I took AP/CP at the end of my 4th year of residency and passed both parts successfully. Below is my personal experience. I hope it might help someone. If not, I’m sorry: you’ve got to find your own way.
There are many rumors, horror stories and conspiracy theories about pathology boards – you’ve have heard it all. Myself, I have a couple of very smart and hard-working friends with high scores on RISE who passed CP only on third try. I don’t know why it happened to them but it doesn’t really matter. The truth is that the boards are not scary or exceptionally difficult: more people pass than fail, and a passing rate for both AP and CP gets higher every year. Don’t let the boards to overwhelm you. Life doesn’t stop while you prepare for the boards, and even failing is not a big deal. If you really think that the board exam is the end of the world, get counseling.
I had pretty normal lifestyle. I trained for a marathon, I did a series of adventure races, I went to the movies, read non-pathology literature, traveled and so on. My good friend, a mother of four, managed to prepare whilst managing the entire family including her aged mom and being a chief resident. She was studying at baseball and basketball games, symphony orchestra concerts, etc. If she could do it, everyone can.
I doubt that my style of preparation will suit the majority. I’m an audio person, and I can retain information well by listening while doing something else. I listened and listened for audio- lectures from both ASCP and Osler courses while running (1 to 4 hours a day), swimming (1 hr a week), commuting to ski resort and back (3 hrs/weekend, seasonal), etc. – you got the idea. I looked through images shortly after, and it was more than enough for me. Don’t get me wrong: nobody in clear mind can stand 4 hrs of lectures in a row especially on 20-miles training run. I’m no exception. I mixed studying materials with audio books and French lessons. I don’t know how many times I repeated all lectures, but at some point I didn’t need to refer to images. I could picture a micro- plate, or a fungal culture in a mold form, or whatever easily. (Advice for “listeners”: get a hands free bluetooth headset for terrestrial activities and a water-resistant player for swimming).
I stopped preparation one week before the test. I couldn’t take it any longer. I wished we took the boards in May but my program was scheduled for June. When RISE results came, I knew I would be fine. I was in 95th percentile overall with half of the sections in high 600th. Does that mean that RISE outcome has a correlation with the boards? I would say yes.
I didn’t study for AP that much: I felt I knew enough with certain exceptions like non-neoplastic derm. But who cares about a couple of questions?
I didn’t review any of the following at all:
Forensics: there were about 5 questions, all common sense. Every program has at least a month of forensic path – that should be more than enough to get right answers.
Non-neoplastic renal: there is probably 1 question per year. Our program has a very good EM/renal rotation, and I like this subject. I figured, I could get away with what I know.
Informatics: I have enough knowledge about computers, and I remember only one question, which everyone could answer.
Statistics: I hate it with passion, and I never bothered to lean it. I reviewed calculations at the very end and picked random answers on ROC, Westguard rules, etc. on the exam.
I DID NOT read Robbins – it is so primitive, that I can’t stand it. There were maybe three questions on general pathology. All could be answered without consulting Robbins.
A couple of words on what I used for AP:
I did 1 or 2 California tumor registry boxes a day till I finished all we had in the department. I had to repeat most of ‘em twice: one time with a friend who was studying for Royal College exam (Canadian boards) and another with a friend who was taking American boards with me.
I pulled out old cases (including bone marrows and peripheral smears) according to the list of recalls from both American and Canadian boards and did ‘em three times in total (myself and with every friend). Let me tell you, It was quite a stuck of trays:).
When I was exceptionally bored on clinical path rotations, I did John Hopkins surgical pathology conferences. Each case has detailed explanations with references. I like this web-site and find it helpful.
I used Utah (http://library.med.utah.edu/WebPath/webpath.html#MENU) web-site and went through all pictures a couple of times.
I despise cytology. IMHO, it’s a useless discipline for the most parts except for pap smears. (“I’m positive, it’s a fibroadenoma”! – “Hmm, it’s a 90yo male with three primary malignancies being worked up for metastases” – “In this case I cannot exclude a poorly differentiated carcinoma, and I need a biopsy for correlation”. Right. Tea leves reading has about the same specificity and sensitivity). Regardless of my attitude, the subject is tested heavily on the boards. Fortunately, even the most worthless resident in my program knows enough of cytology to get high scores on RISE and pass the cytology part of the boards. We have a weekly cytology conference and a three months rotation, not counting numerous journal cubs, visiting professors’ talks and an obsessed chairman. All I did for cyto were ASCP power points. I couldn’t listen to it. Gyny cytology in ASCP 2010 is very good: it gives precise algorithms on management, and that’s what was asked for the most parts. I read Bethesda book before my rotation on the third year – it’s very shot and simple. Baby DiMay is worthless – too primitive in my opinion.
The rest of AP
I listened to the the audio- lectures from ASCP 2009-2010 and Osler 2007 (you have to take information with a grain of salt – some parts are outdated) and looked through .pdf presentations. My version of Osler had real pictures, not just plain text. I acquired it from a friendly fellow while doing outside rotation on my third year.
I did Lefkovich book three times in total: just 5 to 10 questions as a bed-time reading. Some chapters are good, some are so-so. But it’s a decent source to review.
I decided to give it only one try and waive it if I fail. But I felt that even one shot is worth an effort. I obtained an extensive list of remembrances from past years and added answers, comments and information I found useful. The file grew up to 36 pages. I used to look through it at boring conferences and read it several times two weeks before the boards. Apart from that, I used the following.
- Konneman’s color plates, and whatever bacteriology atlas we had in the department – I looked through them at least 10 times. Don’t forget viral CPEs in Konneman – they are in the text, not at the end of the book. Although, Osler virology lecture has the most testable ones.
- Board review lectures
Osler micro is much better structured than ASCP, and this woman is interesting to listen unlike a boring guy from ASCP. But ASCP has more images of better quality – take a good look at them.
- Ash’s parasitology atlas: I made my friend memorizing the entire book till she was able to recite all details of an egg or a worm including size, epidemiology and life cycle. She hated me after the boards: she felt cheated. We bothered learning it all, and they showed us only 3 stinking eggs??
- I looked through a couple of parasitology web-sites and “doctor fungus” – I don’t think it was useful. Ash has all you need.
- A chapter in Lefrovich book
In spite of 3 months of micro on my junior years, I had no interest in bugs and retained no knowledge. Three years in a row my score on RISE was in 480s or even lower. At the beginning of my 4th year I started micro from the scratch and at the end I developed a classic Stockholm syndrome: I was liking micro! Especially parasites and mycobacteria followed by fungi:). RISE results came. I got 680 that time. It proves only one thing: studying helps:).
- ASCP lectures and Henry. Fortunately, most of the tested chemistry is related to pathophysiology we learned in medschool. Instrumentation is not a big deal for the boards, and ASCP covers enough of it.
I’ve never been a big fun of chemistry, but I always had a decent score on in-service exam. So much for that.
Molecular and Cytogenetics
- ASCP lecture
- A chapter in Lefrovich book (I didn’t understand a half of it even on the third go:))
I’m in peace with cytogenetics but I hate molecular with passion. Miraculously, I did well on respective sections of RISE. I don’t remember many molecular questions on the boards. I don’t mean FISH – everyone can count colored dots. There was a question on PCR and that’s about it.
Hematology and hematopathology
During my 4-month rotation I had very little instructions except for a month of pediatric pathology in a different institution, where I was taught some hemepath. Heme became my vendetta, a matter of principle. I got 680 on these subjects on my 3rd year but it wasn’t good enough. I studied more and rose to 725 on my last RISE. That was the best I could do, and heme portion of the boards seemed to be easy after all these efforts.
- WHO 2008 – I read it 4 times and had to go though the entire book with my Canadian buddy. That makes 5 readings in total.
- ASCP lectures with humongous .pdf at the end. D. Mais is a cool guy. I like him making mistakes while speaking and correcting himself with laughter. For some strange reason he kept saying year after year some things contradictory to WHO. I eventually emailed him reminding that ALK- ALCL DOES exist in new classification, and that ringed sideroblast requires 5 granules in 1/3 of a ring, not 10. He thanked me and promised to fix it in 2011:).
- Peripheral smears and cell counts on-line
- Slides I pulled out for my Canadian friend
I like hematology, and what I’ve learned was sufficient to pull though exam. Can I practise hematology? I doubt. I’m saying all this not to show off. I’m saying it for those who have whatever deficiencies in their training due to various circumstances: they can be remedied by self-studying.
Transfusion and coag
We have a very good rotation on both. Our attendings are great and clinically oriented. They drilled us on all possible transfusion situations, and that’s what was asked on the boards. I memorized all numbers and formulas but very little of that was tested. This year they gave mostly clinical scenarios. One of our attendings writes questions for the boards. He never revealed any of them but when he said “you have to know it” we listened and tried to remember. Same story with coagulation disorders: the doc in charge is one of the most cerebral human beings I’ve ever met. I didn’t study for coag at all, and all questions on the boards were a piece of cake.
- Osler blood bank guy lectures – they are awesome; much better than ASCP.
- Yellow “Transfusion medicine guide”, latest edition
I have never opened an AABB manual. I have no idea if it is useful or not.
- Osler and ASCP lectures
- Henry book
- Utah web-site for immunofluorescence patterns
We have a designated 1 month rotation on this boring subject. Out lab management person is crazy: she makes you learn the most obscured regulations hard way. I had the rotation in May and didn’t study anything else. It was more than enough to answer numerous questions in both AP and CP parts.
I Did NOT read CP Compendium – this book has way too many mistakes and is organized so poorly that I gave it away. What a waste of money!
The exam, AP part
The boards are shifting to virtual slides: there were 26 of them, and the rest were “traditional”. Practise software for both surgicals and cytology to get the idea. Virtual slides take longer to look at: all computers are slow, and it takes ages to switch “objectives” from 5 to 10 to 20 and so on. Betsy Boobs suggested us doing slides as they were given: a box of glass, a set of virtual, a box of glass and so on. I would recommend doing it. That way you won’t screw up the order and will have sufficient time. Another approach will be to do all glass and then all virtual, but again, watch the order for god sake! Some virtual slides have a diagnostic green box – you cannot go anywhere else but this area on higher resolution. It’s great cause it saves time. Some virtuals had 10 to 15 breast or prostate cores with no diagnostic box. You have to look through each and every. Two thirds of all slides were straight ID, and the rest asked secondary questions meaning that you have to know what you are looking at in the first place. There were no unfamiliar cases, and I did all of them twice just in case and still had 40 minutes left. I sat in stupor for 10 minutes or so – I didn’t dare to leave right away, but I couldn’t force myself to do the last portion all over. Then I simply walked away and had a nice long break before the next part of the exam.
Written part was not difficult as well – I did all questions twice and left without hesitation.
Practical part with images had a lot of cytology, but, again, nothing esoteric was asked. Bear in mind, that you can enlarge an image by clicking on it. I didn’t know it till I turned my paper in. I saw some people getting huge images when I was passing by and was wondering why I didn’t have enough common sense to do the same:). Anyway, only two questions required bigger pictures. I was staring at these thumbnails thinking how on earth they expect me to make a diagnosis on THAT. Nevertheless, I managed to select an answer based on provided information. Was it right on not I will never find out.
The exam, CP part
The question were long, and the majority of the information was useless – check the answer before reading all this crap. Sometimes they throw in a table with lots of numbers and then ask something stupid like how IgG works in ITP. There will be some completely unfamiliar questions – don’t stress about them. There were not that many on my exam. Just guess and move on. On practical part, the pictures were very shitty but sufficient to make a diagnosis. Don’t forget to enlarge images! I would have missed some hadn’t I learned a day before about this trick. There were tons of peripheral smears and bone marrows. They seldom asked about immunos: most of the questions required a diagnosis based on morphology. As I said before, most of the questions on chemistry, blood banking and coag were clinically oriented. Don’t fear antibody panels. There were three on my test. Two questions could be answered without doing a panel, and the third one was not difficult. We did more complicated ones on the rotation.
I cannot think about anything else right now. If you have questions, email me.
Good luck to all takers and retakers!