How to study for the ABA [American Board of Anesthesiology] BASIC exam13 min read

Today’s inane image of the day:

[Updated 9/2022 with TrueLearn discount for $25 off!]

Introduction

First and foremost, check out my original article on all of the resources for the in-training exam (ITE) and BASIC exam. If you opened that entry and immediately thought, TL;DR… or you only care about how to study for the BASIC exam, this is the entry for you.

Some basics about the BASIC

From the ABA:

The BASIC Examination, the first in the series of exams, will be offered to residents at the end of their CA-1 year. It focuses on the scientific basis of clinical anesthetic practice and will concentrate on content areas such as pharmacology, physiology, anatomy, anesthesia equipment and monitoring.

https://theaba.org/staged%20exams.html

There is always a summer [June] and fall [November] administration of the exam. Exact dates can be found on the ABA website. For each administration, there are two days – you have no say in which day you are going to take it [believe me, I tried to request a specific date from the ABA for my ADVANCED exam since I’m running the Medical Women’s International Association Centennial Congress [#MWIA100] during the weekend of my exam… and I got the date I didn’t want, heh].

The exam isn’t cheap – $775-$1275; sign up once they announce that you’re able to register so you don’t have to shell out an extra $500 for waiting. My program reimbursed us for this exam and the ADVANCED, so make sure you save your receipt.

The exam has 200 questions and you have 4 hours to complete it. As you’ll see from the sample questions, they’re pretty short and to the point.

How do you have any credibility to advise me?

Well, I passed my exam [first attempt, June of my CA1 year]. That’s a start, don’t you think?

I’ve also incorporated recommendations from Peter Brown’s book, “Make it Stick: The Science of Successful Learning” into my entry. For example, spaced repetition, active learning approaches, and doing questions in random mode [not doing a set of questions related only to the subject you just reviewed]. I highly recommend reading this book at some point, especially if you’re interested in a career in education.

WAMC [what are my chances] of passing? Show me the data!

Lucky you, the ABA has this useful data to guide your likelihood of success: 2017 ABA Exams Report.

Pass rates based on your ITE score:

I’d like to highlight that the norms table from the 2018 ITE shows that for CA1s, 31-32 translates into 46-55%ile. Using this information with the data presented in the table above, if your ITE score was average, you fall into the 94% BASIC pass rate [*raises hand* that was me!]. And if you are more awesome than average, you’ll most definitely pass.

If you’re curious about overall pass rate for the BASIC exam:

Here’s another table with some vital information — for the 1,696 candidates that took the exam in June 2017 [oh hey, I’m one of those candidates!], they had an 88.4% pass rate! This slightly down from the June 2016 pass rate of 90.7% [a similar document is available for 2016 through the ABA – update: the ABA changed their website in 2020 and this document is no longer easily accessible] but are still pretty good odds.

The most important thing to take away from this, is that you probably have good odds of passing, BUT you shouldn’t neglect the exam altogether! After all, it’s not a 100% pass rate.

Pick your adventure…

Anesthesiology residents come in numerous varieties and are enrolled in a diverse range of programs. This means that what works for one resident may not work for another resident. This means that the amount of time that a resident has at one program to study may not align with another resident. This also means that the availability of resources may also differ. I’m writing this entry to try to address a couple of different scenarios, but I’m delineating the different “adventures” [in a somewhat snarky manner] based on time to examination.

Here are your options [these are fancy anchor links, so either read the whole entry with all the options or jump straight down to the one that is applicable to you!]:

Gunner Style [1+ year prior to the exam]

Casual Studier [3-6 months prior to exam]

Procrastinator [1-3 months prior to the exam]

Gunner Style [1+ year prior to the exam]

If you’re seriously an intern looking into studying for the BASIC exam, I applaud your planning and motivation. I also wonder if you could send some of your ambition and drive this way to me?

Anyway, there are a ton of resources out there if you’re really more than a year out from your exam. I’d say the most difficult thing about trying to tackle studying for the BASIC exam before you’ve started clinical anesthesiology training [unless you’re at a categorical program that integrates anesthesiology rotations into your intern year or elected to do an anesthesia elective rotation] is that… well, you don’t have a ton of context or background in the material you’re studying. A lot of the material will be difficult to learn without a patient, experience or person around to explain why a topic actually matters. Either way, you can still start trying to lay the foundation for your anesthesiology practice.

If you’re at an internship that requires the anesthesiology in-training exam, then that is a good launching point for determining where you’re at. When you get your score report, there will be a page titled, “Personal Performance Report.” This page will give you “Your Percent Correct Score for Basic Items” and another one for Advanced items. For the purposes of this exam, you only care about the Basic items. At the bottom, you will have categories laid out and the # Answered Correctly. On the third page, you will get a categorized report of the questions you got wrong, with specific numbers of Basic vs Advanced items. “Clinical Subspecialties” is an Advanced-only category… so you can glance over that [but really, ignore that until 2 years later when you’re in my shoes as a CA-3].

How will this report help you? Well, you have just used this information to identify where you need to focus your attention from the ABA Content Outline. Make sure you review the areas that you got wrong and understand the concepts surrounding those keywords! There are only so many questions that can be generated about “basic” anesthesia topics, so inevitably there will be repeats.

Now, in terms of an active study plan, if I had the patience, organization, and time to study this far in advance for the BASIC exam, here’s how I’d do it:

6 months to 1 year prior to your exam, make a review book/document & flashcards out of the ABA Content Outline – Basic Topics in Anesthesiology and supplement this with questions.

Pages 4-21 include an outline of the specific keywords you will be asked on your exam. Starting a Google Document or creating Anki flashcards [this is a free program that automatically employs the spaced repetition concept for your review; it costs money to get the phone app, but this is well worth the cost] with each of the keywords and pertinent things to memorize would essentially serve as an active way to study and will be useful for ITEs during CA2 and CA3 years.

I would make a schedule [by week] so you have an idea of how long it’ll take you to get through each of the topic areas. This way you can keep yourself accountable and give yourself flexibility each week. You can then also account for your busier rotations; if you’ll be q3-4 call or an ICU rotation with a brutal stretch of nights, studying for this exam should be low on your priority list.

I recommend this approach if you have lots of time because you will be creating a study bank/book on your own schedule/time rather than paying for one later. This also gives you an opportunity to delve into the evidence and original studies related to concepts you’re learning and collect helpful references that you can pull up easily/quickly.

Just keep in mind that you may find that once you start CA1 year, you’ll feel overwhelmed with trying to learn the clinical aspect that this type of studying takes a backseat. That’s okay.

The best resources to use to create this study guide/flashcards:

1. M&M or Baby Miller – By the time you get to your BASIC exam, you should have read most of one of these books. Most institutions have library access to AccessAnesthesiology which provides online access to M&M as well as Longnecker’s Anesthesiology. During “easier” cases, it’s a good idea to read at least one or two chapters in these books to build a foundation for your anesthesia knowledge. Remember, you cannot use review books as your FIRST resource; these come after you’ve gotten an idea of the concept from a primary source.
2. OpenAnesthesia – Some keywords do not have a definition or explanation available, but this is still a great first source to find a summary and a reference to one of the classic residency textbooks [M&M or Baby Miller] so you can open up to that particular chapter and read up.
3. Faust’s Anesthesiology Review – I highly recommend this review book; the chapters are short and manageable, the information is accurate and it covers all the material you’ll need for the ITE, BASIC and ADVANCED. I’ve used this to create Anki flashcards and have annotated the margins with additional notes. I’ve yet to find glaring errors [though the reality is that most books have at least a few errata].
4. Anesthesiology Core Review – This is essentially the ABA Keywords in review book form. It’s available through AccessAnesthesiology. Although I used this book because it made me feel better about focusing on the “basic” topics that’ll be on the exam, it was frustrating to encounter typos or straight up incorrect information. If you feel confident in your knowledge base going into using this resource, you’ll be able to catch the errata, but it does make you second-guess yourself sometimes.

After I’ve gotten through 50% or more of the keywords, I’d start adding in questions. The highest yield questions available are:

1. Hall’s Anesthesia – This is a classic Q&A review book. It has stood the test of time and has a lot of the important “basic” questions you’ll encounter throughout your residency. Like any book, it has errata, but after you’ve grasped most of the concepts from your primary sources, you should be able to identify where things just “don’t sound right.” There’s also an app version of this question bank.
2. M5 – I really like this resource for earlier in residency since the answers are very thoughtful and it is split up into Basic and Advanced topics. Plus, you can save 15% off with “M5MGH2021.”
3. TrueLearn ITE Question Bank [SAVE $25 WITH MY LINK or the code “AMANDAXI”] – I highly suggest filtering out the basic subjects [you can select the subjects you’d like to create an exam from] and using random mode [see above about Brown’s book on the science of learning]. If you’re buying this question bank for the ITE, I’d do a longer subscription and use it even after the ITE. I do not recommend getting the TrueLearn BASIC question bank until you’re about 3-6 months to the exam.
4. ACE Books – You cannot filter out “basic” questions from the rest of the questions, so I put this toward the end of your resource list. It’s a great resource for ITE and overall studying.

Casual Studier [3-6 months prior to the exam]

I fell into this category – I studied for the ITE then took a long break before realizing that I didn’t have a ton of time to study for the BASIC. Looking back, I wish I had looked at my ITE breakdown of incorrect questions in my report a bit closer so I could make sure to address those obvious weaknesses. So don’t make the same mistakes I did.

The single best resource for the BASIC exam is the TrueLearn BASIC question bank.

I have heard from numerous residents that they passed by just completing the BASIC question bank and reviewing the questions they got wrong [including going back to a primary source and reviewing the concepts missed]. There are under 1000 questions in the bank, so it is manageable to do 10-20 questions a day and finish it. That’s totally doable.

The approach I took to reviewing questions I got wrong was to write down the concept as well as make Anki flashcards with similar types of questions. This ensured there was an active learning component, and also meant that I’d see the question over again to reinforce the concept. I also tried to finish the question bank at least 2-3 weeks prior to my exam date to give me time to review the incorrect questions and do them all again.

Procrastinator [1-3 months prior to the exam]

If you’ve gotten away with approaching all of your exams this way and did at least average on the ITE, you’ll probably pass the BASIC as long as you complete 1 full resource [i.e. question bank, review book, etc] that addresses the ABA BASIC Keywords/Concepts. I want to mention that if you scored less than 20-30%ile on the ITE and you’re scheduled for the June administration, I’d seriously consider talking with your program to determine whether you’ll be adequately prepared to take the exam. There is a later administration date in November — it may make more sense to take more time to prepare.

My advice from the Casual Studier category above applies here — finish TrueLearn’s BASIC question bank, and make sure to review what you got wrong. The biggest mistake people make is picking up a new resource and only getting through part of it; you need to be exposed to all the concepts before you take the exam.

Parting advice

The BASIC exam turned out to be more straightforward than I had originally anticipated. Most people pass. Many questions that you see in TrueLearn you will see on the exam [in some flavor]. Many concepts are repeated on the exam itself. There are curveballs [there always are!], but you have to go into the exam recognizing that this and just take your best guess.

You got this!

As always, feel free to email me with any questions, concerns or just to get some positive words of affirmation. I love hearing from readers [and colleagues!].