I don’t produce these recordings to earn a living– I earn my living as a psychiatrist. I began making these recordings a few years ago as I studied for the Boards– first for the written exam, and then the orals.   I made the recordings for myself, because I couldn’t find what I wanted– something that I could listen to during my drive to and from work each day.  Like you, my life was pretty busy– with residency, family, and other obligations.  It was hard to set aside a couple hours at night, knowing that my three kids hadn’t seen me for a couple days!  But the drive time was being wasted.  I didn’t like talk radio, and as a “second career psychiatrist” I was a little old for the pop music on most of the stations.

Once I started using the recordings, I knew I was on to something.  Heck, the review courses were charging almost $1000 for  recordings that were MUCH less useful.  I had a hard time understanding them because of heavy accents or poor sound quality, and they were mostly from lectures that included a bunch of accessory information, that I knew would not be on the Boards!  Some of the lectures even referred to slides or other visual information that didn’t even come with the set of recordings.

Psychiatry is my second area of medicine.  I passed the Boards in Anesthesiology back in 1993, and so I have a bit more experience in taking the exams than some people.  I’m also older– I’ve been a doctor for over 20 years– so I have a bit more confidence about what I know and what I don’t know than the average resident.  My goal in making these recordings was to take my experience with Board exams and my knowledge of psychiatry, and to produce a better and less expensive product than what was currently available.

I can assure you that I pulled it off– I frequently hear nice things about these recordings in e-mails from people who have purchased them, and many people who purchased one set have returned a year later for the next exam.  After passing my own exams I re-made the recordings, tinkering with the sound quality to flatten the dynamic range so that they can be heard more easily in a car.  I also used the audio software to subtly speed up the recordings, packing them with information more efficiently.  I slowed down when going over more complicated topics, and you can always hit the pause button if necessary!  Finally, I took out the ‘ums’ and ‘ers’ and vocal pauses that often take up 20% of a lecture– something that is never done to those more expensive recordings.

Finally, I priced them much more reasonably than the ridiculously-priced competition.  Don’t let the cheap price fool you– I lecture at a major medical school (I actually was nominated for a teaching award this year), and I know the material as well as anyone.  I passed the boards myself on my first try;  I have a PhD in Neuroscience that adds to my understanding, particularly of psychopharm, and I have a voice that projects well and is easy to understand.

In fact, if you want to hear my voice, go to itunes and search the podcasts for ‘junig;’  I have a weekly radio show about psychiatry and you can download a show for free!

Thanks for reading this long appeal…  and I encourage you to check out the recordings.  The ‘criteria’ are particularly helpful for the second exam, but are also very useful for anyone looking to improve their understanding of how the diagnostic criteria fit together– to get a solid base for understanding psychiatric pathology.  And the psychopharm, of course, is always a part of every psychiatry exam, whether written or oral.  I wish you the best with your studies!

Psychiatry Board Preparation

The process for becoming Board Certified in Psychiatry is exceedlingly complex right now, thanks to the phasing in and out of three different processes. The old format for the oral examination was changed in 2006 to include patient vignettes. Apparently not satisfied by the confusion caused by that change, oral examinations were phased out completely for current residents, replaced by the ‘clinical skills evaluation,’ which must be passed three times during residency. As for ‘who must do what,’ here is the description from the ABPN site:

Psychiatry Certification Process: New Format and Timetable Announced September 2008

For residents who began training as a PGY-1 on July 1, 2007 or as a PGY-2 on July 1, 2008:  The Psychiatry Part II (oral) examination will be eliminated. The Psychiatry certification process will consist of a single computerized examination (Psychiatry Certification Examination); first administration in 2011.

For residents who began training as a PGY-1 before July 1, 2007 or as a PGY-2 before July 1, 2008:  To become Board certified in Psychiatry, candidates must pass both the Part I (computer-administered) and Part II (oral) examinations.

Candidates who do NOT pass the Psychiatry Part I examination in 2013* or before or who do NOT complete the certification process by December 31, 2016, will be required to submit documentation of satisfactory performance in the evaluation of clinical skills completed by the current Program Director of an ACGME-accredited program as part of the ABPN credentialing process. In addition, such candidates will be required to pass the new Psychiatry Certification Examination.

Got it?

Bottom line– if you are starting residency after 2007, you must pass the clinical skills evaluation several times and then take one certification exam.  Residents who started earlier– poor blokes– must take part I, pass, and then be invited to take part II.  If it is any consolation, those who are adequately prepared for part II will find it to be, in it’s own way, a fun time.  The examiners are not there to fail you; they are doing everything that they can to pass you.  Once you understand that, you will loosen up and display the confidence and breadth of knowledge to ace the exams.

Of course, some people fail part II. The way to fail the exam is to present yourself as ‘cocky,’ to argue with the examiner, to make the patient feel uncomfortable or humiliated, or to refuse to answer questions.  The examiners want to engage you in a discussion about psychiatry;  don’t let them down.  Even if you are not absolutely certain about something, let the examiner know what you are thinking.  Talk about the issues you are thinking over in your head, so that the examiners know that you are not just ‘blank’ inside.

And of course, be prepared.  I prepared the ‘psychiatry criteria’ tapes to help me to keep things straight, and they did exactly that.  They consist of a monologue, slowly recited, of psychiatric diagnoses and their criteria, presented in an orderly way.  I used the recording for board preparation by playing it over and over;  the result was that I had the criteria down cold.   When I viewed the vignettes or met with my live patient, I was noting criteria as easily as ‘shooting ducks in a barrel’ (sorry to the PETA folks– it is just a phrase!).

Whether you are facing part I or part II, be careful to watch the deadlines, get your paperwork in on time, and get a good head start on studying.  The most recent examination schedule can be viewed here.   Of course, when it is time to study, I recommend using MY recordings– they are inexpensive, direct, and well-organized.  I prepared them in order to study for my own exams, and they worked well.  They are meant to be used as a stand-alone tool– using audio only– so if you exercise with an MP3 player or have a morning commute, you will be all set.   In fact, if you have the exam somewhere ahead of you– say a few months away– now is the time to start listening.  I can promise you that if you listen to them several times over– not a difficult task– you will be miles ahead of your colleagues at exam time, whether for part I, part II, or for the clinical skills evaluations.  Do well!

I have received several questions about using the recordings for recertification.  I have not yet taken the recertification exam myself, but I have read some forum posts here and there and spoken with colleagues about the examination.  As for using these recordings, I know you will find them useful– especially the ones I’ll describe in a moment.  The main value for the recordings is that they are designed for use while driving, during time that would otherwise be wasted.  They are also considerably less expensive than other courses out there, and stack up favorably– particularly if you can pass on the Osler black plastic binder.  I saved you about $600 bucks right there!

The ‘diagnostic criteria’ recordings consist of major psychiatric diagnoses, followed by recitation of the criteria for each.  When the recertification exam asks questions like ‘which of the following are criteria for x disorder’, or gives a case and asks you to determine the diagnosis, these recordings will prove useful. The ‘QA’ recordings for child, psych, and neuro consist of PRITE-style questions, followed by a list of answers and then the correct answer.  They would be similar to studying old PRITE tests, except that the studying can be done by audio, without the need for books or reading. 

The psychopharm series may be more or less helpful depending on your confidence with medications.  The information covers the basics about the different medications used in psychiatry, with details such as the risks to pregnancy of lithium or divalproex, or the side effects of various antidepressants.

The recordings are all very ‘efficient,’ with a minimum of extra jargon.  Comments are welcome;  Good luck on your exams!

I have completed a recording of questions and answers for child psychiatry.  The format is the same as prior question/answer recordings;  questions that are found on the written board exam and on PRITE exams read slowly, followed by multiple-choice answers.  After a pause for the listenter to answer, the answer is provided.  As with all of the recordings, the child psychiatry recordings are intended to be used during one’s commute by car.  The recordings are 75 minutes long, and can be purchased on audio CD, or by instant download in MP3 format.  The MP3 can then be burned onto a CD, or transferred to your i-pod or other MP3 player.

I was asked recently about ways to reduce the size of the MP3 files;  I recommend using an ‘audio splitter’ downloaded from from cnet.com.  There are several to choose from.

Thank you for your interest, and as always, good luck on the boards!

Instant Download, $19.00:

Or on audio CD, $24.oo:

Six months ago I wrote about the change from oral board examinations in Psychiatry to a series of clinical skills assessments to be done by members of the resident’s training program.  I had some concerns at that time about the change;  I tend to do well on oral examinations and believe that with a couple helpful bits of advice, every candidate with a reasonable fund of knowledge can do well.  I have received good feedback about the approach taken in my recordings, which is to learn the basics so darn well, through repetition day after day, that intelligent discussion comes to mind automatically– even during moments of anxiety-provoked brain freeze!

My reservation about the change from Oral Board to CSA was concern over the residents own faculty performing the examinations.  On one hand such an arrangement could provide an unfair advantage, but I am more concerned over the disadvantage from being examined by someone who perhaps has negative preconceptions from prior courses or clinical work.  The change from orals to CSA seemed to drastic;  the policy in the former was to exclude anyone who had ANY knowledge of the candidate, and the new format guarantees that most or all of the examiners will know something about the candidate!  On the other hand, having knowledge of the candidate is not completely unique. I think back to my PhD disseration, which like all dissertations was presented to my thesis committee and to the university at large.

After serving as a Clinical Skills Assessment examiner several months ago, I have a better feeling about the new system.  The format is actually identical to the format of the clinical interview portion of the old Oral Boards.  The ‘vignette’ sections were eliminated, although that may be changed going forward.  I made a couple small changes to the recordings to account for the change in format, and all of my comments in prior posts remain valid– for those of you who take the time to read them!  Bottom line, I stand by my recommendation to use the recordings during your commute, ideally for weeks or even months before the exam.  Talk back to the recordings out loud to become completely familiar with the criteria for psychiatric disorders.  Doing so will guarantee your ability to provide an intelligent differential diagnosis as you run through the critera with ease!

Best of luck in your examinations and careers,

Jeffrey T Junig MD PhD

Psychiatry Oral Boards will soon be a thing of the past.  This development will no doubt cause considerable consternation for those who make a living by providing week-long practice sessions, but will be welcome news to psychiatry residents who suffer from performance anxiety!  I have mixed feelings about the news myself.   I confess to the feelings that anyone has when there is a sense that the journey has become a bit lighter for those following in one’s footsteps.  I remember similar feelings years ago when resident work hours were reduced to the limit of ‘only’ 80 hours per week!  After all, misery loves company.

But I found that I was wrong about those feelings about resident work hours.  I teach medical students now, and I realize that current grads have it as tough as I ever did.  I had to remember the name of one or two beta-blockers, I needed only a general understanding that something called ‘cytochromes’ degrade medications at the liver,  and there were no classes that required an understanding of the human genome project’!  I would guess that psychiatry residents will face new challenges that are not anticipated now. 

I do hope that there is a significant hurdle placed at some point in the process– for reasons that current psychiatry residents may not yet fully appreciate.  Right now, Psychiatry Board Certification means something.  Those residents who work hard to truly understand the most difficult aspects of the art and science of psychiatry should have for their work to ‘count.’  As a solo practice psychiatrist who does not belong to insurance panels, I must rely on providing a good product– i.e. being a good psychiatrist– to keep my practice going.  I see patients who have become fed up with what they describe as ‘psychiatry mills’ where they are hurried through appointments, are prescribed medications for reasons they do not understand, and who never feel a sense of support from the psychiatrist who has been assigned to provide their care.  I am always surprised when I ask a patient the name of his/her previous psychiatrist and the patient cannot remember the name!  The sad thing is that such an occurence is not unusual.  I encourage residents and others studying to be mental health practitioners to continue to demand a rigorous curriculum, as that is what will allow psychiatry to remain a respected field of medicine.  I also encourage individual practitioners to strive to set themselves apart by being a psychiatrist who is truly valued by your patients– not someone who just happens to be on all of the panels.

The changes in the exams mean that I will have to change the way that I market my recordings to some extent– for example the keywords ‘oral psychiatry boards’ will no longer be all that useful!  But the good news is that the recordings that I have prepared are as valuable for the new standards as they were before.  I now recommend that people consider the recordings that provide an understanding of the DSM criteria for psychiatric disorders for use earlier in their residencies;  I used to recommend the recordings for the oral boards, but now the plan is to assess competence at earlier points in the residency.  The recordings for the diagnositic criteria are useful to lay the bedrock for your psychiatric education;  I recommend listening to the recordings during your commute many times over (they are over 3 hours long, so it will take some time!) so that you have an automatic understanding of where different illnesses are categorized and the criteria required to make each diagnosis.  Once a person has a good understanding of the diagnostic criteria he/she is miles ahead in the learning process, able to focus on the details, the studies of treatment paradigms, the theories of disease… or just to more quickly finish the write-up and for once get home at a respectable hour! 

Good luck, everyone–

JJ

I have added new recordings for Psychiatry Board Preparation;  I just added a ‘questions and answers in neurology’ recording.  As always, the recordings are designed for efficiency;  I take topics that have appeared on written Psychiatry Board Exams and ask the questions, pause, and then provide the answer.  The goal is not so much to help you memorize specific glycogen storage diseases as it is to help you get a sense for what areas of neurology you have covered, and what areas you need a bit more focus on.  The recordings are almost two hours long– about the amount of neurology that most psychiatry residents can tolerate before needing to walk away for awhile!

I have also posted a ‘combo special’, with significant discounting if you purchase several of the recordings together.  As always, I appreciate your patronage, and I appreciate the nice comments that some of you have written back to me about the tapes.  I recommend that you continue to use them during you morning and afternoon drives;  using that little bit of extra time by popping the CD into the car CD player (or using an I-pod) will put you ahead of the pack, come exam time.

I have finally put together the new recordings;  As I have mentioned in the past I am trying to think of the things that I would have found useful to study for the boards.  I was going to go through the mood disorders next, but realized that trying to cover all of the disorders with a ‘shotgun’ approach would be the same old thing that is already out there.  I remember purchasing an $800 set of recordings that covered all of the different disorders;  90% of the material was obvious, another 8% was unintelligible from different accents or skipping CDs, and 2% was very helpful– but I had to listen for hours and hours to get to that part!

My hope is that by first covering ‘Q and A’ the preparing student or resident would learn the areas that need the most ‘brushing up’, and then focus on those areas for the other studying programs. These Q and A recordings consist of questions similar to those found on old Board Exams, Prites, studying guides, tests I helped make up for undergraduate studies…  and completely consistent with the questions found on the Part I Boards.  That does NOT mean that they won’t be helpful for Part II;  On the contrary the questions are similar to those asked during the newer portions of the Part II exam, and also provide the facts needed to converse about the differential diagnoses for the patient interview (e.g. how many weeks before bereavement becomes depression?).

The Q and A recordings will be released every two weeks, in a series of different categories.  This first category is ‘adult psychopathology’; future categories will include child psychiatry, forensics, emergency psychiatry, neuro, consult-liason. and others.   Each edition will contain from 110 to 120 minutes of questions and answers.

As always, the recordings are intended for use during otherwise wasted time, such as a morning or evening commute, or during a jog at the end of the day.  I simply ask the question, list the possible answers, pause for you to come up with the correct response, and then provide the correct response.  If you miss a question I suggest that you make a mental note of that section, or better yet use the myriad of recorders that are now found on I-phones, cell phones, and other hand-held devices.  Or buy a cheap voice recorder at best buy!  You will quickly identify the areas that you ahve down cold from those where you need to do a bit of review.

I welcome suggestions that would improve upon the product;  if you have nice things to say (and thank you to those of you who have already sent me those!), send them in with your name if you don’t mind.  I am realizing that for marketing purposes I should put a few of them on the site.

Thank you for your interest and for your purchase, and good luck, as always, in your studies!

Jeffrey T Junig MD PhD

Like most Board Certification examinations, the proving ground for psychiatry covers two areas.  Part I makes sure that the candidate has the ‘facts’– all of the things that are picked up during residency didactics and personal reading, including the different types of aphasia (ick), the metabolic derangements that affect brain development (ugh), or the specific pharmaco-kinetics of each therapeutic agent (I actually like that stuff!).

If you are reading this after searching for ‘part II preparation’, you have made it– you won’t neeed to really memorize that material for another ten years– for recertification! (sorry).

Part II is different– you need a totally different set of skills.  You need to think on your feet.  You need to diagnose on the ‘fly’.  You need a bit of confidence.  You need the basics down cold.

That is why I focus on these recordings so much– they are 90% of what you need!  They improve the basics– dramatically.  And they provide confidence–  Think about it–  think about how it would feel to KNOW, for CERTAIN, that the criteria will come to mind no matter how threatening the case?

If you can talk CRITERIA during the exam, and point out how the criteria match up with your patient, you are SET for Part II.