Question: Can you provide a brief overview of your Oral Board PREP program?
NFJ: The goal of the program is to rigorously focus upon test content and then to simulate the actual exam.
Oral Boards is a test of the Content Domain of the ABA applied to clinical cases. If you know Big Red, the best and most focused one source for Oral Board review, if you get some practice, and if learn and practice outlining you should do well on Oral Boards.
With respect to the course, I’ve given more released Oral Board examinations than anyone in the history of the ABA—with all humility. I’ve done this not as an actual examiner, but as a coach. I ‘ve developed uniquely focused materials--Big Red, Audio Red, Spiels, and Ranger Red. And the methods taught as to how to outline stem questions are highly specific, effective, and often decisive. The real time power-points at the course are now the gold standard and transformative when it comes to participants maximizing the value of the course.
The course is small, less than 20 people. The faculty who work with me are excellent. We most often give extra exams.
If you worked with me for the Written, you are already most of the way home. We just need to further tweak your information database along the lines of this exam, teach you effective and rapid outlining skills, convey oral exam strategies,, preview the scenarios most likely to be tested, and you’ll pass with confidence.
Question: Can you break down the components of the program?
NFJ: The program combines several essential ingredients for passing Oral Boards: home study materials to facilitate review and quick recall of essential information likely to be tested (from experience as well as study of the ABA Content Domain); materials to enable one to practice at home; and a live mock Oral Board review course where specific cases likely to be tested are administered in a practice testing format followed by a review of best possible answers. Again, the goal is to rigorously focus upon test content and then simulate the actual exam.
Question: In your opinion, what is the best strategy to attack Boards?
NFJ: I would try to come to an early course to see where you are and where you need to go and then to a later course for a final tune-up and polishing.
Question: Why? What is your rationale?
NFJ: I have a lot of high quality cases I’ve developed and more than twenty years experience teaching what it takes to pass this challenging exam. People don’t get a lot of training in Oral Board preparation during residency, so this is an opportunity to close the gap in this area and to level the playing field with the ABA. We see the progress, the progression, the results of someone obtaining insights as to how to do this coupled with practice and experience; it’s exciting to see how people progress so rapidly. It works. Given that oral examination skills are virtually ignored throughout our educational experience, it’s very good to get the critical insights, practice, and experience—even in the 11th hour. The course achieves these ends and stimulates success.
Question: Can you summarize why the program works and what makes it unique?
NFJ: Yes. The course has several major advantages over any other program:
- 1. Excellent cases with challenging scenarios. Intellectual content is high.
- 2. Size limitation permits more individual attention. The course will have less than 25 people, not 100 or 120, like the other major course; you won’t be lost in the shuffle.
- 3. The power point slides which reveal the answers to questions as real, live, simulated exams are being conducted, in real time, makes listening to cases much more effective as one can see and know in real time the correct answer to questions as they are presented, rather than listen to incorrect information (which sometimes is never corrected). This also adds greatly to your work with Big Red, to your ability to get our central source into your synapses, and to the overall integration of Big Red, Spiels, and Ranger Red with the CDs.
- 4. The faculty who work with me at the meeting are very experienced and outstanding in their own right. Besides being experienced, well-trained, and well-versed, they are knowledgeable, compassionate, and helpful.
- 5. You will hear MORE scenarios and MORE cases than at any other course. This is a mock Oral course, not a course which is heavy in theory, a talking heads course, or an instructor show-off (“let me show you how smart I am”) course.
- 6. You’ll get outstanding practice, not only with me, but with experienced, well-trained faculty who have been with me for years.
- 7. You will gain a grasp as to how best to handle difficult scenarios, and how best to present your views regarding them.
- 8. You’ll learn how to organize and outline cases—a critical skill.
- 9. You’ll appreciate much more that this is a talking test, and get a much deeper understanding as to what you really need to verbalize, and how best to do so.
- 10. Finally, you’ll have fun—appreciating that this is not torture, but a real opportunity to better yourself and to become a better anesthesiologist.
NFJ: It works because it strikes at the central reasons most people fail, namely that information from the ABA Content Domain (which at the time of one’s taking the Written examination was so fresh in one’s mind) is no longer fresh, no longer on the tip of the brain, nor on the tip of the tongue, and/or organization of this material is scattered and/or presented indecisively.
The course addresses this by quickly and effectively reviewing the core material with an emphasis now upon verbal presentation.
The other important goal of the course is to help people avoid critical errors arising from a failure to quickly frame, organize, and outline the case being tested. Outlining a stem question is a critical skill, and if one studies failing exams, so often the critical lapse has been an error in outlining the stem question. This is too bad because most major errors are really anticipatable through effective outlining; the course emphasizes outlining stem questions.
The course hammers away at all of these areas, good and motivated anesthesiologists ramp-up, and they usually find their actual examination is straightforward following the training received.
Question: Why study Big Red, as opposed to other sources?
NFJ: Big Red is definitive central source that can be memorized. It’s contained, summarized, and fits into one’s synapses nicely. This knowledge, this data-base of information, is precisely what is most likely to be tested. Being solid with the information database designated by the ABA, the ABA Content Domain applied to clinical cases, is the first step in effective oral presentation and this is the foundation for Big Red.
Again, the information in Big Red has been summarized and is highly tweaked for oral command and oral presentation.
The summarizations of tested information contained in Big Red creates a realistic expectation you can have as an examinee that the goal of highly organized, presentable knowledge and information is being attained. With this achieved, issues and difficulties with presentation are much easier to address.
Question: Why study Big Red over other sources?
NFJ: There isn’t another central source for this examination which has anywhere near as much work and tweaking over so long as Big Red. It’s an outstanding focused source. With regard to the many excellent textbooks we have available to us, they are helpful to look up and reference key words, but they are very difficult to memorize because of their sheer size and the many extraneous details which are very unlikely to be tested on Oral Boards. They also do not specifically point-out, as Big Red does, weird and unpredictable topics known to be tested.
With regard to other sources, I want to make clear my own respect for anyone teaching highly motivated people trying to pass this potentially difficult exam. This said, I have not personally used other sources, but having inspected many of them, they are often lacking in my opinion in careful, precise summarizations of difficult key word topics—a strength of Big Red. Often, they are too wordy, too detailed, not focused, and contain much extraneous content irrelevant to the ABA Content Domain which governs the exam.
Question: What the highest priority of the program?
NFJ: We seek to provide the best, most individualized training for physicians who want to improve their verbal organization and presentation, pass a challenging test, and become better anesthesiologists in the process. The course is size limited to achieve this end, as to be your very best as a presenter of information individualized coaching is very helpful. I provide that, one on one, and as do my fine faculty, one on one. Sitting in a lecture hall with a large group of people does not optimally develop presentation skills nor confidence in those skills. These skills and this confidence are crucial when being examined by the best ABA Oral Board examiners.
Question: What about people who might say and feel, “I worked with Big Blue and it helped me pass the Written and I just wanted a different approach. . .”
NFJ: I might say, “I don’t think getting off from a winning horse, a winning team, is ever a good idea, but I understand and respect what people feel and may want to do. . .”
Question: What about people who are on the fence, or who are wondering whether to work with Big Red, given some overlap with Big Blue?
NFJ: Some overlap is good and there are big differences between Big Red and Big Blue, many entirely new and different chapters and much different content within chapters. These are detailed on the site. Those whom I worked with for the Written are in an extremely powerful position for Orals, as you have 60-70% of the work of memorization done.
Big Red is substantially different from Big Blue. The additions are not trivial, they are real differences both in terms of new chapters added and information within chapters added, modified, and/or refined for this specific exam. However, there is similarity in striking at the ABA Content Domain and this is very helpful as it gives one a big leg up in terms of working with and learning Big Red; much of the style and even content is already familiar, a huge advantage with so much to have on the tip of your brain and tip of your tongue.
Question: So it’s an advantage to build upon Big Blue?
NFJ: Exactly. It’s confusing and totally unnecessary to do otherwise, as Big Blue is a wonderful window upon the ABA Content Domain; it’s a clear cut advantage to build upon knowledge and experience from the Written, in the form of Big Red, to pass the Oral as soon as possible. There’s a good line: “The path to the finish line will be a lot shorter if one does not get off the track looking for short-cuts. . .” Big Red will shorten the path as much as possible, with appropriate repetition from Big Blue, but there are clear differences and there are no short-cuts.
Question: Are you saying having used Big Blue for the Written gives one a competitive advantage for Orals?
NFJ: Precisely. If you used Big Blue and are wondering whether to embark upon commanding an entirely new central source, I would say, “Why throw away your competitive advantage, namely Big Blue and your knowledge of the ABA Content Domain?” It doesn’t make sense. Get Big Red, work with it, come to a course, and in this way you’ll build upon Big Blue and the Written program and will very likely pass the Oral exam.
Question: Can you suggest a “bottom line simple formula” for someone who worked hard with Big Blue, but is now a little fatigued and is wondering what to do?
NFJ: Stay the course until Victory is achieved. We won before, we will again; we passed the Written, we’ll pass the Oral. Again, you have much of the knowledge for the Oral, the relevant Content Domain, through study of Big Blue. Review similarities in Big Red quickly and command the differences delineated in the list “Big Red versus Big Blue.” This can be easy, there’s no reason to make it complicated. Switching sources, switching from a winning program, doesn’t make sense—at least to me.
Question: Tell me about your mock Oral course?
NFJ: The course is not a lecture course, but rather is an effort to cover as many of the wide-ranging topics and scenarios likely to be tested as possible and in a simulated exam, mock oral format. The course is a previewing of the exam—what is tested and the manner in which it is tested.
The course is personalized, while others are not. I try to get you as many extra exams as I possibly can. It’s not like the other main course, where you’ll sit anonymously in a large group, not get much attention or practice, or sit in front of a computer while someone in a distant city “works with you,” while also working with hundreds of other candidates.
Question: What’s distinctive about the course, what’s unique?
NFJ: The course has several unique aspects.
First, for most cases presented at the meeting there are real time answers posted to the questions posed to examinees on the stage. This is a big advantage, a transformative change made over the past couple of years. By projecting the correct answers in real time in a manner blinded to the examinee but accessible to the audience, every case is useful.
Second, again, size limitation leads to more personalization.
Third, the material presented is interesting, challenging, and even controversial at times, which makes it fun and interesting for everyone.
Question: What specifically is the format of the course?
NFJ: Every 40 minutes a different case is presented to a different examinee in a Board like Oral exam format. The goal is to coach each person and also to get through as many excellent cases as possible.
Meanwhile, my excellent faculty are in side rooms administering exams of their own privately so we can maximize practice and also provide people who desire strictly private exams that option.
Question: When you say a case is presented, what precisely does that mean?
NFJ: Every 40 minutes a different examinee-candidate is called upon on a strictly voluntary basis to come up on the stage and take an examination closely modeled upon an actual ABA examination, usually from me. The format is the same as that of the actual ABA Oral exam, the questions are very often the same or very similar, and the pacing is designed to get through the requisite material tested; the pacing must be up-tempo, if one evaluates the actual ABA sample exams, to have any reasonable chance of covering all the ground covered in an actual examination.
Question: What defines the subject matter of the cases?
NFJ: The subject matter has been defined by the ABA, both in their past practices, as guided by their sample cases, and as designed by the ABA Content Domain, which is the covenant between the ABA and the American Board of Medical Specialists defining this entire examination process. Specifically, there are about one hundred case types tested, and several hundred clinical scenarios within those case types commonly tested. In this mock Oral format described we cover as many of the cases and as many of the scenarios reasonably and humanly possible to cover in the time frame we have to cover them, while not travelling so fast that things just become a blur.
Question: Don’t other courses do this?
NFJ: No, actually they don’t. The other main course, in fact, offers itself up as a mock Oral course, but really just uses cases as a launching point for long discussions and digressions by the course instructor. Some call this a “let me show you how smart I am” format.
He purports it’s an advantage for him to “only teach Orals,” but I believe what’s really an advantage is my knowledge of the ABA Content Domain, which I believe is second to none. It’s not personal, just a fact, that I’ve studied this content domain longer, more rigorously, more relentlessly, and this is key to understanding why this course is stronger. In addition, no one has my experience doing this; no one has administered more ABA Oral examinations than I have.
Question: What’s wrong with a very large Oral course?
NFJ: Again, I respect everyone doing this and am grateful not to have the intense and at times unbearable pressure of 100 people who want and deserve individualized instruction, when it’s not humanly possible to offer it to everyone after a certain course size is reached; there are only so many good hours in any one day, so much energy participants and instructors have. So I appreciate the demands, as well as the effort. But it’s impossible to serve this many people effectively, to personalize instruction, and to cover the cases. A course of 25 is perfect, a course of over 100 for Oral Board preparation is smoke and mirrors.
Question: How many cases can one expect to do personally at the course? In other words, how many cases can each participant expect to do personally at the course as opposed to listening to others do cases?
NFJ: One can expect to do at least one case him or herself each day as part of the course, and extra cases are given for free if possible and/or sold for a reasonable amount for those who desire extra work and training.
Question: How many cases can one expect to hear?
NFJ We go through one case every 40-45 minutes, or 11-15 cases/day. We generally start at a reasonable time, 0830 and end at a reasonable time, about 1700.
Question: What kinds of cases are covered?
NFJ: I have an array of prepared cases dealing with every case type they have ever tested. We go through cases dealing with acute respiratory failure, cardiac, CABG, major vascular, ENT, eye, neuroanesthesia, orthopedics, thoracic, trauma, general surgery, obstetrics, burns, pregnancy, airway dilemmas of various kinds, especially challenging clinical dilemmas, management conundrums, controversies, new techniques, complications of various kinds, management of difficulties and interesting complications of all kinds.
Question: Is there a theme?
NFJ: Yes, the theme is the importance of what the Board tests, namely prudent and safe practice reflected through thoughtful and cogent articulation of what one does every day in clinical practice. What is the fitness of the examinee to exercise command and control authority in the operating room? This is ultimately the judgment the Board must make. They are not perfect in their judgments, but this is what this entire process is about.
Question: How do you balance the need to go through as many cases as possible with the need to cover them carefully and to answer relevant questions from the audience?
NFJ: That’s a significant challenge. Philosophizing all day about issues which are self-evident is bad, but so is moving along so quickly that things are a blur. It’s a fine line. I did a couple of hundred courses at a 30 minute clip—every 30 minutes we turned to another case. With the new power points which follow each exam and mindful of the need to provide optimum advise and coaching to the examinee on the stand taking the exam, a little slower format is really best—balancing the need to cover material while making the most of the material before us. A full hour could used for each case. However, this compromises the need to cover as many different relevant cases and scenarios as possible.
Question: Can you further summarize the components of the program?
NFJ: Sure. Big Red is a premier Oral Boards central source, a focus tool, substantially different than Big Blue (differences posted on the site), is the best one source, the best memorizable source for Oral Boards. This test is a “talking test.” Esoteria can be tested, but to a considerably greater degree than the Written this is a test of real world, clinical anesthesia and especially the critical judgments governing it. Given this, Big Red is written, re-written, parsed, and re-parsed to include just the information which is tested, which has been tested, and which is likely to be tested based upon analysis of the ABA Content Domain in summarized form. I really would emphasize the words “summarized form,” where Big Red is strongest.
Question: Beyond Big Red and the mock Oral course, what else do you recommend?
NFJ: Beyond Big Red and the course, we offer Audio Red, the Ranger Red cases with CDs, the Ranger Running cases with CDs, and the little “on the go” study book for memorization, Spiels.
Audio Red is a reading of Big Red, by me, over twenty some CDs. Audio Red helps people cement Big Red into their synapses sooner and stronger. This is a “talking test,” so it’s best to be in a talking environment as soon and as much as possible. The CDs provide that environment, as does the course, too. Ranger Red is a unique and powerful practice tool, and Spiels provides the very top lists and differentials for the tip of one’s brain.
Question: What’s your pass rate?
NFJ: No one truly knows pass rates except the Board. Whether they admit it or not, hardly ever does a course know its true pass rates. I’m very close to many participants, and have tried very hard to get complete, solid numbers. It’s almost impossible, as there are issues related to privacy; complete reporting does not occur, and especially since people who fail are understandably very disappointed.
I have many positive letters and reports, and the course has helped scores of people who had failed before to succeed. But numbers purporting to show pass rates are suspect because a valid denominator is almost impossible to get; good people who fail after giving it their all either won’t report or feel great reluctance to report a failure, and understandably so; be careful in interpreting these type of numbers.
Question: If you only had one thing to state about the program which makes it unique and worth the time and effort to attend, what would it be?
NFJ: The program is a highly integrated and effective approach to preparing for the Oral exam. The home study materials are highly focused and work very effectively. At the course itself, the intellectual content of the cases presented is high. This, coupled with realistic pacing, the stress upon the importance of outlining, and the accurate simulation of the real examination with the best teaching tools and techniques available makes for a very strong and effective program of study. We know from over 20 years experience that we can take people who have failed and help them succeed. We also know personalized, individual help makes a big difference. We further know from so many stories and letters that our methods are superior to “the other course”. The program works and we’d love to work with you.
NFJ: Thank you.
PS: Talking to people who have failed often provides very valuable insights for subsequent success. Here are just three people who we worked with for the Written, who desired a different path, who lost their way, and who failed the Oral after taking the “other course.” They subsequently took our course and passed. You might find their experiences valuable.
On Oct 23, 2013, at 4:03 PM, R wrote:
Thank you Dr Jensen! I passed my oral boards after working with you at Fort McDowell in AZ, as well as in Dallas this spring and fall. I appreciate all your help with the courses and the excellent study source you have developed. My family thanks you, as my previous two attempts at oral boards were harder on them than it was on me. I have been spending much more time with my 2 1/2 year old now that this ordeal is over.
You might remember, I tried other study courses which resulted in nothing but wasted time and money. There was no good reason to change after I had success with Big Blue. I could have been done with boards and without all the heartache if I had only used Big Red sooner! I hope you continue assisting many more Rangers in their quest for board certification.
On Oct 22, 2013, at 2:10 PM, B wrote:
I want to thank you from the bottom of my heart...I passed.
It was a long hard road the second time around, with my studying starting the day I had my first child (10 months before the exam). Going over Big Red 3.5 times, memorizing the vitals and many of the spiels cold (some of the vitals spiels I must have practiced 300 times honestly), taking two of your courses, and most importantly, taking to heart all of the advice that you gave me in our individual sessions...it proved very successful in the end.
While I did not know every little detail, I felt I was able to have an intelligent conversation with each of the examiners. When they pushed back or asked the same question in a different format, I did not try to search out less likely diagnosis or management...I simply reasserted what I would do or what is the most likely diagnosis. With all of the practice at your courses, I went in barely nervous, but I felt pretty comfortable answering their questions and did not feel like I made any killing errors. I even made a joke prior to one of my answers at which one of the examiners laughed at.
Bottom Line: Reading the Big Red multiple times and memorizing the sections that will always be on a board exam (vitals, RR complications, etc..) in preparation for oral practice at your courses (and nightly in between with my wife and colleagues) is what it takes for some of us to pass the exam.
Once again, I thank you.
On Oct 24, 2013, at 7:00 AM, LCDR wrote:
Thank you for your kind words. I will certainly continue to spread the word about your course. Having taken the "other guy’s course” during my first attempt I can say with certainty that your course is far superior. Keep up the good fight and let me know if I can ever do anything for you.
LCDR MC USN
Department Head, Anesthesiology