We hate to think about the possibility, but if you don't pass the Boards on your first try... what do you do? A survey of 2004-2008 Board participants demonstrated that 82% of respondents passed the Board Exam on the first attempt. Which means that almost 1 in 5 had to try again... here is their advice:

  • Of respondents who did not pass the exam on the first attempt, 46% indicated that 'studying harder' was the most crucial factor in passing a subsequent time.
  • For 32% of respondents, 'participating in a live review course' was a crucial factor.
  • Not passing the boards is a serious blow to the ego and it's important to realize that many good pathologists have struggled with the test and you just need to get up and go at it with everything you have, so that it can finally be in the rearview mirror and you can get on with your career.
  • Identify where the problem was and remedy that. Most people who are unsuccessful have a specific reason, i.e. not enough time to study, didn't get through the material, had a particular problem area that needed more attention, etc.
  • It is best to study for Boards during residency; afterwards, you will have much less time to do so.
  • Carefully review your section scores to identify weak areas and focus your study on those portions.
  • Make sure you have access to your residency's board preparation materials. (But don't bring them to the exam room!)
  • Look at lots of clinical cases -- review as much glass as possible.
  • Stay calm, focused, and don't be intimidated by the test.
  • Likewaise, do not let the anxiety of the test cloud your thought processes. Do not panic during the test. Consult a psychiatrist - a beta-blocker or other anxiolytic may be helpful.
  • Study hard in preparation... you will be surprised by how much you know.
  • Do Osler and take the exam during or right after residency if possible.
  • Go into more depth. Details matter.
  • But don't ignore the "most common" benign/malignant diagnoses of any organ system -- concentrate on Robbins for AP and Henry for CP for this material (make note cards)!
  • Use atlases heavily. Don't rely on "clues" like patient history or demographics to help guide you.
  • Get formal testing for a learning disability such as dyslexia which can affect reading speed and therefore affect test results. The board is receptive to increasing the time required for the exam if there is a formal documentation of a learning disability.
  • Pay attention to detail and stay away from the "Go to End" button.
  • Take notes on the glass slides - you can change your answers on those questions, but you can't get those boxes back.
  • Use practice questions, practice slides, practice pictures, and a positive mental attitude.
  • Study from an exam point of view, concentrating on the most esoteric AND the most common things, and not from a practical point of view, how you would approach a case in real life.
  • Take a review course again and listen to the review discs when you return. Don't wait until you feel ready to re-test. That may never happen. Just study a lot more and go to Tampa again.
  • Study board review notes from candidates who passed successfully.
  • Think twice about retaking the exam in October, assuming the first time was in May/June, unless your score was very close to passing. The short preparation time and letdown of not passing are not easy to overcome.
  • Relax before the exam and practice for the computerized microscopic pictures (try
  • Use pathology outlines as a guide and Ackerman for pictures.
  • Work hard, don't lose confidence.


  • Individual contributors
  • Extracted excerpts from linked websites.
  • [1] 2009 CAP Board Exam Survey

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