AAOS Now

Published 1/8/2021
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Kaitlyn D’Onofrio

Course Instructors Share Best Practices to Approach the ABOS Exam in the Age of COVID-19

Best practices for preparing for the exam during COVID-19 and beyond

Editor’s note: The AAOS Orthopaedic Board Preparation and Review Course will take place virtually from April 20 – 24. Pre-course content release begins Feb. 1, and all course content will be available through July 31. To learn and more register, visit the course webpage.

The American Board of Orthopaedic Surgery (ABOS) Part I Examination can be a challenging and stressful time for orthopaedic surgery residents. AAOS Now spoke with the codirectors of the AAOS Orthopaedic Board Preparation and Review Course: A. Jay Khanna, MD, FAAOS, of Johns Hopkins Medicine, and Francis (Frank) H. Shen, MD, FAAOS, of the University of Virginia. They provided tips on how to best prepare for the exam, as well as described changes made to the course in past year in response to the COVID-19 pandemic, which forced the course to transition to a completely virtual experience.

A. Jay Khanna, MD, FAAOS, of Johns Hopkins Medicine
Francis (Frank) H. Shen, MD, FAAOS, of the University of Virginia

AAOS Now: Can you share how the course is structured this year? What do the new format and learning experience look like?

Dr. Khanna: In previous years, the live course took place in Chicago each April. We offered 50 hours of instruction over five days. The program has been very well received, and we think it’s been the ideal preparation for the ABOS Part I Exam and for the Orthopaedic In-training Examination (OITE) ®. For the 2020 course, with the pandemic, we had to make a quick shift to a virtual course. The pandemic began in early March 2020, and we were set to deliver the course in person in April 2020.

Thanks to our volunteer faculty members and AAOS staff, we were able to make the rapid shift to a virtual course. We were concerned as to how it would be received, but we’re very happy, thankful, and grateful that the course participants loved it.

We had all of our faculty members record their lectures—about 50 hours’ worth of content—ahead of time in a digital format, along with PowerPoint slides and audio. That pre-recorded material was posted to an online course portal in advance of the course for attendees to access before and after the live-streamed course. Those lectures cover all of the testable topics with current content.

To increase engagement with the course participants, we also wanted to offer live-streamed sessions. Having been residents ourselves, having trained many residents over the years, and in speaking with many prior course participants, we know that attendees really like that dedicated time to focus on preparation and review. Although some like to spread out the work, others like to cram, and this flexible new format catered to both learning styles.

For 2021, the course will follow a similar format, incorporating learnings from the inaugural virtual course. Pre-recorded lectures will be released periodically beginning in February. Then, from April 20 to April 24, we will live-stream high-yield review lectures covering the key take-home points for each specialty area, review mock exam questions, and allow for interactive question-and-answer sessions with faculty.

With multiple faculty in each specialty area, while one faculty member gives his or her presentation, the others will be answering live questions on the online chat. Then, post-course, from the end of the program in April until the exam in July, all of the didactic material, including the recordings of the live high-yield review sessions, will be available to registrants. We hope to reduce Zoom fatigue while offering an interactive, convenient, and effective review experience.

How has the course adapted over time to meet the learning preferences of residents? How is the new format beneficial for residents?

Dr. Khanna: We’ve always thought that the course was optimized and as perfect as we could get it, but the pandemic and the need to go virtual and stay distanced really turned out to be a boon for us. It allowed us to reconsider what we thought was a great course and make it even better. With the shift to virtual, although we were concerned that it may decrease engagement, it actually ended up being successful in terms of accessibility to busy residents [in terms of] convenience and adaptability of the course to different learning styles.

After the 2020 virtual course, we polled attendees to gauge course satisfaction, which showed that the course participants really loved the ability to reference documents from the pre-recorded lectures before the high-yield reviews. Consuming the material in different forms and amounts of content density was really appreciated.

All residents and course participants don’t have the same areas of strengths and weaknesses, so when we provided a live course, the intensity of material was relatively similar and spread out among subspecialties. For the recorded course, participants can dig deeper into and re-review areas of greater weakness, which is a key factor in doing well on the exam.

How is an in-person review different from an online course—particularly, how is in-person support different from online support?

Dr. Khanna: We were very concerned that being in a virtual format would lead to disengagement and attendees zoning out during the lectures, and thus the course wouldn’t be as well received. Thanks to the AAOS education specialists and a lot of the teaching experience from many of our faculty members, we found a way to strike the perfect balance among convenience, accessibility, and suitability for learning styles and engagement. That really comes from that dedicated week, which is similar and complementary to our previous live format, where we have live-streamed lectures where participants can form a one-on-one and personal bond with the lecturers. Now, when they listen to the material later after the course, they can get a feel for who they’re interacting with on the course site and through the videos.

We feel that education is not always a one-way street. It should be interactive, and it’s nice for residents with different learning styles to be able to ask questions, for their peers to be able to learn from some of those questions via the chat boxes, and also the ability to reason through exam questions. Residents really love that, and we’ve maintained that course benefit.

Some board courses are held in the summer, just before the board exam. Is there an advantage to holding the course in April, as the Academy does?

Dr. Shen: There is a fine line in identifying the right time to hold a board review course before the exam. If the course is too early in the year, there is always the risk that material presented and reviewed may be too quickly forgotten or that the resident focus may not be entirely on the exam. Conversely, if the course is too close to the examination, this runs the risk that there will be too much material to cover in too short of a time, which has the added negative effect of overwhelming the participant to the point that they may give up or simply shut down for the exam.

The Academy has been holding the annual Board Review Course in April for years, and through continual feedback with attendees and faculty and participants, we have been able to determine that an April date allows enough time for residents to reinforce old content, while providing enough time to solidify new content.

Dr. Khanna: Many participants take the course their chief resident year, which is right when they graduate. To have so many transitions going on, including moving, getting a new job, graduation responsibilities, and graduation parties, we wanted to keep distance from the May and June timeframe.

Is there any value in attending the Board Review Course prior to a resident’s chief year?

Dr. Shen: Absolutely! Learning orthopaedics is a continual process, and the best learning is through repetition and correlation between what you learn from books, video, speakers, and classrooms with what you learn during clinical practice and residency. Although there will likely be a lot of “new” material that is presented to junior residents, it will provide a clear indication for them to gain a better understanding of what their strengths and weakness are and what some of the important concepts are that they should be continually reinforcing during their residency. Furthermore, this makes the return to the course as a chief more of a reinforcement of old concepts.

Do you have any recommendations for the last couple of weeks prior to taking the exam?

Dr. Shen: The last couple of weeks are typically not the time to learn completely new concepts. Use that time to get into a routine. Try to do a set number of questions every day to train yourself to sit (again) for an extended period of time and to see a large number of Boards-type questions. Remember that there are only so many ways that core concepts can be asked [in] Board Examination questions, and the more you see [them], the more comfortable you will be on examination day. Also, try to set a more regular sleep-wake cycle. This can be hard during residency but can certainly help in the week leading up to the examination. Don’t forget to eat well, exercise regularly, and spend time with family. Lastly, don’t wait until the last day to confirm where you will be taking the exam, that you have all of the necessary paperwork and identifications, etc. Getting the logistics finalized as early as possible will let you focus on studying and patient care.

What tips do you have for preparing for the Board Examination during the COVID-19 pandemic?

Dr. Shen: Although in-person didactic teaching, society meetings, and courses have had a dramatic drop-off, this by no means has been associated with a lack of resources and teaching material. On the contrary, the wide variety of virtual educational meetings and online content in the past 10 months has exploded due to the COVID-19 pandemic. Explore some of these “newer” course offerings and take advantage of the fact that you can join a course, meeting, or didactic lecture right away on your smartphone without having to travel.

In addition, do not forget the basics. Regardless of what happens with the pandemic over the next year, continue to protect yourself and your patients, and set aside dedicated time to study. Although there are still several months before the Board Review Course and Board Examination, focus on high-yield topics that may be areas of weakness for you. Try to take advantage of this time to solidify some new concepts and review questions to reinforce what you learned.

Dr. Khanna: I think everyone is worried about passing the exam, which can add to the stress of preparing, so it becomes really important for the resident to remain relaxed, focused, and keep up with their daily routine during those last few weeks. If we add in the pandemic and the associated social isolation, change from one’s routine, inability to exercise as frequently, work responsibilities, family responsibilities, etc., I think it is a recipe for increased stress and anxiety in the weeks coming up to the examination. One should be aware that they aren’t alone in that boat, and everybody is facing the same issues.

I think maintaining one’s routine, especially in these trying times, is very important with the stress and the exam upon us. During the crunch time, I think it’s very important to try to figure out what one’s weak areas are. We find that the typical weak areas for most orthopaedic surgery residents are pediatric orthopaedic surgery, basic science, spine, pathology, hand, and foot and ankle. The typical strong areas for most residents are their areas of fellowship interest, as well as trauma, sports, and joint arthroplasty, because I think those are commonly seen during residency.

Other specific tips are to do things to minimize stress and anxiety, such as keeping up with exercise, sleep, and one’s routine. For people who tend to become anxious in an exam setting, I think it’s important to simulate the exam setting. We know the exam is about eight hours. We know we have approximately 320 questions, which averages out to about 1.2 minutes per question. Instead of studying, taking test questions, and practicing one hour at a time, take a Saturday and simulate the exam—have a morning session, afternoon session, lunch break, etc. Simulate the entire exam to help decrease anxiety, stress, and other factors on the day of the exam.

Kaitlyn D’Onofrio is the associate editor for AAOS Now. She can be reached at kdonofrio@aaos.org.