Board Certification in a medical specialty is in essence the ‘stamp of approval’ of a doctor’s competence to practice medicine. As you probably know, in most states a doctor can practice medicine without completing a full residency, but such work is limited to urgent care centers or other clinics where there is no need to declare a specialty. But in order to call yourself a psychiatrist, you must satisfactorily complete an accredited residency in psychiatry. A psychiatrist who has completed residency is assumed to be competent to practice, but most physicians and some patients recognize that the person who graduated last in his residency is still called a psychaitrist. If you intend to be considered a true expert in the field of Psychiatry, Board Certification is required.

The Psychiatry Board examination process is quite thorough. After completing residency you are eligible for Part I of the exam, a day-long test that covers topics in psychiatry, psychology, neuroscience, and neurology. The test is difficult, and requires a great deal of study for most candidates. Your reward for successfully passing the Part I exam?  The ability to sit for Part II, the Oral Boards in Psychiatry.

The psychiatry oral boards consist of two parts. During the first part you will interview a real patient under the scrutiny of two examiners, and then present the case, come to a multi-axial diagnosis and treatment plan, and answer questions about the patient and related psychiatric issues. For the second part of the exam you will be given four patient vignettes that are either written or on video; you will reads or watch the vignettes in the company of an examiner, and then answer a series of questions about the patients portrayed in the vignettes. During both halves of the oral exam, to be successful you must make an impression on the examiners in several spheres: you must appear professional, you must be organized, you must know the material, and finally you must be able to think and formulate while at the same time being observed and feeling anxious.

Passing the oral portion of the psychiatry board exam is as much about performance as it is about knowledge. I do not mean this as a criticism of the exam, because being a good psychiatrist involves more than knowing facts. If Board Certification is to mean something, psychiatrists who obtain that distinction should be able to interact with other physicians using effective organizational and communicative skills, present themselves to the public in a professional manner, and have the ability to educate patients clearly and succinctly.

That said, I recognize the challenge faced by physicians who are taking the boards in their second language or struggling with performance anxiety. The exam day goes by very quickly; if a person has a problem early in the process there is little if any chance to recover and make it up on the rest of the exam. If you do in fact have problems with one part of the exam, I recommend that you do all in your power to forget about it and move on as the next part of the exam will be with a different examiner who will judge you anew.

How do you prepare for the performance factor? Like everything else- practice, practice, Practice! I suspect that one of the most effective techniques is rarely used– consider videotaping yourself presenting a case, and then watch the tape to identify all of the nervous little tics that take away from your performance. You can learn a great deal using this technique– and not just for the boards. I learned for example that I am a bit ‘hyperbody’ when I am nervous, and my hand and arm movements reduce my ability to put psychotherapy patients at ease. Behaviors identified in this manner CAN be changed… with PRACTICE.

Psychiatric Diagnostic Criteria Audio Board Preparation

I found something that made a tremendous difference duing my own preparation for the oral board exam. I realized that during both halves of the exam, I would be called on to talk about how different symptoms are assimilated into psychiatric diagnoses. I knew that I would become confused– for different diagnoses there are different lengths of time, different numbers of individual criteria, different exclusionary criteria, etc, and I knew that if I became too nervous, all of the criteria would start to jumble together. But if I really knew the criteria themselves– the building blocks of psychiatric diagnosis– I would be much less nervous and the other parts of the exam would fall into place. And so I prepared audio tapes where I recited the crieria for the diagnoses one by one, and then I played the tapes during my morning and evening commute using time that was otherwise wasted. I listened to the recordings over and over again.  And it worked– during the first half of the exam as I interviewed my patient her symptoms seemed to check themselves off against the criteria– criteria that were firmly entrenched in my mind.

The audio tapes were also very helpful with the performance part of the exam. The multiple sections of the exam gave me ample opportunity to demonstrate my knowledge, and being able to recall the criteria in an automatic fashion made me appear– and FEEL– professional and knowledgeable. Moreover having the criteria in mind and at the ready-knowing that I would be able to come up with the diagnostic criteria even when I was ‘on stage’-eliminated that internal voice that otherwise would have made my voice shake and my mouth go dry. I was able to portray a sense of confidence throughout the exam.

I am now Board Certified in Psychiatry, thanks to a large part to the recordings and the firm knowledge they provided of the buidling blocks of psychiatric diagnosis. Knowing the criteria so well helps me even now as I assign diagnoses to patients I see in my solo practice. I have since made similar but new recordings, using good audio equipment and compressing the dynamic range so that they are easier to hear over the background noise in a car. The recordings are available for a reasonable price on the right side of this blog page–  I paid over $800 for Osler review tapes, and I have no doubt that these recordings are more useful. I invite you to purchase a copy, either on Audio CD or by Direct Download of MP3 files, and study with me as you prepare for your own Part II Exam in Psychiatry.