Tuesday, August 01, 2006

Psychiatry Board Exam Recertification: Epilogue

So I took my decennial ABPM exam today. The exam process itself was quite smooth. Here's how it works...

You're supposed to start the exam at 9am, but it takes about 6 minutes to check each person in... don't worry, the clock doesn't start until you sit down in front of the computer. Before then, there is a highly secure process including digital signatures, digital photographs, and digital fingerprinting (redundant term), to ensure that you are you and that no ringers can slip in to cheat for you. They provide lockers to place your stuff in... cell phones, papers, change, keys, pens, pencils, even all your paper money. That's right, no #2 pencils. It's just you and your mouse.

There were 200 questions, and you get 5 hours to complete them (more than enough). Note that other folks in the room may be taking other tests (e.g., GMAT, LSAT, etc). You get a corral to sit in so that you are not distracted by movement elsewhere in the room. They even provide you with earplugs if you ask (you cannot bring your own).

Now the test. I cannot give you specific questions, but you can go to the American Board of Psychiatry & Neurology website to see the content areas on the exam. (Had I looked there, I would have realized that I didn't have to spend the time this morning looking up syringomelia.) Read this last linked PDF closely. Each area comprises 13% of the questions. I counted 28 questions on personality disorders. If you get confused between schizoid (emotionally cold, aloof) and schizotypal (eccentric) personality disorders, better get that straight now, Cowboy.

I was surprised to see only 3-4 questions that assessed one's knowledge of drug-drug interactions. This is a glaring deficiency, in my opinion, as drug interactions are highly prevalent, and not a week goes by that I do not consult on a couple patients who have been admitted medically due to problems which can be traced back to drug interactions and unsuspected pharmacodynamics and pharmacokinetics. Many of these are preventable, if one is mindful of the problem (e.g., the SSRI/triptan combo mentioned earlier; however, the significance of this particular combination is overrated... the biggies are lithium/thiazide, tricyclic/SSRI (Prozac or Paxil, mostly), and anticonvulsants).

I will mention my favorite question (I don't think I'm committing a breach here). This question was asking about therapeutic boundaries. It was something like this:

"You are providing psychodynamic psychotherapy to a woman who took an overdose two months ago after being rejected by her boyfriend. She offers you two tickets to a concert for which you have been unable to obtain tickets.
The appropriate response is: ________.

One of the options was: "to tell her that you have to check with your wife and you will get back to her this weekend."

I think I laughed out loud when I read this.