NEXT>>>

So then after passing the written...you get to proceed to the clinical portion.

However, if by some chance you don't pass with a score of >75% this is the end of LA for you...today. Instead of proceeding to the clinical portion, you go and register yourself for the next upcoming LA exam and try again! You re-register on the WREB website, and re-pay. And you should also eat something chocolate.

Prior to entering the clinic, you have another short orientation. The examiners read from a script again, perform a skit...yes an actual skit! It was pretty good too. They have some different verbage than us, but what you know is acceptable.
Here is our verbage:
1. Find your landmark insert the bevel just into the tissue and state: AT SITE OF PENETRATION
they look, get in your way (put just hold still) and on examiner says..."I see" the other examiner says, "I see. Proceed" It is important to pause and hold until you get the "proceed."

2. You then proceed to the depth and angle of your injection. Checking to make sure your angulation and depth are correct and you state: AT SITE OF DEPOSITION
Just be sure you are SURE that everything is correct before you announce this.
The examiners look, get in your way, and say the same as they did before...as long as there isn't a problem. In which case they will ask you to withdraw, and you can get nervous at this point or at any point before you have completed the injection.

3. Then after you get the "proceed" you announce: ASPIRATING you make a visible movement with your thumb against the opposing side of the ring, moving the plunger slightly, see small air bubbles, and no blood. This should take you about 4-5 seconds. Then, you announce: NEGATIVE ASPIRATION or in my case POSITIVE ASPIRATION you then handle the positive aspiration. You can either choose to withdraw and re-attempt for which you will state: Permission to withdraw and get another set up. or if the positive aspiration is slight (and in my case you are on your second positive and out of set ups) you can state: I am going to withdraw slightly and redirect. Just be sure to not completely withdraw from the tissue. Then you redirect and pray that you get a negative.
4. Then you state: DEPOSITING SOLUTION and they watch your rate of deposit, and after they have seen what they need to see they tell you to "go ahead and withdraw" but this time it is ok to hear that.

5. Then an examiner will watch you break down and dispose your sharps. There is some confusion as to which comes first...needle then cartridge or cartridge then needle. Both actually are acceptable...at least they were for us. Malamed says cartridge then needle, but we are taught needle then cartridge. The important part is keeping your little fingers far away from the front side of your card and not dropping your card into the sharps container.

For this exam you demonstrate 2 injections. The IA and PSA. (You will eventually know what these mean.) The injections have certain criteria that must be met, and it is outlined in your CANDIDATE GUIDE. You can decide which injection you would like to give (meaning RIGHT or LEFT)
Here is my advice for the clinical LA Board Exam:

1. Use a pt you can count on. They need to be on time, not be too nervous, understand how important this is, and not have a latex allergy or a herpetic lesion.


2. They cannot have any previous puncture marks, so if you are going to use them, don't inject them at least 2 weeks prior.


3. You can use each other (classmates). However, your exams must be 2 hrs apart from each other. And keep in mind that you can't all use each other. Some people will have to re-attempt after failing an injection, and it is handy to have a classmate as a backup.


4. Know how to handle a positive aspiration. If you have never had a positive aspiration: practice how you would handle the situation. You know...pretend/role play-everyone's favorite. This could be the difference of a pass or fail.


5. Have at least 3 syringes ready to go. 4 is best, but at least 3. Borrow from your peer pal, pass them along, or borrow some from your office if you can.
   

Everyone needs to come prepared with a cashier's check for $120 made out to WREB. This is just in case you fail an injection. You can pay and re-attempt one or both of the injections at this time, and pass. But after a re-attempt, and yet another fail, you have to re-register (and of course re-pay) and complete the clinical portion again at another exam location.

Hopefully, all will go well. You will handle the BOTH the positive aspirations, walk out of the clinic with your heart pounding, and look in your envelope and see this:





And take home your $120 cashier's check!