When it comes to examinations, oncology fellows have been through the gamut: all the way from kindergarten spelling tests to the SATs, the MCATs, and the USMLE. But as training winds down, there’s one more exam to prepare for in order to become a fully fledged, practicing, board-certified oncologist: the oncology boards.

Most oncologists receive board certification from either the American Board of Internal Medicine (ABIM), which certifies medical oncology as a subspecialty, or from the American Board of Radiology, which certifies radiation oncology. The American Board of Surgery certifies surgical oncologists, although there has been increasing pressure within the field to create its own specialty certification.1

How do you prepare? What should you expect? Do you need to attend a review course or will books and other preparation materials be enough? How much time should you allot to studying? The questions are myriad, and there’s no one-size-fits-all answer.

Many oncology fellows will choose to take a board preparation course, either one offered internally by their own training institution or one of a number offered by large academic medical centers.

In addition to live and recorded preparation courses, there are a number of review books, guides, and notes to help fellows prepare for the medical and radiation oncology boards.

Within medical oncology, probably the best known is ASCO’s Self-Evaluation Program (ASCO-SEP).2 “I did all the questions in ASCO-SEP multiple times, and I really found it helpful,” said Elizabeth Comen, MD, medical oncologist at Memorial Sloan-Kettering Cancer Center in New York. “I went section by section: I’d do lung one week, and then read all the answers and see what I got wrong and right, and then redo the whole thing.”

Robert Den, MD, assistant professor of radiation oncology at Thomas Jefferson University Hospital in Pennsylvania, who is now preparing for the fourth and final stage of his boards—the orals, coming up in spring 2012—used several review books and materials for radiation oncology. The most helpful, he said, were the infamous “Caggiano notes” (by physicist Joseph A. Caggiano) for radiophysics,3 and Radiobiology for the Radiologist by Eric Hall (“It’s a rather short read”) on the radiobiology side.4 Another text that many radiation oncologists cite (sometimes with bleary eyes and aching heads) is Faiz Khan’s Handbook of the Physics of Radiation Therapy.5

With so much material to cover, what should the prospective board examinee focus on? The medical oncology boards focus a significant amount of time on the most common cancers, said Dr. Comen. “You have a limited amount of time and you can’t focus on everything, so you need to realize that you must know common malignancies like breast, colon, lung, and prostate in and out. If you get the bread and butter and the biggest cancers down well, and you know how to treat the different stages and the mechanisms of the drugs, you’ll be fine. I got caught off guard with some very specific questions about lung and colon cancers—things they did say ahead of time you have to know in and out—including the mechanisms of action of certain chemotherapy drugs and targeted therapies and where they’re metabolized.”

By contrast, Dr. Den thinks that the radiation oncology boards are broader in scope. “I felt like the gamut was covered,” he said. “I don’t remember that many prostate and breast questions; I felt like it was a wide variety of cancers. Some questions surprised me on some of the rarer tumors.”

Dr. Comen warns fellows at leading-edge academic institutions like Memorial Sloan-Kettering to bone up on what is the standard of care. “Your institution may try a particular experimental therapy, but that’s not what the board is asking. You need to know not what your institution does or your department head does in a particular case, but what is standard.”

Both Drs. Den and Comen began preparation for the board exams months in advance, a little at a time. For 2 months, Dr. Den allotted his train commute to and from work (20 minutes each way) to studying; during the last month before the exam, he ramped that up to 2 or 3 hours daily. Dr. Comen adopted a similar schedule, then studied all weekend immediately before the boards.

“Slow and steady wins the race,” she said. “Could someone pass by cramming? Yes. But at the end of the day, it’s an opportunity to synthesize everything you’ve learned during your fellowship and give yourself a foundational knowledge. If I’m going to say I’m board certified, I want to be able to back that up.”

References

     

  1. Pollock R. Surgical oncology at the crossroads: the future is now. Ann Surg Oncol. 2008;15(3):661-669.
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  3. American Society for Clinical Oncology. Board Review Course. http://www.asco.org/ascov2/Education+&+Training/Training/Resources+for+Fellows/Board+Review+Courses. Accessed November 28, 2011.
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  5. Caggiano AJ. A Review in Radiation Oncology Physics. Vienna, Austria; IAEA; 2011.
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  7. Hall EJ, Giaccia A. Radiobiology for the Radiologist. 7th ed. Philadelphia, PA; Lippincott Williams & Wilkins; 2011.
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  9. Khan FM. Gibbons J, Mihalidis D, Alkhatib H, eds. Khan’s Lectures: Handbook of the Physics of Radiation Therapy. Lippincott Williams & Wilkins; Philadelphia, PA; 2011.
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