Cardiology Fellows

Update:  I have added my approximate performance for each question book my first time through. The reason being two-fold: 1) To prove you are smarter than me, 2) So you can gauge your "performance" against someone who passed the board exam.

I am putting this page up mainly as a resource for general cardiology fellows who will be sitting for their cardiovascular medicine board certification exam after graduating. These are the resources and method I used in order to pass the boards. I'm not saying this is the only way or the best way to prepare, but it worked for me.


The backbone of my preparation was the Mayo Clinic review course. I signed up early and booked my plane tickets early so I wouldn't be able to back out when the time came. It was the best investment I made. The course itself runs about $1000 so budget about $2000 for the course, flight and lodging. I won't go into the details of the course itself. JUST GO.

The course is generally held in September, about a month before the board exam itself, so relying on the course by itself to prepare for the boards would be foolish. Here is what I did leading up to the Mayo course. I started buckling down around August. If I had to do it again, I would have started really studying earlier. I think the beginning of June would have been the optimal start time for me. You'll be surprised how fast time goes by when you're starting a new job/EP or interventional fellowship.

1.  O'Keefe - Absolutely essential for the ECG portion of the board exam. Remember, if you fail the ECG/imaging portion of the exam, you're cooked. While this is essential in preparation, I feel the best way to use this book is strictly for the coding practice. Print out a truckload of copies of the ECG coding sheet (available on the ABIM website) because it is subtly different than the coding sheet in the book. I wouldn't waste any time with the filler material between each ECG. Just code away and come up with a routine that works for you. I would go through this book at least twice leading up to the exam. The second (third and fourth) time(s) through shouldn't take you long.

Warning! The O'Keefe ECGs are much more difficult than the ones that will actually show up on the boards. Also, O'Keefe may precondition you to overcode due to the complexity of the ECGs. DO NOT fall into this trap on the actual exam. The exam ECGs are very straightforward and if you are coding more than 4-5 items per ECG during the exam, you are most likely overcoding (most of the ECGs will need at most 3-4 codes).

2. Mayo Clinic question book (my performance ~60-70%) - None of the question books available are ideal in terms of reflecting board-style questions and/or difficulty, but in terms of material, I felt the Mayo question book was the best. The difficulty of the questions are most similar to the board, but most of the questions are not in the clinical vignette format that seems to be the norm on the exam. The EP section in particular was extremely helpful and well-done. I went through this book twice before the exam.







3. Cleveland Clinic question book (my performance >70%) - I found that the questions in this book were easier than what I saw on the exam, but the image questions were extremely helpful. There are also some errors in this book so be wary as you go through it. I went through the images several times leading up to the boards.










4. Braunwald question book (my performance ~50-60%) - Out of the three question books I used, this was by far the most difficult. I would still go through the entire book, but don't get discouraged by its difficulty. The questions are much more difficult than what you will see on the boards. I also felt there were too many basic science questions in this book, but you can easily skip or skim past those questions. The more clinical questions are excellent and out of the three books, the explanations in Braunwald were the best.







ECG-SAP III: Electrocardiography Self-Assessment Program (CD-ROM)
5. ECG-SAP - ECG-SAP may or may not be worth the money, but in either case, I bought it and used it. The ECGs were more straightforward and slightly easier than those in O'Keefe, but still a bit higher in difficulty than what I saw on the board exam. With only 50 or so ECGs, the cost is a bit high, but you can probably find it for a decent price second-hand. I went through all the ECGs several times.

Random thoughts
- The first time through each book, I read each answer explanation thoroughly regardless of whether or not I got the question right. You'll find subject material and questions that are repeated over and over. The chances are high that these things will be tested on the boards. I went through each question book a second time after the Mayo course, this time concentrating on areas of weakness and supplementing the answer explanations with my notes from the Mayo course. I found this really effective in the last month leading up to the exam. At this point, you don't want to be learning any new material. You want to be hammering home the important concepts and solidifying/fine-tuning your knowledge.
- When you go to the Mayo course, be an active learner. Do not sit through the lectures just listening. This will not be helpful and you won't have anything to study from when you get back. They provide you with PowerPoint printouts of their lectures and you will have online access to the taped talks, but realistically, you won't have time to go through the lectures again. The notes I took were invaluable in the final weeks leading up to the exam. The notes you take will be your crib sheets as you fine tune your knowledge.
- ACC-SAP: In the last few weeks when I felt like I had run out of things to study (believe me, it was a nice feeling), I spent some time looking at ACC-SAP. I would categorically say do not waste your time with this unless you are starting your studying a year in advance. It is a veritable laundry list of topics without any clear delineation of high-yield material. In fact, I felt a lot of material included in ACC-SAP is not covered on the boards. I hate to harp on it again, but the advantage of using the Mayo course as my foundation was that the entire course was tailored for taking the board exam. When it comes to guidelines, they pare everything down to the essential minimum and try to incorporate the use of algorithms to better illustrate the thought process you need to go through as you sit the exam.
- The imaging section (echo/angio/LV gram) was extremely basic. Familiarize yourself with the coding sheets and some high-yield images. I mainly used the Cleveland Clinic question book and certain sections of the blue Mayo Clinic textbook Mayo Clinic Cardiology: Concise Textbook, Third Edition (Murphy, Mayo Clinic Cardiology). I would save studying for this section for the last week or two.
- I think it would have been advantageous to have gone to the Mayo course during my third year, as opposed to the same year as sitting for the boards. I feel the advantage would be that you would have a solid foundation upon which to build your knowledge for a year or so leading up to the exam.  Of course, the reality is that most of you will sign up for the course after you finish your general fellowship, but if you have the option or opportunity, consider taking the course a year earlier.
- One question I get asked a lot is Mayo Clinic DVDs vs. review course. To make it simple, I look at it like this: listening to a concert CD vs. going to the concert. I'll leave it at that. Interpret that how you will.
- When you sign up for the exam, you'll have a choice between the taking the exam on days A and B or B and C. Day B will be the ECG/imaging section for everyone while days A and C will be the MCQ day. I would recommend doing the MCQ day first to clear your mind of all the clutter going into the ECG/imaging day. It makes for a much more relaxed day, and it's nice to be done after a fairly short day as opposed to having the longer MCQ day looming ahead of you.
- High-yield = pattern recognition. I saved a lot of time skipping a lot of the clinical vignette crap during the exam by being able to tease out the patterns (physical exam findings, lab values, diagnostic study findings, etc.). The only way to increase pattern recognition is through repetition (i.e. practice questions).

Final thoughts
Most of the fellows I know are at least several-fold smarter than I am. Remember, taking the board exam is a game and you are trying to play the game to get the best score. This has nothing to do with your abilities as a physician, your clinical know-how or even your fund of knowledge. It is all about how you play the game. Develop a study routine, concentrate on high-yield material (you'll figure that out as you go along) and don't stress. Just as in any video game, pattern recognition will become key as you progress in your studies. You WILL have problems if you cannot recognize the patterns. Give yourself enough time so that you're not "cramming" the last few weeks leading up to the exam. The ECGs are straightforward so do not let the ECG section get to your head. If you prepare adequately, this section should be the least of your worries.

Good luck! Post your questions and I'll try to answer them the best I can. I will also update this post as I think of things.