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VIII. Design of the Oral Examination:
In total, each candidate will have two 30 minute oral exam sessions with a 15 minute break between the sessions. Each session will be conducted by 2 individuals that are current or former Board members or previously DABNM certified individuals. Thus, a total of 4 different examiners will examine each candidate. The Board will attempt to assign examiners for each candidate such that no conflict of interest with the individual candidate being examined will exist. Most specifically the examiners should not be employed by the same, or competing, institutions and should be able to be unbiased in their examination. Preferably the examiners should not know the candidate, but this is unlikely to occur in all situations. Sufficient flexibility should be present at the examination for changing examiners if an unanticipated conflict of interest occurs. Since the goal of the oral exam is to assess judgment of the kind needed in the operating room during monitoring, the format will involve questions similar to those that could occur during a surgical procedure. Although they will inevitably involve some knowledge of anatomy, physiology, anesthesia and surgery, the questions will focus more on the application of this knowledge in a surgical case. It is important to stress that the oral examination is not a test of knowledge; each candidate has sufficient knowledge as demonstrated by having passed the written examination. The oral examination questions will seek to assess judgment, interpretation and application of monitoring and will assess adaptability when problems occur. The focus of questioning will frequently revolve around the reasoning and thoughts involved in arriving at an answer or resolution of the problem. Occasionally the questions may border on controversial areas where the answer may be “gray” or not firmly established. In essence, the exam will seek to test those aspects of monitoring that extend beyond the technical aspects of monitoring and determine if the candidate has developed sufficient reasoning power to make informed, intelligent decisions. To accomplish this, each 30 minute test period will revolve around a presented, real surgical case and a hypothetical surgical case. To make this most effective, the candidate will submit an actual case they have monitored for the first examination period – the presented case. The applicant must d ocument in the Case Report and demonstrate in the Data Records of the presented case, the occurrence of significant events that occurred during the surgery and associated communication that occurred between the neurophysiologist and the surgical and/or anesthesia teams. These events may or may not involve significant changes in the neuromonitoring data. The examiners will review the submitted case prior the examination period so as to allow the candidate a maximal opportunity to demonstrate the insight and judgment requested. In addition, the submitted case allows the candidate to demonstrate the quality of their tracings and documentation as well as their professionalism in the monitoring. A hypothetical case will be provided by the Board for the examination in the second examination period. The two examinations will involve two different types of cases and/or monitoring. For the purposes of the examination, the Board has divided up the monitoring cases into the four broad categories shown below. The candidate will be examined in two of these categories. Certainly the case presented by the candidate will define the category of the first examination. The candidate will then choose the category that they prefer to be examined for the second examination.
The categories and cases for the oral examination are:
| 1. |
Spine |
| |
| A. |
Scoliosis |
| B. |
Thoracic Stabilization |
| C. |
Lumbosacral Pedicle Screw Fusion |
| D. |
Cervical Fusion |
| E. |
Spinal Cord Tumor |
| F. |
Tethered Cord |
|
| 2. |
Vascular |
| |
| A. |
Carotid Endarterectomy |
| B. |
Intracranial Aneurysm |
| C. |
Thoraco-Abdominal Aortic Aneurysm |
|
| 3. |
Intracranial |
| |
| A. |
CP Angle/Post Fossa Tumor |
| B. |
Large Skull Base Tumor |
| C. |
Pituitary Tumor |
|
| 4. |
Intraoperative Diagnostic |
| |
| A. |
Brachial Plexus/Peripheal Nerve |
| B. |
Epilepsy/Electocorticography |
| C. |
Functional Neurosurgery |
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For example, if a candidate should bring a case involving spinal surgery (category I), then they must choose a case for the second room from one of those listed in categories II, III, or IV. The candidate should not only specify the category (e.g. II, III, or IV), but should also specify which type of case in the category (e.g. A, B, C, etc). Similarly, a candidate who brings a carotid endarterectomy case must choose a case for the second room from categories I, III or IV since the carotid surgery is in category II. The choice of the category and type of case (A-C or D) for the second examination need not be made until the day of the examination, but a brief case scenario from the chosen category second examination will be provided by the Board within the category and case chosen by the candidate. The case provided by the candidate is extremely important, not only for setting the framework for the examination in the first room, but also as a means of demonstrating the professional nature of their monitoring. This case should be sent to the examining committee at least two weeks prior to the examination so the examiners have time to review the presentation. As discussed below, the first examination will be a short presentation of the case followed by directed questions about the case or judgment aspects involved in that case, or one similar to it. Finally the type of case will serve as the framework for “what if” questions that will complete the first examination. The real case provided by the candidate should include several basic essential elements. During the first 5 minutes of the first examination period the candidate will be asked to describe the operative procedure used and describe the anesthesia chosen for the case. Therefore it is recommended that a one page overview of the case be included in the materials. Such a report might give a brief description of the patient (i.e. age, relevant medical problems and neurologic symptoms and findings), the proposed surgical procedure, the monitoring modalities used and the anesthetic management chosen. Further, any intraoperative events may be noted in the overview. This summary may serve as an excellent means of summarizing the case for the purpose of the 5 minute presentation to the board. The presentation must provide examples of waveforms obtained in the case and show the OR record keeping, documentation as well as the interpretation of the case as a whole. These waveforms should serve to demonstrate the quality of the monitoring traces as well as examples of all of the monitoring modalities used. If changes did occur, the relevant tracings should be presented so they can be present for discussion, however, there is no need to choose a case where changes occurred. It is highly recommended that the waveforms chosen represent the highest degree of quality possible as these will reflect the professionalism of the candidate. The candidate should also include the report they wrote after the case for the purposes of their own laboratory records and any documents placed in the medical record. The ability to make a succinct presentation and stay within the 5 minute time limit is important for demonstration of the ability to highlight the salient aspects of the case. It is important to note that to maintain patient confidentiality the candidate will be asked to remove all patient, surgeon and hospital identifiers from all materials brought to the examination. The case chosen need not be a particularly complicated case or a case where some unusual aspect makes it special. Some candidates feel that it is important to bring an “interesting case” or a case where they did some unusual form of monitoring. Actually, to the contrary, since the case demonstrates the professionalism of the candidate, the case and its documentation should showcase the very best tracings and professional documentation of the candidate. Hence, unusual or interesting cases do not improve the presentation, and may actually raise issues of documentation or practice that may work against the candidate. The candidate should also choose the case based on the category in which they wish to be tested and one where the documentation and waveforms demonstrate the highest professional standards. |
