP CDs (via my iPod and iPhone). Even the 3-4 year old talks were about right for the exam. I listened to those on every commute -- they brought a lot of old memories online. (I'll resubscribe 2-3 years before my next exam if I do the boards again in 7 years so I've got a topical pile to listen to.)
  6. I read and partly reworked my old online medical notes. This works since I have so many old memories attached to them.
  7. For quick topic lookups Wikipedia, amusingly, is rather good. Actually, very good -- especially since it's not hard to spot junky alternative medicine additions. Otherwise the AFP site is the best place for reviews; in service exam critiques reference American Family Physician more than anything else.
Given more time I'd have liked to review the arrhythmia portions of a current ACLS handbook, but I there's nothing else I'd have changed (except manufactured more time, but I haven't figured out that trick).

Update 8/3/08: You need to recheck your ABFM profile about 8 weeks after the exam to get your results. There's no mail notification. The ABFM allegedly sends an email notice out when the results are online, but email is very unreliable now. Best to check.

Update 9/19/08: The board sent out a result notice as promised. If you passed you see immediately that your certification has been extended. I passed by a good margin, but I'm no longer in the 95+ percentile! Of course considering that I haven't seen a patient for about 10 years, last did full family medicine 15 years ago, and had a pretty compressed study program I'm satisfied. The results show I was consistent across all topics.

The program I outlined above was the right one for me, with the caveat mentioned in a prior update.

The result files are PDF password protected. They don't contain any real exam information, so I assume the passwords are to prevent people creating fake result letters. I saved the password with the file name.


Anonymous said...

I am also getting ready for the FP exam and am no longer practicing so your blog was immensely helpful. Thanks!

Country Doc said...

Thanks for the info in your blog. It has been 7 years I have had to take a multiple choice test like the upcoming ABFM recert exam. I like the Sound Medicine podcast from Indiana University. It is concise and practical.


Anonymous said...

Appreciate your information! I'm doing more urgent care + admin vs. full scope family medicine these days. So, your comments/ tips are very useful! I'm getting ready to re-cert JULY 2009.

For some, Swanson's 5th ed. of FP Board Review may also help (can go on to see prices). Goes over a variety of FP topics with good explanations.

Thanks again!

Anonymous said...

I took my ABFM boards today
I thought I prepared well but didnot feel very staisifed
Questiosn felt a little too confusing many time esp the once on oncology. any opinions?

Anonymous said...

Thank you for this blog! I had no idea about the "In traning exams". I don't understand why the ABFM booklet didn't tell us about them. I found out about them on your blog 3 days befor ethe exam. Several of the questions were actually on the exam!

This is my fourth time taking the exam. I was an ED doc ffr 13 years and since then an FP doing office practice plus taking care of my hospitalized pts. I can now say with authority and certainty that this test was ridiculous. The corect answer for a whole bunch of questions was: "Don't know, never knew, never will, and don't NEED to know".

There are whole important areas that I spend much of my work day dealing with that were not queried. I think there were only 2 questions on diabetes: on too easy (what's the criteria for dx) and one two hard (difference between Byetta and Januvia...ugh).

Anyhow, if you are reading this, do the In-House training exams for sure and good luck!

Anonymous said...

Many of the questions were directly from the online AAFP board review questions. (took the exam 7/11/09)

Unknown said...

I'll refer to a 7/9/09 post from Anonymous. Similar situation for me--- I did primary care and rural emerg med from 1984-1991. After that, it was strictly hospital-based emerg med and then retired from clinical practice in 2003. Over the past 2 years, I have worked in patient education development, and I made the huge error of assuming that my daily reading would prepare me for the 7/2009 Boards. NOT!!! I failed by 10 percentage points.

Being a chronically terrible test-taker, I am very nervous about my scheduled retake of the exam this December. Via eBay, I purchased a whole set of Board Review materials (50+ DVDs & 1700+ pages of printed out slides and materials from those lectures and workshops) that were being unloaded by a new grad who passed the July, 2009 exam.

After an intense review of the first 40 DVD lectures, I came across your blog a couple of days ago. I clearly have been approaching this totally wrong. Similar to Anonymous, I did not know about the In-Training Exams (and I never clicked on the "ITE" link buried within my physician profile on the ABFM web site).

In addition, there is good advice that focuses on the statistically skewed selection of questions within certain subspecialties and away from other subspecialties. Interestingly, I have now learned that the Self-Study questions (100 of them that came with the stack of review materials that I purchased) bear NO resemblance to the distribution of questions that actually exist on the Board exam. A glaring example is that 10% of those 100 questions focused on OB/GYN (mostly Obstetrics) whereas the actual exam has a much lower percentage of questions focused on Maternity care and the Female Reproductive system.

This whole process is extremely stressful and a significant waste of time, energy, and money. With continued daily diligence, I believe I will pass the exam in December; but it will certainly be the last time I pursue re-certification.

Thank you again for your guidance on this blog.