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An Open Letter to PBO Diplomate Aspirants

By Anonymous

Dear Readers,

I would like to share with you all my experience in taking the much dreaded PBO exam. It was undoubtedly the most difficult hurdle I had to overcome and a day doesn't pass that I am thankful that I did what I did--hurdle it and pass it.

Before taking the exam I heard numerous horror stories about it, such as intelligent doctors flunking the exam and some taking it multiple times and giving up eventually. But there was one train of thought that stuck in my mind, that was, the test won't make you a better doctor and that you can do your business (being a doctor) without it. With the fear in my mind and this outlook -- I deferred taking the exam year after year -- until one day I decided to take it. It took me 6 years before I got the right frame of mind and the courage to take the exam.

So one fine afternoon in February I started reviewing book after book lecture after lecture -- I slowly crept back to residency mode -- trying to remember those fuzzy terms and funny acronyms that by themselves were difficult to remember. As I ventured into the yesteryear routine of having to hit the books, I realized that I was too slow compared to the new graduates. They could answer questions with a drop of a hat – quickly, precisely with matching cockiness as if to say "alam mo yun?" ("didn't you know that?"). I didn't mind it really -- I just went on with my business of trying to pack my sluggish brain with as much ophthalmological knowledge as possible-not to mention clinical optics and evidence based medicine -- subjects that I barely touched as a resident. Day after day I was relearning the basics again.

Then the day came -- I took the exam. I was nervous and a bit ashamed that I was with younger doctors. But I just told myself, "relax its just a test." When I finished the exam-I was literally exhausted. It was hard -- very hard. I asked other takers -- all of them shared the same sentiment. I slowly gained confidence and I said to myself -- "pasado ako dito, nahirapan naman lahat." ("I passed this one. Everyone found it difficult anyway")

The day of the results came -- we waited anxiously for it until 11pm. Then came the bad news -- I failed. It hit me hard -- really hard. There was confusion at first -- "is this really happening to me?". Then hope – "baka may appeal pa" ("maybe I can ask for an appeal"). Then despair "I am a failure." Then anger "I don't need this!"

It was one of the most difficult times of my career as a doctor. It was easy to make up reasons and to put the blame on others -- the board, maybe the other takers had tips -- so on and so forth… It took me a month before I recovered from that debacle. I slowly stood up and frisked the dust off my shoulders (after falling on the ground so to speak) and went on and carried on with my life. But there was something different in me -- there was something stinging -- something I couldn't evade --that saying of having an annoying monkey on my back seemed to persist. It was hard seeing colleagues -- sometimes I even avoided meeting them altogether. It was really hard. I struggled thru it all and wanted to forget about the exam.

Then came December of the following year -- I was facing a crossroad between having to take the exam again or forgetting about it and just continuing with my life. It was really easy to do the latter -- letting go. With encouragement from my friends and family -- I soldiered on and registered.

I joined a new batch this time during the review. But this batch was different. They showed a different type of determination -- a type that was contagious -- a type that showed an "all for one, one for all" attitude. We went thru reviewing as if we were engaged in a tug of war -- everyone pulling for each and everyone --everyone filling in the gaps in knowledge for the benefit of everyone. It was during this time that I realized that passing this exam would require an extraordinary effort from me. I had to revamp my lifestyle with an aim to attain absolute focus on the task. First I had to detach myself from daily distractions, namely -- my family and my work. So I ended up renting a place all to myself for 3 months. Then more importantly I had to remove all fear and all anger -- all negative vibes about myself, the board etc.

I started slowly -- as each day passed and as each book read I felt I was learning slowly but effectively. Soon I found myself answering like the new graduates --quickly with precision -- and most importantly with confidence. As a month went by, I was enjoying my new routine of studying by myself. I found it more effective so I ended up doing just that -- living like a monk.

Then the day came -- it was all the same -- I was nervous, shy and scared. There were even times when I was talking to myself -- trying to ease the stress of having to retake the dreaded exam.

As I answered question after question -- as I flipped page after page -- it felt different -- it felt weird -- I found myself having an easy time answering the questions -- answering with quickness, precision and with surprising confidence -- just like a newly graduated resident.

When the first half of the test was over I went over the room where lunch was being served. There I mingled with the other examinees. I was expecting to hear them say that the exam was easy so far. To my great surprise they were stating the opposite. This made me feel a bit anxious. I was thinking then that I might have been overly confident. But when I finished the second half of the test, I felt the same. The exam ended with me feeling happy inside that the new technique seemed to have worked. I knew I was better this time around -- a whole lot better in fact -- because when the results came out 2 weeks after, I made it! I was jubilant, to say the least. I was relieved.

The oral exams came along and it was to me more difficult. We employed a different technique but the same "one for all- all for one'' attitude prevailed during our review sessions. We passed the orals too.

There is much said about the board exam before one takes it. There are stories that encourage you -- yet there are also stories that scare you.

I have learned a lot since passing the PBO diplomate exam and I wish to share this to the readers and more importantly the ones who are going to take it and those who have failed it -- once or more than once.

To the new graduating residents -- all I can say is take it as soon as you finish residency training. You can't be more prepared than the time you finish residency for the obvious reason that the concepts are fresh in your mind still and not dumped into the deep abyss of your aging brain. You can't afford to have the "ay oo nga pala" ("oh no, that's right") experience -- it will hurt you -- not for this exam specially the orals -- no room for that -- I swear. It will make a world of difference if you have that "all for one-one for all" attitude. Care for your fellow review mates -- treat them like fellow soldiers going to war -- no one must be left behind. I assure you it will reap benefits come exam time.

Now for those who have failed -- I feel you. I know how it feels. I've been there and I have done that. It sucks to say the least. I encourage you to take it again because there is this sense of completeness and satisfaction when you pass it. But I think the more important message is, believe it or not -- it actually will make you a better physician. I admit that after studying for it like my life depended on it made me a better clinician. My charts were getting filled with additional examinations. When conversing with colleagues -- I had tons to say about procedures, diagnoses and the like. There was a point when I was telling myself, "all that hard work did me good too in clinical practice". Yes I am eating my own words but I have to say that it's the truth. I'm just being honest. I even dare say that you owe it to yourself to pass this test -- "be the best that you can be".

There are multiple reasons why some give up completely, I think most will have the pride factor somewhere in there. Others will have the fear of failure hanging over their heads just like the sword of Damocles. These factors are distractions which prevent one from effectively studying properly.

So what will it take for people like us who finished way before these new breed of ophthalmologists to pass the exam? It will take a monstrous effort on your part. Just imagine, you have to get your mind set to the point as if you just finished residency. You have to relearn everything plus you have to learn the new stuff with them -- Lasik, medical ethics and optics to mention a few. Is it impossible to do? I believe it's not -- I did it.

There are some important things that you should keep in mind. Failing doesn't make you a lesser doctor. It only means "kulang pa". Just like in martial arts nasa brown belt ka na -- konti na lang, black na ("if you've made it to brown belt—you're just one step away from black belt"). Konting (Persevere in) training pa. Shield yourself from self persecution because you are the only one doing it to yourself. I had friends who failed and they seem to be avoiding me lately. I said to myself, "I was like this before!" Don't be ashamed to flunk. It is a hard exam. But you owe it to yourself to give it everything you've got. Don't go in there just for the sake of trying it out -- odds will surely be against you.

If I could put my secret of passing into 2 words it would be FOCUS and DETERMINATION. Anything less would be like fighting Manny Pacquiao with both hands tied to your back.

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