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IC 301-2022: Tips and Tricks for Surviving and Thr ...
Tips and Tricks for Surviving and Thriving During ...
Tips and Tricks for Surviving and Thriving During Your First Two Years of Practice (4/4)
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We're going to talk about ABOS prep and just kind of some brief kind of pearls. It's obviously a big stress in your first couple of years. And so we'd love to kind of just, you know, discuss this topic. And, you know, I think the best piece of advice I got was just start out your practice as if you were in boards collections. And so, you know, board collections happens typically like around March or April of kind of your first year in. And then, you know, the problem is if you start either promising surgery or indicating people, you know, that may, oh, maybe it's a borderline, you know, meniscectomy, you shouldn't do that in general. But especially if you kind of get tempted, well, I got to do some cases, then they cancel their surgery in February, then they book it in April. Now all of a sudden you got this like degenerative knee scope during boards that you may have to defend. And so you kind of want to be mindful of boards collections from the very get-go as to how you should kind of practice in general. But especially like pretend like you're in boards collections from day one. And then when you are in boards collections, it's a little less, you know, surprising or, you know, you may avoid having some of those problem patients that, you know, that you don't want to have to stand up there and defend. So real quickly, so Dave, Joe, Kelly, how do you fail ABOS? Like I think that's everyone's fear. Like how do you fail it? And then the converse would be what do you do not to fail? Yeah. So real quick, just to his point, my year is the perfect example of act like you are always in board collection because of COVID, we had to retroactively log cases for a three-month period. So, you know, the ABOS has the ability to say you have to go retroactively log. I don't know that that's going to happen again, but, you know, we are a great example of always practice the way you should be. The way you fail ABOS, you know, I don't have direct experience from this, but from what I hear, key things, documentation is huge, indications, and then responding to complications in an appropriate way, not burying your head in the sand and saying, I think this is going to be okay. And giving yourself false optimism, having the courage to stand and face a complication head on and do the right thing. Ultimately, if you do the right thing and you document well, you will pass boards, generally speaking. I know that may oversimplify, but again, to the fact that we had to retroactively log, the areas that from that three months I had to go back and log, I was most concerned about was my documentation of the things you don't think about. My indications, I was fine on, responded to complications fine, but where I felt a little stress about how I was looking for boards was, you know, I see a lot of hospital consults. We take call at a big trauma hospital. The residents do a lot of the documentation. You have to submit your HPI for patients, any board collection case. So, you know, I had times where my addendum was not as good as it should be on the resident note. You know, so making sure you cover everything you need to do to document, you're looking at the right things while in that patient, consents, have your consents be very thorough. You know, we're going to use patellar tendon autograft. We're going to use allograft or possible, whatever may be possible. Have it stated well, obviously have them signed and just know that you will eventually have to retrieve all this documentation and upload it. So if you're in a situation where I am, where I'm in four different hospitals at times plus our surgery center, you know, having that knowledge on the front end, but to summarize big things, documentation, good indications, not burying your head in the sand with the complication. Yeah. And I was a little, you know, I'm not at an academic center and I, you know, my colleagues are far removed from the board's process and it was kind of lost in the shuffle that you have to upload all your consent forms. And I'm very picky about my consent forms. I do them all myself, but at some places you may have a fellow or a resident filling them out. Copying the booking sheet. So you want to be very proactive and then you want to keep track of all the copies. So it's very easy to upload it. If it gets picked, you don't want to have to go to medical records and ask for the chart and ask for the consent forms and, and add that headache. So the other thing that I found very helpful was you can get a history, like a private information release form that the ABOS has on their website. And basically if the patient signs it, it allows you to submit your documentation without having to block out their name. And so I know now with PDF, it can be a little, you know, pretty easy to redact everything, but it's, it's just one less hassle to have to block out their name on all the x-rays that you copy, all the MRI snips, all the clinic notes. So as part of my surgical consent process, I had every patient or their parent, if they were a minor, if they felt so comfortable, release the, their HPI, like their PHI, the private health information. So then when I uploaded all my documentation, I didn't have to redact it. So that saved me a lot of time on the backend. I think some people are a little afraid of asking patients about that. I just say, look, our board, you know, certifies us to make sure we're meeting industry standards. This just gives me permission to submit the op report and notes. If your, if your case is picked, they won't ask anything more of you. And I didn't have any issues, at least in my community with them being, oh yeah, that's great. I'm so glad, like, you know, that's great that they keep track of y'all. And you know, you just phrase it as a good quality assessment thing. And I think most patients are very reassured by that and it saves you time on the backend. So what about you, Joe? Any tips, tricks, how to fail, how not to fail? So with a grain of salt, I take this test on Tuesday. I take mine Thursday. So I'm hoping Dave and Kelly really help me out here. But I did go to the Miller's course. I've done several mock boards with my mentors. And to add to what they've said, arrogance can kill you too. So people who have great documentation and great everything can potentially get sunk by being arrogant and not humble. And also don't be defensive. So if you did something that wasn't perfectly appropriate, take your licks when they happen. Tell them what you learned from the experience and move on. No one single case will kill you. No one single thing that you did during any single case will kill you. Stay within your comfort zone. Do what worked for you during fellowship. Now is not the time to do bridge-enhanced ACL repairs in 16-year-olds. Now is not the time to do, you know, quad with internal brace if you did BTBs in fellowship. Discuss the cases with your mentors if they're controversial or even if they're not. And document it. If you had, you know, 16% clonoid bone loss with the Hill Sachs lesion and you weren't sure what to do, you reached out to your fellowship mentor, you decided on a Latter-Jay, document that in your note. That way they'll see that you thought about that critically. To Dave's point, fill out your own consents even if your typical flow is to have your staff help you with the consents during the board's collection period. Do it yourself. Write it out by hand and make sure everything is on there. Be careful with using templates for your op notes. If you do use templates, be sure that you read through every op note before you hit submit. It's not fun to have to addend stuff. It just doesn't look great. Follow your patients and keep tabs on them. So if you lose a patient to follow-up, that's on you. If you contacted them at six weeks and 12 weeks and 18 weeks and 24 weeks and you couldn't contact them, document that in the note. That way if that case gets selected, they can see at each time point your clinic or yourself tried to contact the patient and it's not necessarily your fault. Dave mentioned scope photos too. So they are going to expect you to submit all arthroscopic pictures. If you have the ability to do like an electronic version, like Arthrex has their surgeon vault for example, that can allow you to select individual pictures, which is a little bit cleaner than entire pages. Because when you get into practice, you'll notice that some of your scope pictures don't look great. So if you can cherry pick the good ones and send the representative ones in for your cases, it makes the presentations much better. So my two cents from somebody who will probably fail on Tuesday. All right, Kels, how about you? No, you won't. You'll do great. I would say, I mean, what Dave and Joe just talked about are perfect things to kind of follow step by step and do. One additional thing that helped me and Dave, that COVID year was crazy. I always tried to practice like normal, not to be under like, okay, boards is coming up. I have to change all these things, but to do what you would normally do for your patients. And then at the end of the day, one thing that took a lot of stress off of me was just take care of your patient. Like literally just do the best thing and do the right thing for your patient. And that shouldn't change whether you're in collection or not. Now, I will say there are some cases that, and I remember being a resident and attendings making fun of certain new attendings, like, oh, they're on board, so they don't want to do this case. Right? Yeah, I get that. You can do it, but I'm telling you, the stress level is a lot less if you don't. You know, like, or if you do it with a colleague or one of your partners, because the other thing is if you have a combined case, like that's technically not your case. Even if you're co-surgeons, they'll say you cannot use that case. Right? So to do it with a colleague, but still take care of your patients, it's just less stress. Because if you're going through major complications, and then all the cases that they pick, majority of them have a complication of some sort, you know? And it's always that one where you're like, God, I hope they don't pick this one. For me, I just got to the point where I was like, I know they're going to pick these. So I literally have the cases that I thought that they would pick initially, because, you know, they're going to go after the complications. They're not going to go after the ones that, you know, you're hitting out of the park. They'll go after the really complex, complicated cases, especially if you're doing them in your first couple of years. And the other thing is sometimes you can't pick and choose your cases. Sometimes you can't say, I just want to do, you know, the basic ACL or whatnot. Your patients come to you, and if they need something, then you got to take care of them. But to do the right thing for your patients, documentation is key. Dr. Beth Schubenstein had told me, I sat down with her, and one thing that she did, and I essentially just redid it, except using jump drives, is I always had articles to back up what I was doing. Even if it was basic, like ACL, like we discussed these different graft choices. I went over this. They're more likely to fail with allograft, or after the age of 35, there's no difference in allograft. I put that in my note, because Dr. Schubenstein had said that. She said, every case you do, have two articles that go along with it. When you're in practice, now we know a lot of the studies, and we can quote them, right? But starting off, that actually helps you in terms of your ability to do so as in attending, and for you to know the literature. So it kind of helps you, and at the same time, you're doing that during your prep, too. So I also had literature in there. And then I documented the hell out of consent forms, and things that could go wrong, and the discussions that you had with patients. I can't reiterate enough how important documentation was, because it really does come down to that, and how clear, and concise, and crisp, and accurate your documentation is, and it made it very easy. Because during our COVID year, fortunately, I didn't have to go and sit for boards, and that was a blessing. They looked over everything. They had everything that they needed. They had no additional questions. I don't know if they're still doing that, where they may not even bring you in. So we can't. No, yeah. Yeah, we're going in. So I think those are all great points, and I think one common theme is load the boat. So if you have an open FISIS ACL, document that you talked with a PETE's colleague, and just that he agrees that it should be FISIL sparing, or it's okay to cross the FISIS. If you have a complication, load the boat. If you have an open FISIS ACL, document that you talked with a partner, or a hand colleague, or whatever the case may be. You also need to upload those consult notes. So I had a ulnar nerve neuropraxy after a Tommy John procedure. You have to hold on to the neurology note. You have to hold on to the EMG notes. You have to hold on to your hand surgeon's consult notes, because they want those uploaded. So you really have to load the boat early. I don't think any one complication is going to fail you, unless it's just an egregiously negligent complication. But even then, what really can sink you is just ignoring the complication. I think all those surgeons that are grading you understand that they happen. It's ignoring it. It's downplaying it. It's denying it. It's being delayed in your response to the patient. And so just making sure that you stay on top of it is more important. The actual complication won't put you in trouble. It's how you respond to it that could. So you just have to, like I had an attending say, you have to run to the fire whenever there's a complication. You don't want to see the patient back twice as often. Like Jordan said earlier, call that patient every day for a week or two. Document that you called them. That patient with the ulnar nerve neuropraxy, I think had like 30 notes to upload to his chart for boards. Show that you care. Show that you're constantly checking in. And that's important. So I think we're out of time. Any burning comments? Well, I was going to say one other thing. Yes, you don't necessarily always have the staff or the help to assist you in collecting all this data. But I will say, you know, when you first start off, make friends with a couple of people in the office and kind of, you know, help them help you to collect your cases and to gather the information that you need. Because when you're busy in practice and you're trying to collect all this information and upload it, it really does help to have help. And I gave like two of my coworkers essentially like, you know, bonuses and just like thank you gifts and just appreciated them so much because I would not have been able to do that alone. That's a great point. Great point. So take home points. Maintain good indications from day one of practice and your whole practice. Pretend like you're in board collections from the start. Be meticulous about documentation during the collection and as Dave said, even beforehand because you never know if they're going to have you retroactively. If you have like a health issue or something and you miss a month, they might say, hey, you can still sit, but we're going to retroactively go back a month or whatnot. So you want to, you know, be mindful of that. Stick with what's worked for you during training, as Joe mentioned. Now is not the time to try new techniques. Be ready to defend all your clinical decisions with supportive evidence from the literature and then practice, practice, practice. Engage your mentors. They'll help you run through it and, you know, keep in mind that it is a 98% pass rate. So the odds are certainly in your favor. So that's very helpful. So we're out of time here, but, you know, I hope this was very helpful to everyone. These are our email addresses. Gabby, do you want to say something? For example, if you change hospital systems, you have to start over your collection. You have to be in a certain location for two years straight. And if you start after October 31st or if you start after November 1, then you're delaying a year because that is the start date of your practice that you need to be credentialed. And you will also need to upload that for ABOS that your start date was the start date that you had, and it has to be like signed by your hospital president. So there's nuance to some of these things you're aware of, and I think it's like you have to have 65 cases during your collection period over a six-month period. I think it was 40. Was that? Oh, they dropped it. Minimum, I think, is 35. I think minimum was 35 or 40. Okay. I think they're still in COVID numbers. Yeah. Then, because I think before, it was 65. But no, that's great. No, so thank you. So these are our email addresses. Feel free to take a picture of this slide. Feel free to email anyone here if they said anything or you feel like you resonate with what they had to say or have further questions. Thank you again for your attendance. This was the first year that we did this ICL, so I'm very open to feedback, both positively and especially negatively, on how we can make this better and kind of serve everyone in a better way. So if there were topics that we didn't hit on that maybe we should incorporate, definitely feel free. We're going to be hanging around for a while, so feel free to come up and ask us any questions, engage us in any conversations. And thank you again very much for your attendance, and hopefully we can see you and your other friends and colleagues next year in Washington, D.C. So thanks, everyone.
Video Summary
In this video, a group of surgeons discuss their tips and advice for preparing for and passing the American Board of Orthopedic Surgery (ABOS) exam. They highlight the importance of practicing as if you are in board collections from the beginning of your career, being mindful of documentation, indications, and how you respond to complications. They emphasize the need to load the boat by including thorough documentation and supporting evidence in your notes, as well as maintaining good relationships with office staff who can assist with case collection and data gathering. They also discuss the impact of COVID-19 on case logging and the need to be aware of any changes or requirements for retroactive logging. The speakers encourage ongoing learning from mentors, sticking with what has worked during training, and practicing self-care during the stressful exam preparation process. They conclude by offering their email addresses for further questions or feedback.
Asset Caption
Kellie Middleton, MD, MPH; Joseph Lamplot, MD; David Bernholt, MD
Keywords
surgeons
American Board of Orthopedic Surgery
exam preparation
documentation
case logging
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