Oral board exams: A window into how you behave in the operating room

When I clicked on the “View Your Exam Results” link on the American Board of Anesthesiology website, I thought something rashly exuberant would engulf me. I thought that everyone in the lunch room would turn suddenly, throw their reheated pasta and cafeteria sandwiches high aloft with glee and balloons would gush from the cracks between the fluorescent lights on the ceiling as the whole world burst into song.

But instead, there was only the word on the computer screen. At the right top corner of the webpage it read “Pass.”

I smiled broadly.

I floated back to the operating room and finished my case. As I saw my friends I told each one, receiving the heartiest hugs that I have ever been given in the hallways of the operating room. It was over.

Board certification in anesthesiology has four elements. You need to complete an accredited residency program. You need to be neither drug-addicted nor a criminal. You must pass a written examination. And finally, the year after you finish residency and take the written exam, you need to pass an oral board examination. This last step is the most daunting, and I will never have to do it again.

After the new year I decided that I would study for half an hour every day. The exam was in April, so I had four months. Half an hour every day, no excuses. There were some excuses, but they were rare. I started in January, when the sky darkened before I picked the kids up from school and we ate dense, spiced chili with hot cornbread every chance we could get. Every night we would put them to sleep at 7:30 and I would study for half an hour, and many nights the half an hour would bleed on into an hour, and then on into another fifteen minutes, until I went upstairs to sleep.

The key to the oral exam is practicing conveying your ideas out loud. So I would send Miles to the basement, where there is a computer and a TV and a comfortable couch, and I would talk to myself. Read a question, answer it out loud, check the answer. The kids always want to pretend – tigers, Star Wars, mice, dinosaurs, so the pretending was natural. I sat at my kitchen counter for half an hour and pretended that white men in suits were asking me questions and that I was answering each question perfectly. I even laughed. At times I challenged them.

On the day of the exam it was raining in Boston and I parked my car in an expensive garage and borrowed a friend’s suit. It is held twice a year, each time in only one location, and all the oral board examiners and examinees fly there and congregate like flies to fly paper.

Each hotel room has two examiners and one examinee. In each room I worked through a case scenario for 25 minutes and was peppered with unrelated questions for another 10 minutes. The first room contained a nice older white man and a nervous young white man. The second room contained a nice older white man and a nervous young brown woman. They asked reasonable questions. I gave reasonable answers.

After it was over I drove home and ate a peanut butter and jelly sandwich. I drove to my favorite place and went for a six-mile trail run in a light rain. I picked the kids up just as school was getting out. It was a good day.

On my way home after the good news I felt different. My mind wandered to the nights I have been on call, the only anesthesiologist in the cavernous hospital, and the times when I did the right thing. On my first overnight call as an attending my patient, who had had a massive facial trauma, developed a leak in her breathing tube at 2:00 in the morning. “Leave the tube in” the surgeons suggested, “we’ll change it later in the ICU if we need to.” But because the person who would change the endotracheal tube two hours later in the ICU was me, I elected to change it early and prophylactically in the controlled setting of the operating room with the surgeon standing by with a knife in his hand. I told each person exactly what to do and I had three backup plans. It was a scene from one of my nightmares, but I did the right thing. It went smoothly.

The oral boards questions are always imperfect scenarios, where any answer would be at least partially wrong. The reason for failure is often stage fright, but the purpose of the exam is to have a window into how you behave in the operating room. It is the last step toward board certification. The examiners are making sure that you would act reasonably when the answer is not immediately evident. They will pass you if they believe that you will be a good, safe anesthesiologist.

So although I know a few of them and I know that they are fully human, I imagine these oral board examiners as an imposing and heavy-cloaked crew. I see them as my five-year-old would want them to be. It is a dark and stormy night and the Keepers of the Golden Chalice are gathered around the cauldron. They have sipped from its clouded opalescent waters and they have decided who will be invited to dance at midnight under the next full moon, wearing nothing but the white flowers of the night-blooming jasmine in their hair. They have engraved their list on a heavy scroll, and my name is on it.

Felicity Billings is an anesthesiologist who blogs at One Case at a Time.

View 2 Comments >

Most Popular

Get KevinMD's 5 most popular stories.