Dr. Gerry Lee (Host): Hello, everyone, and welcome to a special episode of Allergy Talk, a podcast by the American College of Allergy, Asthma, and Immunology. Well, it's fall and we have a new class of Allergy and Immunology fellows. And the graduating fellows are studying busily for the ABAI Board Certification exam this fall. So, I'm excited to be joined by the editorial team of the newly released 5th Edition of the ACAAI Review of the Allergy and Immunology Boards, where we'll talk about how you can prepare for the upcoming board exam.

And I know you just graduated, so you might as well start earning CME. You can earn CME by listening to this podcast. For information about that, head over to education.acaai.org/allergytalk. Again, my name is Gerry Lee. I'm the co-host of Allergy Talk. I'm an Associate Professor and the Fellowship Program Director at Emory University. And I'm the Editor-in-Chief of the ACAAI Review for the Allergy and Immunology Boards. I'm joined by the two Senior Editors for the Board Review Book, starting with Dr. Joyce Yu. Joyce, welcome to Allergy Talk. Tell the audience about yourself.

Dr. Joyce Yu: Hi, everyone. I'm Joyce Yu, and I'm an Associate Professor of Pediatrics at Columbia University, and I've been helping Gerry as a Senior Editor for the past couple editions of the Board Review Book.

Host: And in the third chair, I'd like to welcome the other senior editor, Dr. Ben Prince. Ben, thank you so much for coming. Tell the audience about yourself.

Dr. Ben Price: Hey, everyone. My name is Ben Prince, and I am actually an Associate Professor of Pediatrics at the Ohio State University College of Medicine. And I'm actually also an Associate Division Chief of Research for our Division of Allergy and Immunology at Nationwide Children's Hospital in Columbus, Ohio, so dead center in that state. This is actually the second time around that I've had the opportunity to work with both Gerry and Joyce, and it's really been a pleasure.

Host: You know what? It is fun. Boy, it's a lot of work, but you know what? At the end of it, I think we're all really proud about what came out. And it's the sort of thing that, when I was a little boy, this would have been super helpful. But let's get started. Let's think back. We're all old folks here. I wanted to get started talking about our own experiences taking the board exam. Joyce, let's start with you. What do you remember about board examinations like the ABAI?

Dr. Joyce Yu: As always, like everyone else, it's just tons of stress. Lots of stress preparing for and taking any kind of test, obviously. Especially the boards were really stressful. I was in New York City in my fellowship, and I was also in New York City for my peds board exam. So, I remember, you know, going to go to all these certain coffee shops, trying to find a quiet place to study. Checking out the coffee shops, doing some work, not doing some work, taking some naps, and doing it all over again for the AI boards.

Host: it's just hard to just dedicate it, sit down, and study. I know exactly how you're feeling.

Dr. Joyce Yu: It's really hard to focus.

Host: Yes, I know. And it can use a caffeine to keep yourself alert. Ben, how about you? What memories do you have about that time in your life?

Dr. Ben Price: So, I'm also a peds-trained allergist-immunologist, and so my only prior experience in studying for boards was for the American Board of Pediatrics exam. For all of those fellows out there listening, I definitely studied more for that exam. And it was by far harder than the ABAI exam. So, just to relieve some stress there. Not saying you shouldn't study for this exam. It is still a tough exam, but that exam was pretty difficult. When I think back to like my preparation, I feel very blessed. I think my fellowship that I did at Northwestern prepared me pretty well. I think I got a really good sort of foundation of knowledge, but I definitely remember endless nights going through reading, rereading, those textbooks like Abbas, Middleton's, over and over again.

And then, I definitely did partake in the joint American College Quad AI Board Review Course. And then, I distinctly remember, actually, my parents have a condo on Lake Erie, which is not too far. It's up north in Ohio. And I spent about a week to two weeks just secluded there, just going through my notes from that. And then, just spending time with actually the Second edition of the ACAAI Board Review Book, which Gerry was also an editor of. But I'm old, so going back to when I studied for sort of the step exams and things like that, the First Aid was my go to. And so, I held that second edition to that same high esteem. That's where I felt like if I knew that, I'd be okay.

But last fun fact, the ABAI exam, it was the first exam that I didn't need a number two pencil. So, I've told this to fellows and they're like, "What?" But when I took my American Pediatric Board exam, I actually had to do the bubble sheet, the Scantron.

Host: Me too.

Dr. Joyce Yu: It was paper on one, computer on the other. You're like, "What happened?"

Dr. Gerry Lee (Host): I know. It was a two day affair.

Dr. Ben Price: I can't remember if mine was or not, maybe it was, maybe I just blacked that out. Maybe it was just a bad time.

Host: I was in New York. There was like a hotel I stayed at. There was a big ballroom of stressed out pediatric residents with tables. There was like four blocks. And I think the experimental block was the second block at the end of day one, because block two for me was so hard. We're talking to like thousand-yard stairs of just shell-shocked pediatric residents just walking out after day one saying like, "What just happened?" By the way, I don't know if any first year fellows are about to take the peds boards. I'm not trying to cause any anxiety. Sorry, it's just that two-day written exam. Oh, boy.

Dr. Joyce Yu: Yes. It was actually stressful. I did the same thing. We had to go book a hotel. We had to drive out there. It was a whole to do.

Dr. Ben Price: So, maybe not the toughest thing, but like one notable factor in transitioning to like the ABAI exam and a computer test was, I don't know, when you took the Scantron test, did you have your own little way of designating the questions you wanted to go back to and look at it again, like you put a little dot to the side of the scan sheet? There's ways of doing it, but I felt a little more clunky on a computer. And again, maybe that's just my age and whatnot, but that was probably one of the biggest things that I was like, "All right, how am I going to designate questions that if I'm not 100% sure I want to go back and look at if I have enough time on a computer?" That was a big change.

Host: The only thing I want to add is that I had the pleasure of also taking the ABIM, so I'm med-peds. And I'm going to just tell you, anyone who hasn't taken the medicine exam yet , the medicine exam is just nowhere in the same orbit as ABP or ABAI. It is so much easier. I was, basically, a third year fellow. And I just studied one board review mix app thing. And I did it right. I thought that I probably didn't study much as I should have, but I did pretty well.

So, bottom line is that, you know, we know what to do. We've taken these exams all our lives. But I think our goal at the end of this podcast is just to give you the resources so that we've minimized the stress and increased the confidence. And there's just so much stuff out there. We just want to make sure that no one who's coming up for board certification doesn't know the resources available. So, I think we should absolutely get into it and just go for it. So, let's talk about the exam itself. Joyce, just give us a broad overview of the ABAI initial certification.

Dr. Joyce Yu: So, the certification exam includes 225 questions. It's taken in the seven hours that's divided over two sessions. It's taken at one of those Pearson VUE test centers that you have to schedule a visit with. It's divided into basically two major sections, 25% is devoted to basic science and 75% is devoted to clinical science.

Host: And that was a change, right, Ben? How did the board exam change in the last few years?

Dr. Ben Price: So, in 2021, they actually made significant changes, the board made significant changes to the blueprint, which is sort of the outline of what to expect for those that have not taken the exam before. So, I also participate on the IT exam committee meeting, as I know, a few of you guys do as well. And the first time that we saw the impact of that was actually at one of the discussions of that committee, because we put forth that ITE exam every year, and we want to make sure that we're reflecting what we would expect that those board questions to be. Because, I mean, the whole purpose of that committee is to prepare our fellows and to show them where they stand with regard to preparation for the boards. We all want, If possible, 100% of our fellows to pass that exam.

And so, I first saw the impact there. And then really the impetus of those changes culminated when we were coming together. And I think we started some initial emails between Joyce, Gerry, and I. But then, we actually sat down together at, I think, it was either the college or the Quad meeting. And we started to tear apart our old book that followed the old blueprint. And we realized, "Man, this is completely different." They rearranged things drastically, which I think actually is a good thing for the most part. So, what they did, I've looked at it. And truly, I think, they made four big changes.

So, the first thing is what Joyce already mentioned. They really drastically downplayed the amount of basic science on the exam. So, it used to be 35%, it's now 25%. They also changed it. So before, it was split into two categories that used to be like clinical science and then basic science. And they really did a good job of integrating your basic science in to the clinical categories so that you'd have actually two broad areas within the blueprint, which are the first is the allergy hypersensitivity area. And then, the second being the immunological area, with the basic science pieces sort of integrated amongst both of those. They wanted to make sure that the basic science stuff was still there, but they wanted to incorporate it into a more clinically oriented manner.

So, the third change that they made was they did do a couple of tweaks with regard to the percentages of different questions with it, you'd see on the boards like where they would be coming from, and they wanted to reflect what the standard practicing allergist would see. They removed some of those basic laboratory methodology concepts that most people probably don't need to know unless you're running a lab. They also de-emphasized some of those things that other subspecialties need to care about, not that we don't need to know about autoantibodies, but we need to know all of the 30, 40 different autoantibodies and what they might mean. So, they tried to deemphasize some of that stuff.

The last thing that they did was they included a new area, which was sort of this emerging national health priority category. And it's the end of the blueprint. It's actually the end of our Board Review Book. And actually, this was really thoughtful, because I think right now, and maybe like over the last couple of years where that fit with COVID and socioeconomic stuff, but it really opens the door for where our field is going over the next few years. And so, it gives them that flexibility.

As I was looking through stuff, because I haven't looked at this stuff for a while, because I haven't taken the board for a while, I realized that this sort of committee that did this, one of the people on the committee is actually my Division Chief, Mitch Grayson. So, I reached out to him, I was like, "Hey, what's up?" And one thing that actually came from that is, he told me, "I had no idea." They actually spent like two or three years going through this. So, it wasn't just a couple month thing. It was a long process with several notable allergists and immunologists in the field. And one of the most interesting things that he said was, "You might think that it's easy to think about what you would define as the standard practicing allergist-immunologist you would know. But when you come down and you try to fit that all into a blueprint, It becomes very difficult," because we all are so subspecialized, right? Like, we have our A hat, we have our I hat. Some of us trend one way or the other. And so, to think about how that would impact all of us as a whole, I'm not jealous, I'm glad I wasn't on that committee. But I think, overall, they did a good job. They made a lot more work for us. But think in the end, it turned out pretty good.

Host: No, I agree. Clearly, our specialty continues to evolve. And I think some of the older folks in our specialty may sort of mourn some of the de-emphasis on basic science. But at the end of the day, we are trying to see what is relevant and useful knowledge that applies to the diseases that we treat.

And so, by a de-emphasis on the words, it's not de-emphasizing the importance of mechanism, but it's really trying to make sure we are focusing on the practical, applied basic science immunology to our field, and of course, being cognizant of new innovations that impact our and being prepared for that outside. So, I think it was a great revision.

Dr. Joyce Yu: You still need to know your basic science to apply to the clinical science, for sure. It's not just know one and know the other. So, you have to kind of know how to apply it. How does it fit into your practice? So, it makes it more relevant to our practice anyways, in terms of how we arrange the boards, in terms of how we practice clinical practice.

Dr. Ben Price: I think actually that the really tough part is where we are now might be completely different than where we are in five years from now, ten years from now, if we didn't have dupilumab. We don't think that IL-4 and IL-13 is all that important clinically, but actually it very much so is. My point is not to emphasize dupilumab, but to point out we're in a very interesting and, I think, exciting future of our field, where we have tools in our toolkit that we never had before in biologics and small molecule medications, JAK inhibitors and whatnot that can really make huge improvements in both the quality of life as well as the signs and symptoms of disease in our patients. So, who knows what that's going to look like in another five to ten years?

Dr. Joyce Yu: But Allergy and Immunology, you know, has always been the field, right? We're sort of always at the frontline field where we've applied basic science, and it's not just learn basic science and do some clinical medicine, it's like actually we're applying that knowledge into our clinical practice. So, this is a perfect example of that.

Host: Yeah. I think I agree with everything that you're saying. And that's what makes us all excited about this field. Fellows, you picked the right field. That's basically what I wanted to tell you. All right. So, I want to address the elephant in the room. All fellows want to know about is passing. Okay. So, joyce, what do we know about the passing standard for the board exam?

Dr. Joyce Yu: The Conjoint Standards Committee, so with representation from the ABAI, the ABIM and the ABP, recommends the passing grade for the certification and the MOC, so Maintenance of Certification Examinations to the board, first determination. So since 2003, the ABAI sets this criterion reference standard prior to the examination, which verifies a candidate's ability level, so basically their score, relative to the performance on the content of the examination. The passing score is computed from an estimate or the probability of an average candidate answering each item correctly. So therefore, theoretically, everyone can pass or everyone can fail the examination. The validity of the individual's performance on examination is basically secured by every means available to make sure the results are valid. Generally speaking, between 2018 and 2023, we've seen pass rates somewhere in the 80s to mid 90s, and it's estimated that you need properly around high 50s, 57-60% correct raw score to pass, and that's what's estimated back in 2023.

Host: I just want to mention to the fellows out there, for reference, the internal medicine board exam, the ABIM, the pass rate is about the same. It's about 87 to 93. American Board of Pediatrics has been low as 80%. It's 80-87%. So, I just want to let you know we weren't making that up there. It is definitely a harder exam.

Dr. Joyce Yu: The peds board has really random questions.

Host: Yeah, yeah. I think that that's challenging, because, as a pediatrician, you are tasked to see a lot of healthy kids and then pick out the one that's not healthy. That's a very tough job.

Dr. Ben Price: It's actually why I didn't want to be a general pediatrician, to be honest with you. I feel like I would have gotten lulled into the pathway of like normal exam, normal exam and pick out that one needle in that haystack, that's one example. But I mean, I love the field that we're in. But yeah, I don't envy our general pediatricians. They have a really daunting task ahead of them.

Host: I do think that, especially with that change we mentioned, that passing rate going to the mid 90s, 94% over the last year, I think just shows you how the board has listened to what's relevant to fellows, and how I think the training that we're doing mirrors what the board wants us to know. I think it's personally a reflection of fellowship training. I'm just going to pat myself on the back as a program director. Okay. Sorry.

Let's talk about preparation. You may have guessed, we're going to talk about the Board Review Book. And again, I think we should all have full disclosure here, we all received compensation for doing the Board Review Book. But if you want to talk about motivations, it really wasn't compensation that makes me want to work on the Board Review Book. I think the things that I get out of working on the Board Review Book is, number one, I learn a lot. Let me tell you something. I'm editor-in-chief. I read every page of that book. And number two, if I want to stay employed, my fellows have to pass the boards. So like, I have a vested interest and job security to make the Board Review Book as good as possible for my continued employment in the university. So, I just want everyone to know the disclosures, but there's multiple motivations. I think we could be honest, if we were doing this for the money, this is a really bad endeavor.

Dr. Ben Price: The amount of time that we spent going through this and vetting it, and not just us, we had some amazing authors who did a fantastic job and we asked them to blow it up. We said, "Listen, we're not going to just take the old edition and update it. We want to take the new ABAI blueprint, and let's blow it up. Let's make our book so it's actually going to prepare the fellows." Because I think the other thing too is what I found out on a lot of our meetings that we've had in the preparation of this book is that this book is actually not just utilized for our fellows and board preparation. It's utilized all over the country for people that are still in practicing Allergy, because it's not to say Middleton's isn't great, but like it's more up-to-date than Middleton's. It's vetted more frequently than that. And so, a lot of people reference this frequently. And so, I think it's been really fun to work on. And yes, I learned a lot. I didn't realize how much I didn't know before. Every time, it's just very eye-opening of how much more you need to know and how much more you need to learn.

Host: Now, Ben, you reminded me to mention this, and I'm glad that you brought it up. I think it is worth mentioning the history of this book. So, the first edition was published in 2010. And the editor-in-chief at that time was Tao Le. Tao Le, for many of you who went through medical school, clearly know one of the premier board books, like the Bibles, USMLE Step 1 Board Prep is first aid for the USMLE. So, Tao started First Aid when he was in medical school, and he continues to publish that book. You know, Tao was one of my mentors, and I'm very fortunate that he was so influential in my career. And so, Tao went into Allergy and Immunology. So, some people don't know that Tao is an allergist and immunologist. He was in the little Smithtown and now, he's in Louisville, Kentucky. And so, when I joined the University of Louisville, I met him and he talked about this need for fellows for a preparation book for the ABAI exam, and clearly that's his expertise. So, he actually collaborated with the ACAAI, and he had a publishing arm with an editorial team and the editorial software, they used Annotate. And he contracted with the ACAAI to make the first edition. His co-senior editors at the time was Dr. Brett Haymore and Dr. Vivian Hernandez-Trujillo. And I'm going to tell you, I'd absolutely use the first edition when I was starting with the boards.

Anyways, the rest is history. I think even back then, they found that over 90% of graduating FITs use that text. So, it was a very instant success. The year afterward, as Ben mentioned, I got to participate in the second edition as an editor. And then, Tao let me take over as editor-in-chief for the third edition. That's when I invited Joyce and Dave Stukus. And then, Dave Stukus handed the reign to Ben Prince and the rest is history. I think the major changes I made when I took over as editor-in-chief was they had inline flashcards, but I think we'll talk about this later. But memory retrieval is key to long-term memory retention. So, there is a flashcard accompaniment to the Board Review Book that we implemented with the third edition. And I really think that is a critical piece. We're trying to maximize the use of your time when using overview resources. So, Ben, you already hinted on this, but we had to look at the previous edition, this new ABAI revision to the blueprint and implement it into the new edition. So, I guess we'll start with you, Joyce. What sections did you oversee in the book and how did you respond to the changes by the ABAI?

Dr. Joyce Yu: So, I've been the senior editor for the basic science section. And it has already been touched on. The major change for this new edition that we just came out with is that a lot of the basic science concepts have been sort of folded into and meshed in with the clinical science sections. So now, that they're not there anymore, it's just they just sort of like reborn to a different shape, a different form, which I think has been much, much better. It's much more seamless. There's more integration between the two basic science and the clinical sciences. However, we still have lots of tables where people have to memorize those CD markers, the cytokines, the chemokines, all those things that have to be memorized. We still have those there. That's why like it's helpful for people in clinical practice when they had to go to a quick reference like, "I need to find this one random marker." Boom, right here.

Host: That's a huge service. How about you, Ben? What parts of the book did you oversee and what major changes stick out to you?

Dr. Ben Price: So for both the last edition and this edition, I tackled a lot of the allergy and hypersensitivity principles and disorders content. So, I think most of like the closet allergist hat. But I will say, this time around, we truly had to work together because we had to incorporate different things because pathophysiology and basic science is now incorporated into these sections. So, we really tried to integrate stuff that before it was split between you had clinical science and basic science, and that was completely separate. And now, we kind of tried to integrate as appropriately clinically, which is what I think what the whole purpose of the reformulation of the blueprint was for, into the Board Review Book so that we could better prepare people. So, I think it really challenged us in a good way to make this better and to work together to figure out how things best fit in this production of the book.

Host: Our approach reflects that integration that the ABAI is encouraging of really melting together. They're not like in isolation. So, I'll talk about my section. So, I did immunologic disorders, pharmacotherapeutic allergies, and I was assigned the new section on emerging health priorities. Well, we can start with emerging health priorities first. So, that section was brand new. And I want to tell you the last edition came out around 2020 and we had like a sentence on COVID, like a sentence. I'm not kidding. And so, what have we learned? We've learned about COVID and vulnerable populations and COVID vaccine reactions, and we learned about some of the therapeutics for immune deficient patients and so on. So like, there's an expanded COVID section. What have we learned about disparities? We've learned so much about the social determinants of health and the factors important in how there's unequal outcomes in our patients. And so, we have expanded discussion on that.

I would say some of the core diseases that really have come to the forefront are the mast cell related diseases. I think that's more relevant in our practice. I think hereditary alpha tryptasemia was not even described back then as an entity. But we had expanded sections on mast cell activation and the new definition is mastocytosis. And of course, you know, I don't need to tell you about just the exploding field of Immunology in the age of genetic testing. So, obviously, we do our best to summarize it in a table form, so that it's easier to reference, inspired by the IUIS. But those are just a small fraction of some of the changes we make, along with all the e-studies and biologic therapies that have come out and small medical therapies have come out at the time. So, there's a lot to look forward to. Obviously, if you look at the fourth edition and the fifth edition, they're actually quite different. And that just shows you in just three, four years, like how crazy this field is. That's what makes it so exciting. That's what makes this field so exciting.

Dr. Joyce Yu: Yeah. It's not even just organizationally different, it's just content is completely different. I can't believe you remember there's a line on COVID in the last edition. I was like, "Wow, Gerry!"

Host: I looked, I was so curious. I'm like, "Was there COVID in the last edition?" And I found this sentence. It was shocking.

Dr. Ben Price: You know what's crazy is not that I'm actually looking forward to this right now, but when we do the next edition, we're all still together, that chapter is probably going to be the most different, because I think that's honestly the board's way of saying what is relevant. And so, COVID is not going to be relevant anymore at that point in time. And I don't know what's going to be relevant, probably going to be another virus.

Dr. Joyce Yu: Yeah, another pandemic.

Host: Oh, goodness gracious. Oh, please, people. I want to say that none of this would be possible without a lot of the support from the senior leadership from the college. I would say I've been very blessed to just propose educational projects and the college is just so interested in supporting our specialty, the Board Review Book and the collaboration with Tao Le is one of them. And I really want to give them credit and talk about the wide range of resources the college provides to those wanting to do as best they can on the board certification exam. So Joyce, if you could just spend some time and talk about what are the other offerings sponsored by the ACAAI?

Dr. Joyce Yu: Yeah. So, there's loads of resources that the ACAAI has provided. First, there's the board review corner, so that has over 350 review questions. I've done it, and I think a lot of us have also done it as well too. It's been very helpful for preparation for the boards. There's the Allergy and Immunology medicine self-assessment module. So, there's two modules. There's volume one and volume two. So, they're to basically help A&I providers with getting new knowledge as well as affirming old knowledge, current knowledge. As well, there's the online board review course, which used to be in-person, now it's online. And that's co-sponsored with the Quad AI. and that's, I think, basically every single fellow's probably gone through that board online review course. There's the FIT and the new Allergist Toolkit that's on the college website. And then, obviously, though, not to be missed, the COLA lectures that a lot of fellows do in their fellowships. So, lots of resources.

Host: If there's one thing fellows are always interested in is, "Can I get more questions?" And I mean, between the Board Review Corner and the two AIM modules, the college has not only a lot of questions, but just the resources for you to learn from them. And I think it's really great that they're continuing to crank these out because that assessment piece is so important. But, you know, obviously, there's so many people invested in the success for fellows. Ben, outside of the college, what are some other Board Review resources that you would recommend?

Dr. Ben Price: So, I think actually a good place to start is looking at your IT score. So, those fellows that are sort of finalizing things, finishing up, I actually asked one of my, older fellows, who now I have the privilege of working with day to day as a colleague, Gerry, you probably see this, but I'm not a program director, so I don't see exactly what they see and what I saw back when I was a fellow is probably a lot different because I know as a part of the IT committee, we're trying to do a lot better job of providing feedback on where fellows get answers wrong. And instead of being vague, giving them an idea of what concepts they might not be getting correctly so that they can go back and actually utilize that information to learn from it and then do better because, again, the whole point of it is to pass the boards. But she gave me her IT score. She showed it to me. And it's actually pretty cool.

So, it gives you a question breakdown on what you got correct and what you didn't in various categories within the domains of basic science and clinic science, as well as they also give you exactly the learning objectives of what questions you got incorrectly so that you can go back and look at it again. I think that's really helpful because you're not going to get a better direct feedback on what you're strong at and what you're weak at. Because in the end, you're still going to be strong and weak in certain areas, but you want to bring the weak areas up, because the goal is to pass the boards. So, I'd start there. But then, I think the other highlights where board questions come from are going to be practice parameters. Certainly, the textbooks, Middleton's, Abbas, Janeway, even though they're not going to come from our Board Review Book, we try to do a good job of referencing those textbooks. There's the workgroup reports from the Quad AI, the American College Yardsticks, which are really good at giving you updated information on how to clinically treat a specific disease state, the CAS case conference webinars, which come out usually like once a month, but you can go back and, actually, you can look at them. They're recorded. You can watch them. They're really, really good. And a lot of times, various leaders in the field of Immunology are present on those. And I can tell you, I learn a lot just from listening to those in general, and I'm not trying to take the boards anymore, but just from a clinical practice standpoint.

And then, another thing that honestly I wasn't as aware about, but the Quad AI actually has a self-assessment area that they put retired IT questions that you can go and look at. There's, I think, about 11 different quizzes that you can sign up for. They have around 10 questions each. It's free if you're Quad AI member, which why not? Especially if you're a fellow, if it's free, why not do it? I think it can be helpful to sort of highlight areas where you might need to know a little bit more. Whether they're truly reflective on where board questions are going, going forward, because there are older questions, hard to say, but certainly worth a look at as well.

Host: I think bottom line is there's just so much stuff available. I really wanted to have one place where fellows can reference all the rich amount of resources the major societies are doing to try to uplift our specialty and support our people. And I'm really grateful for all those things. But I want to close this podcast not about what's available, but how best to use them, because I think it's really important to talk about the best evidence-based educational strategies, which we use when we're trying to study for tests and encourage long-term retention. So, there's a lot of educational research about this. And Joyce, I'd love for you to comment about what do we know about are the best strategies to study for a test like the boards.

Dr. Joyce Yu: Now, we all have done different things to try to keep the information retained in our brains. But, you know, some of the recommended study strategies, one, doing practice testing. So, that's where you do self-testing to recall any previous information from memory. So, using things such as flashcards, which we will touch on more, or practice questions, which we have touched on. So, that would be considered practice testing.

Another one's called distributed practice, and that's where you spread out your studying over several shorter study sessions instead of one long ginormous marathon session. And that has been proven to help you retain your information better. Another recommended study strategy is called interleaved practice, and that's when you mix different types of materials or different types of problems in a single-study session. Do a little bit of like maybe a flashcard, maybe do a little bit of review, so a couple different kind of methods of studying onto one so you're not doing one thing at once.

And then, this other recommended study strategy is called elaborative interrogation. So, the idea is basically you learn the concept, you learn a fact. But then, you have to kind of practice explaining it to yourself why the concept is true or the fact is true. So, it kind of helps you basically understand it better. And by explaining, it helps you kind of retain information.

And then lastly, another recommended study strategy is considered self-explanation, where you basically learn a material, you pick up the material, you basically memorize the material, since we're all very good memorizers. But then, you try to explain the material, put it into your own words, and integrate all that new information that you just learned into what you already learned. And by integrating all of that, that helps you learn it, remember it, retain it, and hopefully do better on your boards.

Host: That's why it was like so essential for us to include the flashcard product and to have the Board Review Corner and the AEM products for multiple choice questions. Because retrieval practice, practice testing is like the number one strategy. There's so many lectures we attend. You walk out of that room, and the knowledge gained in that lecture is just completely gone. There has to be some sort of activity after any learning activity, but we try to recall it, and that's good feedback for you. Then, you recognize what you don't retain, and that challenges you to learn it again, and it just feedback for yourself as you retest yourself. And, you know, medical students are really good at this. They swear by Anki and other flashcard products. They live on that stuff. So, I think medical students know what they're doing, I just want to let you know.

Dr. Ben Price: I actually think that our field has come a long way in the last, even like five to 10 years in this area. Because when I was a fellow studying for the boards, I didn't have a lot of questions. I didn't have aim. I didn't have these resources, which I think are-- I mean, I'm biased because I'm involved in them, but I honestly think they're phenomenal. I see what other people write. It's people putting like blood, sweat, and tears in not just the question, but the answer explanations. And I remember studying for the USMLE and other things, there was like USMLE World, there was Kaplan. And I learned so much from those, just the questions when I got them wrong, looking at the answers. There wasn't a lot of that in our field five, 10 years ago. And now, there actually is more. And I have a feeling that there's going to be even more in the next five years or so. I agree, Gerry, that's how I learned the best. I think that's how a lot of people learn the best, is actually putting it to the grind, answering questions, seeing what you do and what you don't know, and then learning why you thought something or didn't get something correctly.

Dr. Joyce Yu: We've gone a long way from just rote memorization, that's what we're good at. But you know, you can only retain so much. So, I think these other study strategies will help you retain even more, understand the information even more, right? So, I think understanding is to help you to kind of integrate it. That's how you remember it.

Host: What a great transition! Because I think we have to caution fellows about wasting time on ineffective study strategies. So Ben, I want to throw it to you. There's educational research have shown certain study strategies that are embraced by students that actually don't help them. So, what are those?

Dr. Ben Price: Yeah. So, some of those traps that you could fall into. First is the reading text again and again. I kind of call this the checking boxes. If you read it so many times, you check the boxes, you're going to do well on an exam. Not necessarily true. You have to understand the information.

 I think it's important to understand how you learn. So, there are a lot of effective and ineffective strategies, but I think you need to learn how you learn and apply the effective strategies that might work best for you. So, some of these strategies that you might think like my next point was going to be, those that highlight, highlight, highlight, that's not me. I don't do that. But if you highlight as a part of designating certain information, that might be helpful. If you have an entire book that's highlighted, that's probably not as helpful. And so, those people that highlight the entire page, you're starting to try to learn through osmosis of highlighting, and it's probably not going to be all that helpful.

Another strategy that might not be all that helpful is writing summaries of text. And not that the principle is not there, you're trying to take information and then spit it back out, but it's probably a poor investment to return ratio. The amount of time that you take learning, reading, and then writing it out is a lot of time, and might not give you the best bang for your buck.

Mnemonics, there are some situations that can certainly help. But I think for the most part, it's been shown that if you understand the concept, the principle, and the application of how things work together, then not only will you do better long term, but then as more things are known about that, you can kind of apply it and broaden your understanding. So, think of taking that flashlight and broadening it out and learning the bigger picture. And then, people that want to just read or listen to things and create these mental images, probably not the most effective studying technique in the end.

Host: So if there really is a take home message, whatever study approach that you decide to take on, retrieval practice where you test yourself, it has to be part of it. I think that that's just the bottom line. And some of those resources may not be available comprehensively. So, I do encourage fellows to use existing flashcard resources or make your own worksheets and have yourself fill it in, because you really have to try to recall it from memory to convince yourself that you've retained information. Otherwise, you have no idea until, well, frankly, you're in the exam room. So, you don't want to wait until then until you figure out if you retained something or not.

Okay. Well, these were all super helpful tips. I'm always paranoid I missed anything. Joyce, any last minute tips for our fellows?

Dr. Joyce Yu: Just as I said, it was very, very stressful. You kind of have to also, in a way, and ironically, kind of enjoy your studying, right? Because this is information that you need to know for your career. This is information that you need to know for your daily practice. And this is going to become a part of you, basically. So, I think, studying to know like, "This is what I'm going to be practicing." So doing it that way, I think it's very helpful, rather than just thinking like, "This is like a tour, this is something I'm going to forget for the rest of my life," which is actually the complete opposite of that.

Dr. Ben Price: I hate to say this because, again, it sounds biased, but I think starting early. So if I was a first year fellow right now, I'd actually go buy the book. I'd go buy the fifth edition. This is where I probably shouldn't say that, but I truly would because you start to build that knowledge base and I remember when I was at least in med school and First Aid was big and I would take notes in class and put it all in one place. But I think that the early you start, the more times you hear something, the more it's solidified. There's certainly going to be things that you're going to have to go through, in the few weeks before you take the exam, sort of those rogue memorization pieces. And that's where the, I think, the flashcards are helpful. But as far as the concepts, those bigger principles, if you can start that early on where you're just sort of refining things and adding a little things here and there at the end, I think you're going to minimize your stress. And think back to what Gerry said, that in the end, this is not the most difficult exam in the world, but you truly do need to prepare for it. You can't just show up and expect to just pass it, because there is a lot to know. And I think all of us really want to utilize this information to make sure that we are going out into the field as the best allergist-immunologist that we can be.

Host: Hear, hear! I absolutely agree with that, and I really appreciate everyone's tips. I would be very remiss If I didn't give a big thank you to the 30 authors who poured in blood, sweat, and tears, and even more big thanks to the managing editor. So, the managing editor is Cathy Frail. Cathy Frail, what does a managing editor do? Well, managing editors herd cats. Academic physicians are cats, and they're very busy, and she has to keep a project like this on track. So, I think we started this sometime in the spring of '23, and we cranked it out, and we finished the final proofs in January of '24. And that accelerated timescale only happens when you have a managing editor who knows what they're doing, works extremely hard. And I could not do this job without Cathy Frail. So, kudos to her.

Thank you so much for joining this special Board Review episode of Allergy Talk. If you did like this podcast, please rate us on Apple Music or however you listen to Apple podcasts. Give us some feedback. If you have any corrections suggestions on how to study for the boards or other resources we didn't mention, the email is AllergyTalk, one word, @ACAAI.org. And if you graduated your fellowship, you might as well start collecting CME credit. The website for that is education.acaai.org/allergytalk.

Joyce, Ben, I love working with you all. I always have fun with you all. Thank you so much for sharing your thoughts.

Dr. Joyce Yu: Great to work with you, Gerry.

Dr. Ben Price: Yeah. Thanks so much, Gerry. This was fun.

Host: All right. Have a wonderful day, everyone.

Disclaimer: The ACAAI is presenting this podcast for educational purposes only. It is not medical advice or intended to replace the judgment of a licensed physician. The college is not responsible for any claims related to the procedures, professionals, products, or methods discussed in the podcast, and it does not approve or endorse any products, professionals, services, or methods that might be referenced.

Today's speakers have the following disclosures. Dr. Lee has been a speaker for Novartis, Dr. Prince has done data monitoring for Eli Lilly, and Dr. Yu does not have any relevant disclosures.