Exam candidates have asked me how to develop a really nice differential diagnosis. Although there are no hard and fast rule, the key elements of a good differentials include the following:
1. A good differential diagnosis can be supported by clinical data or evidence obtained during the interview and MSE. This also means that you should not mention a diagnosis that can't be supported by any relevant information.
2. A good differential diagnosis should include only those disorders that specifically pertain to the patient being interviewed. Don't mention a disorder that pertains to another patient or an imaginary patient. In addition, don't create a long list of differrentials to guarantee that you won't miss anything.
3. A good differential diagnosis includes a major diagnosis and other clinical considerations or rule outs. Always be mindful that some patients can have two to four major diagnoses (for instance: MDD, alcohol dependence, and PTSD).
Is preparation relevant to pass the oral exam?
This question may sound ridiculous but I pose this query because I've met many exam candidates who don't schedule enough time to prepare for the exam.
"Too busy" is their common excuse. Majority of them procrastinate for too long, jeopardizing their opportunity to do actual practice interviews, to read relevant topics, and to hone organizing techniques.
They soon realize that the oral exam is about to happen and they are still unprepared despite sending the application a year ago.
So, is preparation relevant to pass the exam?
Absolutely! In fact, preparation is probably the great equalizer.
You may not have an Ivy league training (you know what I'm talking about: Harvard, Yale, Columbia, etc.) but if you have an Ivy league preparation (you burn the midnight oil and do your homework), I will not be surprised if you pass this challenging exam in a single attempt.
Oral exam candidates have told me how anxiety has been a stumbling block and how it has ruined their chance to pass the oral exam.
What really happens when you're anxious?
Well when you're anxious, you can't think straight. Your concentration is off so you can hardly focus on the task at hand. You sweat and have palpitations. You stammer. You feel that your muscles are tensed. In addition, you can hardly breath. Worse, you get tremulousness.
While all these physical changes are taking place, you begin to develop catastropic thoughts about the end result. Such cognitive distortions further feeds the physical manifestations of anxiety.
As you become more anxious, both the patient and the examiners in the room can inevitably sense your anxiety and level of distress. Whether you like it or not, this can create a scenario where the patient can actually feel worse during and after your interview.
Obviously, this is something that you don't want to happen. Examiners are watching.
They want to make sure that you as a candidate can actually help patients feel better or at least, prevent them from getting worse during the interview. They want to see if patients will be better off after the initial contact with you. They want to see if your presence can actually be "therapeutic" in a way.
To pass the oral exam, containing excessive anxiety is a necessity.
Obtaining a Diplomate status in Psychiatry is perhaps one of the most significant tests that a psychiatrist has to face in one's professional career. It is difficult yet it is surmountable. Given the right strategy and adequate preparation, you can certainly achieve your goal.
To be certified, one has to pass two grueling tests of competence. The written exam is probably easier and more objective. While the oral exam (Part II) is more challenging, more anxiety-provoking, and a bit subjective. This subjective component lies in the fact that the examiner has to judge your competence not just based on your accurate answers and ability to obtain information, but also based on your mastery of basic interpersonal skills.
Sure, passing the psychiatry oral exam is not a walk in the park. But there are two effective ways that all exam candidates can implement:
First, show that you're clinically competent. Know your basic psychiatry and learn as much as possible about the most common illnesses -- epidemiology, pathology, clinical manifestations, treatment, course, and prognosis. Show your knowledge by asking relevant questions during the interview that could help you and the examiner rule in or rule out certain psyciatric disorders. During the Q and A section, be enthusiastic in answering the examiners' questions.
As much as you'd like to show your knowledge, be ready to say "I don't know the answer but I'll look it up" when you don't know the asnwer. You may not know it but humility (knowing when to ask for help and to say I don't know) is a sign of competence.
Second, establish a "positive relationship" with the interviewee and the examiners during the interview. When I say "positive relationship," I only mean that you should: establish rapport or alliance, provide a listening ear, be generous with empathy, never argue(with both interviewee and examiners), be nice and pleasant, show that you care, give a tissue during tearful moments. In other words, you should make the interviewee and others in the room feel really good.
Show that you value them.
Perhaps you'll ask why you should be nice to the examiners? The answer is simple. They're are the ones who will decide your fate! Besides, they have to decide whether you can relate well with your professional peers and whether you deserve to be their "Diplomate" colleague.
If you can establish during exam that you're a safe, competent, and pleasant clinician, the chance of success is high.
For more board exam tips, you can read my article: Six Ways to Clear the Oral Exam Hurdle.
Starting May 2006, the one-hour audiovisual component of the examination will assume a new format. This component will now be divided into four vignettes -- consisting of written clinical cases and brief video clips.
This AV hour-long exam used to contain a 25-minute video of a clinical interview shown to exam candidates, followed by about 30 minutes of case discussion with the examiners. This old format requires intense concentration and excellent note-taking skills from the examinees. It's kind of "all or none", that is, either you get the clinical information or you don't. If you blink during this portion of the exam, you may miss some important clinical information.
In a way, this new format offers some advantages to candidates. If you don't do as well in the video clip, you still have more chances to make up with the more "visible" and easier to digest written vignettes.
What are these clinical vignettes?
Well, these are brief clinical cases that will serve as the focus of discussion between the examinee and the examiners. During this time, your knowledge, clinical competence, ability to generate differential diagnosis and treatment options will be tested. Examiners may ask about anything such as what additional clinical information should be obtained from the patient, most probable diagnosis, treatment of choice, hypothetical scenario, prognosis, etc.
Obviously, this new format will pose some new challenges. But if you know what to expect and you're well prepared, your chance to pass will still be good.
Visit Psychedu.com to learn more on how to prepare for this challenging exam.
