Start early. What do I be my early? Beginning of your third year. You have obviously been reading quite a bit during your first couple of years, but it was highly likely related to patient care. While this is obviously crucial in building your clinical skills, and providing the appropriate care for patients, unless you were working 24/7 in a tertiary care center, you will not come across all clinical scenarios.
How many vascular lymphomas or gamma / delta natural killer cell / T-cell lymphomas have you managed personally? May be none, but you know basic breast cancer management very well. I remember when I graduated, I felt amazingly comfortable managing acute leukemias but less so breast cancer. As an attending, I had the privilege of treating more than 50 breast cancers in my first 2 years, and had yet to manage an acute leukemia.
On the flip side, you may have trained at an institution that offered a lot more bread and butter oncology, and are ready for clinical practice, but perhaps did not have exposure to some of the more exotic “Zebras”. Whatever is your situation, you need to be prepared for both situations on the board exam. To reiterate, the purpose of the board exam is to ensure that a practicing medical oncologist, has a baseline level of clinical proficiency to treat a vast majority of medical oncology cases.
As a general oncologist, you may come across a single case of gastric type cervical cancer, during a 5-year period, but may have treated 200 breast cancer cases by that point. The authors of the exam want to make sure you understand breast cancer management very well but can recognize a rare subtype of cervical cancer that may need a tertiary care referral. So how can one prepare?
Set a calendar for yourself. There are approximately 60 sections spanning both hematology and medical oncology. It is best to set a 12-month calendar, during your final year of fellowship, while you still have access to your faculty for questions. I would recommend sticking to a very strict schedule, to make sure you have covered all the topics by the end of the year. Make sure to keep track of areas you may have weaknesses in, or never had a chance to review during the summer and fall before the exam.
Obviously, not all sections are created equal. Lymphoma is clearly a much broader topic than pancreatic cancer, and you may need to commit more than one week but be careful to not let this pattern consume half your year, and you have only covered for different types of conditions. You are much better off knowing 60 topics at the 70th percentile than 30 topics at the 99th percentile and the others at the 50th percentile. We all have a habit of focusing on our strengths and weakness, and that is not an appropriate strategy for acing the exam.
In conclusion, set a calendar for yourself, and stick to it.
Good luck !!!