How to Pass the Boards 20 Years Later

I graduated residency training in 2000 and did well on my written exam the same year. Then I took my orals, which then were administered by the board at a scheduled time and location. All 3 times, I passed my first exam, got worked up, and failed my second. I paid thousands of dollars in oral exam review courses and private tutoring. After 3 failed attempts, I had to start all over with the written exam. By then, I was also under a lot of stress raising a child with severe autism and did not have time to study. I knew I had to put her needs first. I kept thinking, one day I will try again.

In 2020, after I could no longer safely care for my daughter at home, I put her in a residential school. I now had an opportunity to try the board exam again, although my confidence was low. I recalled the program director telling us to pass the boards soon after graduation or we would be unlikely to pass because we would be away from much of the material.

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The most stressful barrier was finding where to do the clinical service evaluations (CSEs)—the oral exams were now done before the written exam. I emailed the American Board of Psychiatry and Neurology for a list of where to get these administered, as residency program directors now conduct them rather than the board itself. The board gave me no list and only said to contact the director from my past residency training. The program director from my residency training refused, and the director from my fellowship program initially said she would do them and told me to do online hospital HIPPA training first. I completed it, and then she never responded to my 2 phone calls afterwards. I had colleagues contact other program directors who also never responded.

I started feeling my dreams of board certification were hopeless, but then I remembered what I learned from my daughter and my brothers: Even when something seems hopeless, if you persist enough, you will overcome the barrier. There are times I thought my brother and/or my daughter would lose their treatment. For example, sometimes I thought I would never find a speech or occupational therapist for my daughter midyear who can also manage her behaviors when someone suddenly quit. But somehow, after hours of phone calls and emails, I always found a suitable replacement. There were times I thought we would lose our court cases with my daughter and brother to keep their services, but we always prevailed, even with the US Food and Drug Administration.

I called a board review course and spoke to a salesperson. She said they had a list from 2016 that the board previously provided, and she would have to look for it. A few hours later, she emailed it to me. The majority of places did not respond, but 3 did. I also found out the CSEs could be done remotely. Only 1 program agreed to spread them out, which I felt I sorely needed. Between the first and second one, I took a walk on a nature trail with my dogs and had a leisurely lunch to calm down. I did the third one 2 weeks later. I passed all 3.

Now it was time to study for the written exam. I continued part-time at work because I knew I had been away from much of the material for so long and needed the time to review. Soon after I started studying neurocognitive disorders from a board review course, I got so frustrated looking at MRIs and PET scans (which were not clinically available during my training) that I became convinced there was no way I could ever pass this exam. I went for a nature walk with my dogs again and kept repeating to myself, “If you can write a book, you can pass a board exam.”

I studied CT, MRI, and PET images and watched YouTube videos to help me understand neuroimaging until I was confident. I did a neuroanatomy coloring book, which was relaxing at night. I found a study partner, and we remotely quizzed each other on a weekly topic, which motivated me to learn the information well before our sessions. A supervisor from my training did some volunteer tutoring sessions with me. I realized that I did not retain information like I did 20 years ago and needed a lot more repetition. I also saw research that handwritten notes are better for memory than typed ones. I kept hand-printing notes and reviewing them. I took a 4-week leave of absence to study right before the exam. In the end, I passed with a good margin.

However, it is concerning that there is not a single research study posted on the board website that a board-certified doctor has better outcomes than a doctor who is not board certified. The website has a link to the “Certification Matters” website administered by the American Board of Medical Specialties, which only has general reasons for why certification matters, such as certified doctors are “skilled and knowledgeable.”

In medicine, we are expected to practice according to evidence-based, peer-reviewed studies. The standard needs to be the same to demonstrate efficacy for board certification. It is disturbing that, despite all the fees the board collects, they have never funded or conducted this research. Perhaps they are afraid that such a study might not show any improvement in patient outcomes for physicians who are certified, and then they would lose any justification for their existence.

In the end, taking the boards was a struggle just like raising my daughter, but much could have been avoided if I had assistance from my colleagues. When my daughter was first diagnosed, another mother spoke to me a about how to get my daughter effective treatment. My husband and I wanted to buy her a gift and asked for her address. She refused and said, “We’re all in this together. We need to help each other.”

I hope one day we psychiatrists can all have the same attitude when a colleague makes a reasonable request, like administering oral exams in my case. We are all in this together, and we need to help each other.