Anesthesiology Boards: A Survival Guide.  By Michelle Starr.New York, Churchill Livingstone, 2000. Pages: 450. Price $49.95.

Glenn P. Gravlee, M.D., 

As stated in the preface, the mission of the author was to create a cross between a narrative-style, key word–based board examination review text and a question-and-answer type of review book. To achieve this goal, she wrote 173 short chapters, most often 2–3 pages long, emphasizing lists of facts. The topics included are based on careful review of key word lists from recent American Board of Anesthesiology/American Society of Anesthesiologists (ABA/ASA) Anesthesiology In-training Examinations. To address the question-and-answer aspect, she concludes most of the chapters with 1–3 multiple choice study questions. The author suggests in her preface that the book is designed for written board examination preparation, which clearly is true, so the title Anesthesiology Boards  could be viewed as somewhat misleading. A more accurate title might be “A Key Word–based Study Guide for the Written Anesthesiology Board Examination,” but a publisher undoubtedly would balk at the length of that title and its likely diminished appeal to impulse buyers craving a quick fix for their (written and oral) board examination study woes.

Dr. Starr has “covered the waterfront” nicely in her key word topic selection. To the reviewer, this type of bullet-point format is more tedious to follow than concisely written narrative text. There are highlighted “pearls” in some chapters, as well as infrequent line diagrams. Coverage of complex topics tends to be too superficial to convey understanding. Inaccuracies are present, which is not surprising in a comprehensive, single-author, unreferenced textbook. Rather, it defies imagination that such a text would lack inaccuracies. This is why most comprehensive textbooks use a multiauthor approach, selecting authors most often for their recognized expertise on a subject. A number of spelling errors were also found.

The council that prepares the Anesthesiology In-training Examination developed key words to help anesthesiology program directors identify areas in which their teaching programs might not be “keeping up with the Joneses” and to help residents direct their study toward areas of weakness. Residency programs, authors, and residents take a leap of faith if they assume that the topics in the key words comprehensively represent the body of knowledge encompassed in the examination. Although clearly a strong relation exists between key words and examination content, this assumption weakens when one recognizes that the key words are selected after the question has been written and edited and that these historical key words do not necessarily predict the content of the next examination. Writing key words is also an imperfect process, often failing to reflect subtleties in the questions, partly because each phrase is limited to 35 characters. The examination questions derive from assignments addressing specific subjects in the Content Outline for the ABA/ASA In-training Examination, which truly reflects the body of knowledge encompassed in the written examination of the American Board of Anesthesiology. Although key words undoubtedly have some preparatory value, obsessing over them or using them as a primary study strategy places the cart before the horse.

The sample questions at the end of the chapters unfortunately leave much to be desired. The majority would not survive the first editing cut for the ABA/ASA In-training Examination. Sometimes, important aspects of the question are not discussed in the chapter. Common question problems include ambiguity and inaccuracy. The formatting of the questions is inconsistent, sometimes using K-type question numbering for A-type questions, which could be confusing for those who may have difficulty remembering the difference between A-type (single answer, choices lettered) and K-type (more than one answer may be correct, choices numbered) questions. The belief of this reviewer is that reviewing board-type multiple choice questions most often uses limited study time less efficiently than reading a narrative-style text or a review article and tends to lead more to memorization than to understanding. To a lesser degree, bullet-point review of key words shares the same flaw. Some candidates for the written and oral board examinations may be laboring under the mistaken impression that they can prepare adequately using the “Cliff’s Notes” approach taken in this book. The harsh reality is that there is no substitute for understanding subjects in depth, and such understanding is not obtained from Anesthesiology Boards . I suspect that the author would agree, so the best use of this text might be as a quick reference on a wide range of topics. One would be hard-pressed to endure reading it cover-to-cover, and such an effort would not be time well-spent.