ABPN® Exam: What’s in Scope and Out of Scope on the Psychiatry Board Exams?

As part of our ongoing quality assurance, I’ve been reviewing and addressing comments left by learners regarding specific multiple-choice questions that make up our ABPN® exam psychiatry 2300+ question QBank. (Our QBank allows each learner to comment on any and all QBank questions.)

One of the most common comments I’m encountering is one that questions whether the topic of the QBank question is in the scope of the exam, meaning whether it is a learning point that is tested on the ABPN® exam. This type of comment expressing concern and frustration is almost always left on a QBank question that assesses some aspect of “Neuroscience and Mechanisms of Disease,” the first category of ABPN’s exam Dimension 2. Let me explain.

ABPN® Exam Topics From the Psychiatry Certification Exam Blueprint

On all ABPN Psychiatry Exams, there are two dimensions of exam topics. Dimension 1 is primarily a list of psychiatric disorders that are tested, which is basically every disorder in the DSM-5, whereas Dimension 2 is primarily a list of the specific aspects of psychiatric disorders that are tested. Both Dimension 1 and 2 lists also provide the percentage of exam questions associated with each of their listed categories.

Dimension 2 List of Categories From the Psychiatry Certification Exam

What you quickly notice is that categories A, C, D, and E refer to the aspects of psychiatric disorders that are most heavily tested. While there are nine total categories, these four account for on average 80% of all exam questions related to psychiatric disorders. The remaining five categories account for the remaining 20% of exam disorder-based questions. (These are additional exam questions that do not focus on psychiatric disorders per se but on aspects of clinical practice, such as informed consent, patient abandonment, malpractice, ethics, and various aspects of professionalism.)

Out of the nine Dimension 2 categories, the category has the highest number of comments communicating concern, disagreement, and frustration regarding particular Beat The Boards! QBank multiple-choice questions in the category “Neuroscience and Mechanisms of Disease” – the first line in the table above. Because this category is associated with on average 20% of disorder-based exam questions, we cannot ignore the concerns and frustrations raised by ABPN exam candidates.

Why is this category of ABPN® exam questions the one that raises the most concern? I think it is because this category is the furthest removed from clinical care and, from the perspective of providing good clinical care to patients, seems partially or fully irrelevant to being a competent psychiatrist. These questions seem like nitty-picky ‘factoids’ of, at best, questionable relevance.

Common comments of frustration and disagreement I’ve run across include:

• “Why would I need to know this?”
• “This is not relevant to clinical practice. No one is taught this.”
• “This is not very relevant to the practice of clinical psychiatry”

The best answer I can give in response to the comments above is that the Beat The Boards! QBank questions that lead to frustration because of not being “relevant to clinical practice” NEVERTHELESS STILL SHOW UP ON THE EXAM! You can argue with the ABPN® about what they should include on their board exams, but I would recommend finding better ways of spending your time. You’re not going to win.

The good news is that a) the ABPN® lets us all know that their exams include these more basic science-type questions that are perhaps not directly clinically relevant – so it should be no surprise to the exam-taker – and b) the Beat The Boards! QBank questions ARE ALIGNED to ABPN® exam topics. So, as exam candidates, we have both the foreknowledge of what to study for the exam and the opportunity to study it.

You’re dying to see some examples, I’m sure.

ABPN Exams From the Category of “Neuroscience and Mechanisms of Disease”

• Genetics of early-onset familial Alzheimer’s disease
• The role of GABA in post-partum depression and the effect post-partum depression medications (like brexanolone and zuranolone) have on GABA neurotransmission
• The structural neuroimaging findings of sporadic and of variant Creutzfeldt Jakob Disease
• The content of Pick’s bodies and their location in the brain
• The genetic heritability pattern of Huntington’s disease
• The role that estrogen and progesterone sensitivities (that lead to serotonin and GABA disturbances) play in the development of premenstrual dysphoric disorder
• The role that apolipoprotein E alleles play in susceptibility to Alzheimer’s disease
• The autosomal dominant mutation that leads to Fragile X syndrome
• The pathophysiology of alcohol withdrawal delirium
• The 4 dopamine brain pathways that are affected by antipsychotics and the clinical effects associated with antipsychotics’ effects on each pathway
• The most common neuroimaging findings in autism, ADHD, schizophrenia, reading disorder, and other disorders
• The type of brain cell that shows the most abnormalities in autism spectrum disorder
• The cellular metabolic pathways that are impaired in Wernicke’s encephalopathy and the role that deficiency of thiamine plays in the development of this condition
• The role of functional neuroimaging in differentiating brain lesions due to lymphoma vs toxoplasmosis
• The functional neuroimaging pattern of disturbance seen in Pick’s disease vs Alzheimer’s disease vs cortical cerebrovascular disease
• The pathophysiology of various presentations of Lewy body disease
• The role of orexin and orexin-producing neurons in development of narcolepsy type 1
• The pathophysiology of delirium from organophosphate poisoning
• What are prions, and what turns them from benign to deadly cellular components
• The pathophysiology of chronic traumatic encephalopathy
• How leuprolide, a luteinizing hormone-releasing hormone agonist, is effective in treating pedophilia
• The amino acid deficiency in anorexia is implicated in the development of depression and other psychiatric symptoms
• The pathophysiology and physical exam findings in Wilson’s disease

I can go on with hundreds of other detailed examples, but this list gives a representative sample. (You’re welcome to share other topic examples with me, and I’ll share them in a future post.)

But now, let me show you the subcategories of the Dimension 2 category “Neuroscience and Mechanisms of Disease” listed in the ABPN® Psychiatry Certification Exam blueprint.

ABPN® Exam: Subcategories of the Dimension 2 category “Neuroscience and Mechanisms of Disease”

As you can see, this is a broad and heterogeneous list of topics and provides intuitive support to the fact that 20% on average of all disorder-based questions fall into this single category. There’s a lot to cover here!

To summarize: ABPN exams are not restricted to “clinically relevant” questions.

If you have questions or comments, email me at drjack “at” americanphysician “dot” com. Thanks and take care.

Yours In Exam Success,

Jack Krasuski, MD

Executive Director

American Physician Institute for Advanced Professional Studies

If you need help preparing to take your ABPN exams, you can access our board review courses for psychiatry and neurology at Beat the Boards. For all other medical specialties, visit The Pass Machine.