Oral Examination

Resources

Invaluable information about the oral examination process and content can be found at the ABCN website, in the ABCN Candidates’ Manual, in the AACN study guide, and in the Oxford book Step-by-Step Guide to ABPP/ABCN Certification in Clinical Neuropsychology: How to Become Board Certified Without Sacrificing Your Sanity (note: a portion of the proceeds goes to the authors and to the AACN). If you haven’t checked out these resources lately, you should do so now.

Your Task and Tips for Success

Overview

The oral examination is comprised of three 1-hour segments completed back-to-back during a morning or afternoon session. Realistically, allowing for transit time, each segment actually lasts about 50 minutes. The three segments, which will differ in order from examinee to examinee, are focused on (a) your work samples, (b) ethics and professional practice, and (c) “fact finding.” During the fact finding session, you are presented with a brief case scenario and expected to ask questions to elicit information that will help you ultimately formulate a diagnostic impression and plausible recommendations.  Examples of mock fact-finding cases can be found in The Neuropsychology Fact-Finding Casebook: A Training Resource.

When studying for the oral exam, the first thing to remember is that in many ways this is the easiest part of the whole process, especially if you have prepared well previously. Keep in mind that this portion of the exam is focused on the clinical things that many of us do each day.  Obviously, this is an anxiety-provoking situation. However, keep in mind that the examiners are all very friendly and really want you to pass. Also, you will not be sitting in front of a panel of examiners for three long hours, but rather a different single examiner for each exam segment. Sometimes there will also be a monitor in the room to ensure that the examiner is doing his or her job, or an examiner-in-training who is being groomed for future examinations; both monitors and examiners-in-training are asked to be silent and unobtrusive. For most folks, the segments go by quickly.

Study Groups

Like the written exam, we recommend preparing for the orals in a small group that “meets” weekly via telephone conference calls. If you are a BRAIN member and would like to form or join a study group to prepare for the oral examination, please contact Eric Waldron (ewaldron@umn.edu), who helps coordinate these groups. Unlike the written exam, it is best if the composition of your oral exam study group is homogeneous with regard to adult or pediatric focus. These calls may last longer than the ones for the written exam, but there should be far less “homework” in between calls. In the first call, we suggest agreeing upon a study format and setting up a schedule for who will do what each week. Below are some suggestions about what to cover and how that have been helpful for prior study groups:

One person is scheduled to present one of his/her work samples. This person sends his/her selected case to the group for review via email, usually the week before the scheduled call. Each group member reviews the case and brings up issues that might be challenged by examiners. Examples include questions like:

  • Why didn’t you give this test?
  • What led you to this conclusion?
  • How does the patient’s neurological condition relate to these symptoms?

The goal is to be supportive but tough. It is better to be challenged by your study group so that you will be prepared with a response if you hear a similar challenge from an examiner. Group members can also give one another references for articles that might be helpful for their cases. Using this method, individuals are well prepared for questions presented by examiners. Indeed, most candidates found that the actual examiners did not ask about most of the things they had prepared to defend/explain and asked very few questions that the group members missed!

A second person should be scheduled to undergo a mock fact finding using a case provided by another group member who acts as the examiner. It’s especially helpful if at least one member of the study group has had some experience with the fact finding process so s/he can try to make the practices as authentic as possible. If no one in the group has this experience, feel free to ask for help from the forum or a colleague.

It also is important for the group to engage in dialogue about ethical issues related to cases. It may be helpful to practice a few mock ethics cases over the study period. Some are provided in the AACN study guide. Also, BRAIN group members have generated a few more ethics vignettes to practice on.

Finally, an open forum for discussing any other issues that come up over the previous week could be held at the end of the call.

It is best to schedule just enough phone calls to assure that everyone’s cases are covered and that everyone goes through a mock fact finding. Obviously, this can be adjusted in whatever way works best for your group’s needs.  An example of an oral exam study schedule for a pediatric-focused individual is provided here: Sample Oral Exam Study Schedule

Beyond the Study Groups

  • Know your cases inside and out. This is the one part of the exam when you can reasonably guess what might be asked, and the examiners will expect you to know these cases exceptionally well.
    • Read up on topic areas that are pertinent to your cases and ask your group what other topic areas they feel you should cover.
    • Know the functional neuroanatomy of your cases’ conditions, the general mechanisms of any medication they’re on, the strengths and weaknesses of the measures you used, the theory and research behind the syndrome or symptoms with which each case presents, and the empirical or theoretical foundation of your recommendations.
    • Unless you need to assuage your own anxiety, there is no need to read whole books, but it may be useful to find a few review articles. It is not required that you cite the literature, but it can be impressive when you do.
    • If you’re obsessive — or just afraid you might freeze under pressure — you may want to write out or type up your responses to possible examiner questions. The goal here is not to memorize your responses, but rather to use this as an opportunity to organize your thoughts ahead of time, when the pressure is less than it might be during the examination.
  • It is HIGHLY recommended that you set up a mock oral exam with someone in your community. Preferably, this would be someone you don’t know well. When you practice with someone you know, your familiarity with that person makes the experience less formal and less anxiety-provoking. You will notice a difference in how you feel about the process after you’ve completed it with someone you don’t know. Most ABPP folks are more than willing to help you in this process. If you need help finding someone in your area and you’re part of the BRAIN forum, consider asking the list — with over 500 members, chances are good someone knows an ABPP neuropsychologist in your area. Of course, if you can’t do it in person, it will still be helpful to do it by phone. Try e-mailing Brandon Baughman (bbaughman@semmes-murphey.com), and he can connect examinees with mock examiners from BRAIN.
  • A special note to child-focused folks: You will be able to choose a child case for your fact-finding session. Also, ABCN tries to assign child-focused examiners if you indicate that you are child-oriented. Finally, if you see almost exclusively neurodevelopmental cases, you can submit these. However, you should make absolutely sure you have a handle on the functional neuroanatomy of the case or disorder under evaluation. This can be unfamiliar territory for clinicians who usually focus on the adaptive limitations and community resources available for a child with a neurodevelopmental disorder. Even if things are murky, bone up on what is known about the neurological underpinnings of the child’s condition, related medications, etc.
  • Although in some ways the fact finding portion of the exam recreates the normal clinical process, it is highly compressed and inescapably different in structure. Time management is important, which makes in vivo practice of this portion of the exam essential.  An example of a fact finding outline is provided here: Sample Fact Finding Outline
    • Plan to use about 45 – 50 minutes. We encourage you to take the first 5 minutes to write down a list of questions that you want to ask.
    • In particular, it is helpful to write out the key topic areas in your history section (e.g., neurodevelopmental history, educational history, etc.), behavioral observations, and specific test domains. Although this sounds overly cautious, you will be surprised how easy it is to forget questions that you ask everyday. Some examinees leave space after each part of the outline so that they can fill it in as they go.
    • What’s most important is that, in advance, you develop and master an outline/approach with which you are comfortable (see also these sample outlines for child and adult cases). Examiners will not look down on you if you take a few minutes to collect your thoughts.”
    • After you have done this, plan on spending 5-10 minutes to formulate questions specific to the case presented, 20-25 minutes to ask questions, and 10-15 minutes to present conclusions and recommendations.
    • When collecting information about the case, ask about major categories of clinical history and functioning, as well as neuropsychological domains. You do not need to ask test-by-test; the examiner will give you test results from entire domains on individual sheets of paper. Don’t hesitate to ask about a test if you are unfamiliar with it; you can’t know them all.
    • In your case formulation, address the following areas: brain dysfunction or not; lateralization (say “yes” only if very clear); etiology; prognosis; and recommendations.
    • Leave a small amount of time at the end for questions.
    • This portion of the examination is designed to elicit your differential diagnostic skills; thus, it is important to share your thought processes. If you rule out an etiology that seems obvious, be sure to state that out loud and why. Even if you arrive at an incorrect etiology, we have been told that you can still pass the exam as long as your reasoning is sound.
  • In the ethics and professional issues portion, you will be asked about your approach to evaluations and about your practice in general. The examiner will ask you about research, membership in professional organizations, meetings you attend, journals you read, and current issues in neuropsychology. They may also ask about examples of ethical dilemmas you have faced and how you handled them. Think about these in advance! Again, the obsessive among us have found that writing this information down helps. You can’t bring anything in with you, but writing things down may help you to organize your thoughts while you are calm.
    • The examiner will present you with a case full of ethical issues. You will need to figure out what the ethical violations are; what was done wrong and how you would have done it differently.
    • Read up on and know the latest ethics codes and HIPAA regulations. You do not need to know the exact code numbers, but know the major categories. Also, be sure to attend to both major ethical violations and more subtle offenses. Bush’s book, Ethical Decision Making in Clinical Neuropsychology and a special issue of Applied Neuropsychology (Volume 13, No 2, 2006) may be worth reviewing.
    • For our Canadian friends, while you do not necessarily need to know HIPAA inside and out, you probably do need to know how your laws differ from HIPAA and how that might affect your practice. In most cases you will know more than your examiner, but be aware that there are several Canadians who are involved in the oral examination process, so keep that in mind as you prepare.

Final Thoughts

The experience is much more pleasurable and less intimidating if you try to schedule your exam at the same time as someone from your study group. The folks at ABCN have been very accommodating in helping us do this in the past. Knowing other people in your evaluation group can be very helpful in reducing your anxiety — plus it allows you to get together afterwards for food and/or drinks!