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Why are ABOG and AOBOG Exams So Stressful?

As physicians we face stress daily.

However being in an oral exam setting seems to resurrect two aspects of stress we may not face on a daily basis.  So exactly how so you define stress and how can we conquer the stress we will face going into the oral boards?

To most people ‘stress’ conveys to mind something unpleasant. But many psychologists write on stress as something that can have favorable effects. Why the confusion? The rationalities lie in how an individual appraises his or her own psychological and physiologic state.

A few examples could assist to clear the point. Suppose two people, one a  first year fellow in urogynecology, the other a general practitioner who graduated 4 years ago are about to take their oral ABOG /AOBOG  boards The fellow has been in academic training daily, researching practice bulletins and articles while the general practitioner in OB/GYN has hardly studied at all, he’s up most of the night in a 1:3 call.

By a purely physiological perspective when each of these candidate enter the exam room both are going to be undergoing similar effects – rapid heartbeat and breathing, higher metabolism, active sweat glands and so forth. Psychologically, there are also similarities – higher concentration on the present and thoughts about the next few minutes, vivid images and heightened sensitivity to feelings.

But there are significant differences, at least psychologically. The fellow is exhilarated, ready for the challenge, and raring to show his prowess and succeed in passing the oral exam. The general practitioner feels doubt and fear, I bet he’s handled a hundred more postpartum hemorrhage cases than the urogynecologic fellow.

In both cases it’s reasonable to say that the two young men are under stress. You could also say they are sensing stress. But the differences are important. The fellow evaluates his situation as confronting a challenge he wants to take on and believes himself ready to tackle. The generalist knows he is inadequately prepared he has not been in an academic environment with daily pimmping sessions and envisions the consequences of his potential failure, a lowered salary and maybe the need to retake the oral exam before he will be granted staff privileges which expire next year.

In both cases the young men are unsure about the final result, but each appraises the likelihood of success differently. Each may also gauge the final result of failure differently.

Let say both fail the exam.  The fellow may wind up disappointing his Chair.  But still believes he can pass on the next attempt he knows his future holds lucrative endorsements and a good future. In addition, the fellow will now try to gain more Obstetric experience and attend OB rounds and MFM rounds.  The generalist may envision his opportunities as diminishing. He may become depressed withdrawn and doubt his self-worth.  Without encircling a support structure the next attempt at the exam for the generalist will be the same.

Of course, the examples are very oversimplified. But the pattern is more or less right. Whether you experience stress or elation can often depend upon how you evaluate external circumstances and your own inner state.

So there are in reality two significances of the word ‘stress’ that sometimes get mixed together. One refers simply to the intensified awareness and the physiological symptoms described above. The other comprises essentially equivalent to the combination of worry and those symptoms. The latter can have damaging health consequences, since those symptoms can be physically harmful. But since humans are both mind and body and the two aspects affect one another, the psychological part is just as significant.

There are three aspects you must understand.  First, you need to practice speaking under stress and have a support structure that evaluates you, this is called a mock exam.  The fellow “pimmping” in fellowship prepares him for the psychological stress, he endures the part daily and has learned to answer questions under pressure.   Second, you need to be prepared, because the generalist has not had luxury of an academic environment he needs to create one by getting up-to-speed on his learning, a board review course is a good option.  Third, know your material–simply taking a boards review course does not guarantee success,  you need to approach this exam as you did your MCAT, COMLEX, or USMLE with months of practice questions/ mocks and a regimented study plan.  If you accomplish these 3 aspects you will go into the exam aware of what to expect and be successful on your next attempt.

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