Post-ABFAS Board Certification Recap: What I Wish I Knew Beforehand About The CBPS Portion Of The Exam

I recently took the latest American Board of Foot and Ankle Surgery (ABFAS) Board Certification Examination and results were posted a few weeks ago. After writing prior to the exam on how I planned to study, I felt it appropriate to give a post-exam debriefing. I also enlisted the help of colleagues to comment on what they found helpful in taking the Computer-Based Patient Simulation (CBPS) part of the exam.

(In an upcoming blog, I will also discuss our experiences submitting for the Case Review component of the ABFAS Board Certification Process.)

At the core of taking the CBPS exam is having a knowledge base of treating foot and ankle pathology. Surgeons obtain this knowledge throughout their residency through preparing for clinic and surgical cases, and reading the appropriate textbooks and journals. In having this foundation, what I found most helpful was knowing all the items on the list of prompts and practicing with as many CBPS example cases as possible. In my last blog, I noted the various board exam preparation websites available.1 For me, the Board Wizard program was the best due to the volume of cases and an interface that accurately mirrors the exam.

When it comes to traditional didactics, I can honestly say I did not truly study that much material in preparation. I reviewed the list of answer prompts, making sure I knew what each item was and what it could be used for. I also made note of how each choice played on one another from section to section. As a result, I then color coded and wrote in the margins of my study notes to make a “quick guide” (see Figure 1).

I also took the available practice exams and made “Key Points To Remember” guides for commonly presented topics and/or topics I had confidence in and knew with a fair degree of certainty would be on the exam (e.g., bunion, flatfoot, cavus foot, infection, reconstruction, trauma, etc.). (See Figure 2.) How to construct these guides becomes fairly obvious from both your fundamental knowledge of the topic and going through multiple cases. I probably re-did the available practice cases four to five times over the course of the four weeks leading up to the exam.

Pearls of Wisdom From DPMs Who Recently Took The ABFAS Exam

• Maximize participation in a well-rounded residency to build a foundational basis in treating foot and ankle pathology. Also stay current on clinical practice guidelines (e.g., ACFAS Clinical Consensus Guidelines - https://www.acfas.org/Research-and-Publications/Clinical-Consensus-Documents/Clinical-Consensus-Documents/). This will limit the actual amount of time one would otherwise need to to re-read textbooks like McGlamry’s Comprehensive Textbook Of Foot and Ankle Surgery or Mann’s Surgery of the Foot and Ankle.

Multiple colleagues found this point to be key as they did not feel like they wasted time re-learning things they should have already known. This is crucial when studying for the exam while also trying to maintain a busy practice and family life when free time is limited.

• Review all of the CBPS choices/items in the ABFAS official practice exam so you know how different procedures, tests, etc., are phrased. Being aware of the choices allows you to know something exists, where to find it and how to find it quickly. This prevents wasted time searching for words that either are not there or are possibly interchangeable. One can find these lists on the ABFAS website.

As I noted above, the test taker should have a standard prompt set algorithm to select during a particular type of case or know which prompts are commonly used together. (e.g, bone tumor, malignant type of case à palpate lymph nodes; CT lung/PET scan). The AJM Prism, originally authored by Andrew Meyr, DPM, is a good starting point for examples of cases and how to work through each section and the associated tools to make a diagnosis.2

• Taking the exam, it is often helpful to start “backwards,” looking at the X-rays first. This approach can give you clues as to the direction for the type of case. From there, you can figure out what kind of labs need to be ordered (infection or not), and what areas to palpate. The case phrase/prompt may say left midfoot hurts, and you may waste clicks trying to figure out where in the midfoot you are focusing. Conversely, an X-ray may show you exactly what is hurt. This prevents the need to backtrack to the physical exam. If you are ever stuck on one section, pick a different one to see if new information (changing from the Physical Exam to Labs, Imaging, or Diagnostic Procedures helps to get a handle on the case. You can often go back to a section to finish making your selections.

• Realize when the exam requires an answer from a particular category section. Typically, the main two to three categories before making a diagnosis are the Physical Exam, Labs, and Imaging. If, for example, the Diagnostic Procedure tab is also present, you know you need to provide something from it (biopsy, diagnostic block, etc.). Throughout the exam, keep thinking “What are they asking me for?" and "What do they want me to do here?" to make sure you stay on track.

Final Notes

The CBPS portion of the ABFAS Board Certification Exam can go smoothly for the test taker. In my experience and those of my colleagues, it is vital to maximize your residency experience, stay abreast of the literature and prepare thoughtfully for the specific format of this part of the exam. Repetition and practice are key as is formulating a personalized “study guide” that works for you. Leaving you with some food for thought, I pose some questions for discussion:

• What resource did you find the most helpful in preparing for the ABFAS CBPS portion of the exam?
• What do you wish you knew or prepared better for prior to the CBPS exam?

Dr. Hood is a fellowship-trained foot and ankle surgeon. Follow him on Twitter at @crhoodjrdpm or check out his website www.footankleresource.com, which contains information on student/resident/new practitioner transitioning, as well as links to academic and educational resources found throughout the Internet related to foot and ankle medicine.

Reference

1. Hood C Jr. How to prepare for the upcoming ABFAS exam. Podiatry Today. Available at https://www.podiatrytoday.com/blogged/how-prepare-upcoming-abfas-exam. Published February 20, 2019. Accessed July 9, 2019.
2. Meyr AM. AJM PRISM And Externship Guide. 2015 Edition. https://tuhpod.weebly.com/uploads/4/7/4/7/474277/ajm_prism.doc. Accessed July 9, 2019.

Editor’s note: Dr. Hood would like to recognize the following physicians for their contributions to this blog.

Chima P. Akunne, DPM, is a foot and ankle surgeon at Ochsner Health System in Baton Rouge, LA. He has recently been board-certified by the ABFAS in forefoot and rearfoot/reconstructive ankle surgery.

Aleksandr V. Emerel, DPM, is a fellowship-trained foot and ankle surgeon at Premier Orthopaedics in Malvern, PA. He has recently passed both forefoot and rearfoot/reconstructive ankle CBPS board certification exams, and plans to submit his case logs in the fall of 2019.

Spencer J. Monaco, DPM is a fellowship-trained foot and ankle surgeon at Premier Orthopaedics in Kennett Square, PA. He has recently been board certified by the ABFAS in forefoot and rearfoot/reconstructive ankle surgery.

Michael L. Sganga, DPM is a foot and ankle surgeon at Orthopedics New England in Natick, MA. He has recently been board certified by the ABFAS in forefoot and rearfoot/reconstructive ankle surgery.