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TRIPLE BOARDING- TIPS FOR PASSING THE BOARDS

GENERAL INFORMATION

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 after July 1, 2007

PEDIATRICS BOARDS
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!

PSYCHIATRY BOARDS

www.abpn.com

Scheduling:

Triple boarders are eligible after completion of residency. The Part 1 examination was eliminated in 2013. The final Part II examination was administered in September 2015. In lieu of Part II of the Exam residents are now required to complete Clinical Skills Evaluations (CSE) . TB residents must pass 2 General Psychiatry CSE’s prior to taking their Board Examination. In lieu of the Part II examination the General Psychiatry Board Exam now includes 8 sections of which 4 include clinical vignettes (2-4 depending on the section) followed by questions.

For Computer-delivered examinations administered in 2015 and 2016 the Board will test classifications and diagnostic criteria that have NOT changed between DSV-IV and DSM V. In 2017 the Board Exam in use DSM V Classifications and Diagnostic Criteria.

Recertification: Recertification is every 10 years.

Resources

• 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!)

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

CHILD AND ADOLESCENT PSYCHIATRY BOARDS

www.abpn.com

Schedule

Triple boarders are eligible after passing General Psychiatry Boards. For residents who begin CAP training on or after July 1, 2010 the CAP Part II exam has been eliminated (the final Part II exam will be given in November 2016) . In lieu of CAP Part II of the Exam residents are now required to complete Clinical Skills Evaluations (CSE) . TB residents must pass 3 Child and Adolescent CSE’s prior to taking their Board Examination (must include at least one child and one adolescent with the 3rd CSE in either category). In lieu of Part II the Child Psychiatry Board Exam will contain one section that contains 7-8 vignettes.

For Computer-delivered examinations administered in 2015 and 2016 the Board will test classifications and diagnostic criteria that have NOT changed between DSV-IV and DSV V. In 2017 the Board Exam in use DSM V Classifications and Diagnostic Criteria.

Resources

• 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)

Good Luck!