Tips on passing the written radiology boards Part I

Written boards are a huge cause of stress to residents. They loom over you from the day you start your residency, somehow making you feel guilty for not studying every spare minute. The amount of material seems overwhelming, where should you start? What should you spend the most time on? I asked three of the successful candidates who passed writtens in May to comment their study plans. Mathieu Spriet from Penn, Sandy MacLeod from Davis, and a resident who preferred to stay anonymous (we’ll call her Lisa), shared their thoughts.

AZ: How many months ahead of the exam did you start preparing?

Mathieu:

3 years! Well that’s not really true but it is a little bit… The past 3 years have contributed in passing boards for sure. I truly started working specifically for the exam in October. (ie when I decided to stop the few research things I was working on and decided to spend at least a little bit of time studying everyday; it did not really happen every day but almost…)

Sandy:

About a year before the exam, I started reading some of the textbooks (Christensen, Hall) and old articles. The majority of my prep was in the 6 weeks before the exam.

Lisa:

I guess I should say up front that this was my 2nd try at the exam–the first time I passed 3/6 sections. As it was my second time around and I had a better idea of what types of questions to expect, I was able to make better use of my time and spread my studying out over the 10 months prior to the exam. I would come across a clinical case that related to an objective and make sure I followed up on the case and tried to find any recent literature pertaining to the clinical case (pathophysiology, imaging studies, etc.). We only get one month of clinics prior to the exam for “cram studying”.

AZ:What did you start with and how much time did you study per week?

Mathieu:

The plan was to review all the vet rad literature from 2000 to 2006 by systematically reading the journal (from top page to bottom page). I started with 2000, was planning on doing that on 3 months (oct-nov-dec), it did not work… I was not able to cover 2005 and 2006 during that period but luckily I had read most of these years already before when they were coming out. Studying time: most likely 1-2 hours a day, a bit more on weekend, so most likely 15 hours per week. January, February and March, I started to review anat and pathophysio following the objectives (but I did not get much done for different reasons…) Then the 6 weeks off before the exam (~ 10 hours studying /day)… I kept the last week for final review and I divided the first 5 weeks according to the objectives in the following way:

• Radiobiology 3 days
• Anatomy 5 days
• Physiology 7 days
• Special procedures 3 days
• Alternate imaging 12 days! (US 4d, NM 3d, CT 2d, MR 3d)
• Physics 3 days

Sandy:

About 1 year before the exam, no more than a few hours a week. About 3 months before, I stepped it up to about 5-10 hours a week. About 6 weeks before, 10 hours a week. 4 weeks before (with the advantage of 4 weeks off clinics) I was at about 40-50 hours a week. At this time I treated it like a job: I would wake up, study all day until about 3 or 4, go for a jog, and review the day for an hour or 2 after dinner.

Lisa:

I started by reviewing the objectives posted online and then attempting to find recent or review articles that answered/related to the objectives. My goal was to study an hour each night and then 3-4 hours each weekend day–this didn’t always work. It sounds childish, but I found it helpful to set a kitchen timer and stick to it–both for studying and taking a break ( say a 20 minute break for each hour of studying). The amount of information is overwhelming and it is easy to fall into a trap of frustration and then avoidance if you can’t see some sort of “end-point”–even if it is just to break away from the books and grab a coffee.

AZ:What was your approach to reviewing the literature? (which journals, which years, any software, etc).

Mathieu:

Vet Rad 2000-2006 with going back to some older vet rad papers or other journal if cited in the papers I was reading.

Sandy:

Throughout the residency, I collected copies of non-vet rad literature from 2000-present. This mostly included JAVMA, Equine Vet Journal, JVIM, with a few references (maybe 5-10 total each) from JAAHA, Vet Surg, Vet Path, AJVR, JSAP.

I created a free account on PubMed and developed a saved search for the words “Ultrasound, Scintigraphy, Radiography, CT, MR” in the titles of articles from these journals (post 2000), printed out this list (about 300 since 1999), and pulled the ones (maybe less than half) that looked good. The point is, if the title of the paper didn’t have an imaging modality word in it, it probably wasn’t as important.

I spent about 75% of my literature reading time on Vet Rad, though. Early on (a year before), I read the old Vet rads (from 1980 to 2000). I didn’t spend much time on an individual article unless it looked “testable,” for example, some of the early contrast study papers are applicable to special procedures, and some papers on radiography of ceratin diseases seemed important. However, early US and CT papers have limited value in todays clinic diue to changes in technology. If an article seems obsolete or irrelevant to your clinical experience, it probably is, and won’t be tested. Unless it’s a “classic” such as a special procedures paper, or a specific disease.

To review the post-2000 papers, I read them and underlined the points, then took notes of 2-3 major take-home points from the article. Real basic stuff. This process of distilling the articles down will start slow, but you’ll get really efficient at it after a few days. And this means you will remember at least 1 significant conclusion about each paper.

There are basically 6 categories which ended up as 6 piles of papers on my floor:

• Alternate Imaging: US, CT, MR, NucMed
• Radiography
• Special Procedures

Lisa:

I had tried using EndNote and organize articles by keywords, but it became more of a chore than a helpful study aid. My goal for the exam this year was to try to find a recent article that related to each individual or group of written objectives. I especially looked for review articles. I would then download the pdf file and use Adobe acrobat to capture the important images, tables or charts and then paste them to a separate document (I used Mac Word)–these pages were a great way to review as I also made additional notes on these pages throughout my studying.

The main journals I focused on were the last 5 -10 years of Vet Rad–plus “classic” technique articles.

• JSAP and InPractice: Great source for review articles (special procedures)
• JAVMA / JAAHA: What’s your Diagnosis and review articles, occasional imaging based article
• Journal of Veterinary Emergency and Critical Care: Some good physiology articles

Lisa sent a few sample pages of her study notes as an example. Download the PDF if you’d like to take a look (1.3 MB).

Sample study notes

I’ll post part II of the interviews later this week. Residents, this is your chance to share your experience. What was your approach? Leave a comment!