Overview of the Oral Examination

Candidates for the ADBA Oral Examination are residency graduates who have displayed a high level of knowledge in the field of anesthesiology gained from both program training and independent study and have successfully completed the ADBA Written Examination. The dialogue format of the oral examination allows the candidate to further demonstrate his or her ability to assess and manage a wide range of patients presenting for anesthesia treatment, as well as effectively communicate these issues with both patients and colleagues.

The ADBA recognizes that there are differences in the didactic training and clinical experience between residency programs, and that there may be multiple approaches to anesthetic management. However, the ability to analyze and act expediently in all situations is seen as fundamental characteristics of the Diplomate. The oral examination encompasses several aspects of anesthetic management, including preoperative assessment, intraoperative management, and management of emergencies.

Applications for Oral Examination must be postmarked 60 days prior to the date of examination.

Conduct of the Exam
The oral examination is organized into three separate sessions, with each session covering a general topic outlined below. Each session lasts approximately 40 minutes, is conducted by two examiners, and will involve two or more cases. The order of the sessions varies from candidate to candidate and there may be a wait period between sessions. Candidates will be given case scenarios which they may briefly review, and will be asked to describe their rationale for management of each scenario. As each case scenario progresses, the candidate may request additional relevant information to aid in their assessment. The focus of each discussion may also change as new issues develop in a given case.

Session Topics

(1) Preoperative Evaluation
     This section assesses the thought processes by which the candidate determines the anesthetic risk and possible modifications to anesthetic management for patients with various medical and physical conditions. Several case scenarios will be presented. For each case scenario presented, information will be available to the candidate including expanded medical history information, physical examination findings, results of diagnostic tests, and other related information, only as it is requested by the candidate.

(2) Intraoperative Management
     This section assesses the decision-making process by which the candidate conducts safe and appropriate anesthetic care for different types of dental, oral or maxillofacial surgical procedures, including adjunctive procedures such are iliac crest bone graft or costochondral graft harvest, for patients of varying medical complexity in both office-based as well as operating room settings. Discussion may include advantages and disadvantages of different anesthetic plans and techniques as well as monitoring options and preparations for anticipated complications. Two or more cases will be presented.

(3) Emergency management
     This section focuses on the recognition and management of a variety of acute emergencies and complications that may occur at any time during the perioperative experience. These may include, for example, airway emergencies, unfavorable medication reactions, and/or unexpected physiologic responses. Two or more cases will be presented.

Grading
Grading is done separately by each examiner; then scores are averaged for a final score for each session. A minimum final score of 4 in each session is required for an overall passing grade. A score of less than 4 in any single session will result in failure of the oral examination.

The grading scale is as follows:

7 = outstanding performance
5 = acceptable performance with non-critical errors or omissions
3 = problematic performance with excessive non critical errors or omissions
1 = weak performance with critical error(s)

Points to Consider by the Candidate
While a solid base of factual knowledge is necessary, the ability to apply that knowledge clinically and adapt appropriately is seen as most important for the successful completion of this examination. It is hoped that the candidate can comfortably anticipate and manage deviations from normal routine anesthetic care. It is also important for the candidate to communicate his or her thoughts to the examiners clearly and effectively. Otherwise, it can be difficult for the examiners to evaluate the candidate. For example, extremely slow responses, or excessive questioning of examiners, may not allow enough time for the full examination, and may not give the examiners enough information to adequately assess the candidate and lead to failure. A Diplomate should also be able to reasonably, concisely and clearly communicate and defend a course of action.

Preparation for the Oral Examination
Candidates are encouraged during their training and practice experiences to engage in active discussion and study, an action which should serve them well in their future capacity as a dentist anesthesiologist Diplomate.

In addition, the American Society of Dentist Anesthesiologists provides a Mock Oral Board Examination for dentist anesthesiologists at their annual Dental Anesthesiology Review Course in September. The goal of this course is not to mimic the exact ADBA oral examination but rather to give the applicant experience in being challenged by colleagues in a formal setting to explain and defend their practice decisions. See the ASDA web site at www.asdahq.org for more information.

Conflict of Interest

It is the long-standing policy of the ADBA to avoid any real or perceived conflict of interest regarding examiners for the oral examination. Examiners are not allowed to serve if the candidate is a former resident, current co-worker, close personal friend or relative. Additionally, if the candidate feels that any examiner has a real or perceived conflict of interest, a new examiner will be appointed without prejudice to the candidate.