Preparing for the Board Certified Oncology Pharmacist (BCOP) Examination

Christine Cambareri, PharmD BCOP BCPS
Clinical Pharmacist Specialist in Hematology/Oncology
Hospital of the University of Pennsylvania
Philadelphia, PA

Kirollos S. Hanna, PharmD BCOP BCPS
Hematology/Oncology Clinical Pharmacist
University of Minnesota Medical Center and Mayo Clinic
Minneapolis, MN

Eve-Michelle Segal, PharmD BCOP
Clinical Oncology Pharmacist
University of Washington Medical Center/Seattle Cancer Care Alliance
Seattle, WA

Three oncology pharmacists who have obtained BCOP certification share their tips on preparing to take the exam.

What year did you finish residency?

Cambareri: I completed my PGY-2 specialty oncology residency in 2015.
Hanna: I completed my PGY-2 specialty oncology residency in 2016.
Segal: I completed my PGY-2 specialty oncology residency in 2013.

When did you pass your BCOP examination?

Cambareri: I passed the exam in the fall of 2015.
Hanna: I passed the exam in the fall of 2016.
Segal: I passed the exam in 2016.

How did you decide when to take your BCOP exam?

Cambareri: I decided to take the BCOP test the fall after I completed my residency training because of how familiar I felt with the diversity of topics in hematology/oncology at that point in my professional career. I was also going into a position working with solid tumor outpatients, and before shifting my mindset completely to that area, I wanted to harness the residency experiences I had just had in pediatrics, hematology, and inpatient care and use the time I had between completing my residency and starting my new position to focus on studying.
Hanna: I took my BCOP examination the fall following residency because I felt I was well prepared during my training to sit for the test, and I was aware of the examination style and format from having sat for the Board Certified Pharmacotherapy Specialist (BCPS) exam after my PGY-1 training.
Segal: I waited 2 years after I completed my residency before I took the BCOP exam. I did this because I felt that I needed to develop and hone my practice skills. Unfortunately, it took more than one attempt to pass my BCOP exam, but I did succeed in 2016. According to the Board of Pharmacy Specialties (BPS) website, the purpose of the exam is to “validate that a pharmacist has the advanced knowledge and experience to optimize outcomes for patients with malignant diseases.” My residency more than adequately prepared me for the foundational content on the exam. However, one critical item was missing, and that was experience. For this domain, I would need to function autonomously as a clinical oncology pharmacist, answering pertinent drug information questions, recognizing and responding to complex patient issues, and assisting in the design of oncology care plans.

What, if anything, did you do during your residency that helped you prepare for taking the BCOP exam?

Cambareri: Personally, I study and learn best by making handouts and taking notes. I felt that the handouts and notes I had made and kept up to date throughout the year for topic discussions with tables, pictures, references, and de-identified patient case examples served as my peripheral brain of experience. These were a huge help when I reviewed them in tandem with the other study materials I had while preparing for the BCOP exam.
Hanna: During my PGY-2 training, my program provided me with the American College of Clinical Pharmacy (ACCP)/American Society of Health-System Pharmacists (ASHP) Oncology Pharmacy Preparatory Review Course to serve as a reference throughout the year. This course is designed to help oncology pharmacy practitioners prepare for the BPS Oncology Pharmacy Specialty Certification examination and obtain broad and detailed updates to their knowledge in oncology. During the first half of residency, weekly discussions with my program director covered different topics in an open-conversation format, and it was expected that the residents would lead the topic discussions to ensure a solid foundational knowledge of the material during the latter half of the residency year. I used the days leading up to the discussions to read the chapter and used guidelines, manuscripts, and video material to research concepts I did not understand.
Segal: You have numerous opportunities to prepare for the exam while you are completing your residency. Take advantage of the learning opportunities provided to you when your interprofessional colleagues ask a question about a drug. Another strategy is to use active learning while staffing. Staffing is a great opportunity to apply your learning to individual patients. While verifying orders, remind yourself of important elements of your learning such as drug class, mechanism of action, dose-limiting toxicities, and drug metabolism. Having a firm foundation in the knowledge of specific medication properties will help tremendously both during your residency and as you prepare for the BCOP exam.

Looking back after taking the BCOP, what would you have done differently during your residency?

Cambareri: In retrospect, I wish I had looked at all the areas I would be tested in on the BCOP exam and noted the less common malignancies and supportive care issues that fall outside of the ASHP requirements for residency training. I would have ensured that I had exposure to these topics and discussed them during my residency training.
Hanna: During the long 60-day wait for the results after I took the BCOP exam, I realized that I could have studied differently during residency. I could have placed a stronger emphasis on reviewing national guidelines (for example, those from the National Comprehensive Cancer Network [NCCN] and the American Society for Clinical Oncology [ASCO]) and focused more on strong or category-1 recommendations. The content of the exam was heavily focused on scenarios seen in day-to-day practice and the role of the clinical oncology pharmacist in treatment, management, and patient education.
Segal: Hindsight is 20/20, but one way to enhance your experience during residency and gear it toward preparing for the exam is to constantly ask questions of your preceptors and yourself as you gather responses to questions about drugs or prepare for topic discussions. This will help foster a deeper understanding of a specific topic and set the stage for active learning.

After your residency, what approaches did you take to prepare for the BCOP exam? For example, what resources did you use or would you recommend for studying? What study routine or schedule did you follow? In retrospect, which tactics were helpful, and which ones weren’t?

Cambareri: After I completed my training, I devised a plan of home study that included compiling and dividing by subject all the topic discussions I did during residency, the most recent ACCP/ASHP Oncology Pharmacy Preparatory Review and Recertification Course for Oncology, and NCCN guidelines. I then made a schedule of review and used the size of the topics to decide how much time to allot to them. To help keep up my motivation, I alternated between studying topics that were difficult for me and those that were comfortable for me. I saved reviewing biostatistics until the end so that all the formulas would stay fresh in my mind. While studying, I made a one-page note per topic, so that as I began to progress through the topics, I could review those pages at the beginning of every study session and benefit from the constant repetition. These one-pagers covered the areas I struggled with and also the major points related to the disease. Having a reasonable schedule and these one-pagers kept me on task and helped me continually review while I studied. By the end of my studying, I had condensed the many pages I had printed to about 20 pages, which made it much easier for me to review and focus in the days leading up to the exam.
Hanna: Following residency, I felt well prepared to sit for the exam; however, it was important for me to obtain the new ACCP/ASHP review course materials (generally released annually in June) and run through the material another time. I felt that this would add to my knowledge base, help me outline the updated material, and aid in solidifying the education I had received from my residency. My study methods included reading through a chapter and watching the provided review video as a guide. I dedicated a 2- or 3-hour window each day for studying. With regard to statistics, I wrote key concepts and equations in a notebook to use for review. Additionally, I reviewed the BCPS review course chapter on statistics because the main concepts did not differ from those for the BCOP.
The ACCP/ASHP Oncology Pharmacy Preparatory Review Course was the main resource I used to study for the examination. Preceptor- and resident-led discussions allowed me to build a solid foundation during residency training. The BPS’s BCOP examination is designed to test concepts that are foundational for oncology pharmacy practice.
Segal: I used a variety of resources to prepare for the BCOP exam. These ranged from developing outlines and highlighting these outlines with all the colors of the rainbow to purchasing review courses. Ultimately, what I found to be most effective was the ACCP/ASHP review course, the High-Yield Med Reviews webinar on statistics, review of drug monographs, review of guideline recommendations, sample questions from the BPS website, and lots of repetition.
The ACCP/ASHP review course is probably one of the most useful tools for preparing and reviewing for the BCOP exam. The course walks a reader through the entire management of a disease state. Although the book content is excellent and thorough, I found the audio recordings of the lectures to be extremely helpful. I would often listen to the lectures daily while working out at the gym or driving home from work. This form of repetition would help keep me on track and ensure that information remained fresh. The ACCP/ASHP review course isn’t without its potential drawbacks, though. There is the potential for the newly graduated resident to study the wrong thing, such as learning the entire TNM staging for breast cancer. It’s important for the test taker to remember that this is a test of practice and application—it’s about applying knowledge of literature to specific patients or determining appropriate treatment and care plans for a patient. As a pharmacist, you are the drug expert. It is imperative that you know how to apply your drug knowledge to a specific patient or treatment algorithm.
I found the statistics webinar from High-Yield Med Reviews to be an excellent resource for biostatistics. The content was pertinent, and it was presented in a way that was easy to understand. Of course, it is also important that pharmacists review the most current guidelines on supportive care.

What other tips do you have for successfully passing the exam?

Cambareri: I think knowing how best you learn and study is key. I personally do better alone and through making notes and handouts. However, if you learn best in groups or through lectures, sync your study schedule with the method that works best for you and give yourself a reasonable schedule and enough time to prepare. I also think it’s important to remember while preparing that you definitely know more than you think you do—and take comfort from that. It’s also important to know and accept that you can’t possibly know everything. However, the most important thing to remember is that the training and real-life experiences you have had in oncology have armed you well with the deductive reasoning and critical-thinking processes needed to take and pass this certification exam.
Hanna: Several elements are important to consider while preparing for the exam. BPS uses a rigorous review process in its analysis of the questions to ensure that the material is heavily supported by a strong body of literature. Therefore, questions on the examination tend not to fall in the “gray area” and are concepts that a clinical oncology pharmacist should know. As an example, one is more likely to be tested on a category-1 recommendation (based on high-level evidence) from the NCCN rather than on a category-2B or category-3 recommendation (based on lower-level evidence).
It is also important to note that BPS does not expect one to have memorized large randomized controlled trials and meta-analyses. It is unlikely that you will be asked to recall a specific data point or outcome from a trial unless it is practice changing. Instead, BPS is likely to assess examinees’ ability to critique and review provided data points in assessing various outcome measures. While studying from the ACCP/ASHP review course (both book and videos), I found it often difficult to distinguish between these elements. It is expected that faculty members have different teaching styles; however, some were significantly more statistically focused regarding trials and outcomes than others. I found this difference in approach to be stressful at times, and it skewed my perception of the exam. It is important to remain focused on the overall general concepts. For example, if a faculty member chooses to discuss the clinical trials of checkpoint inhibitors in second-line metastatic bladder cancer (IMvigor 210, CheckMate 275, Keynote 045, etc.), remember that although these data are important, they support the use of drugs that are a category-2B recommendation in this setting rather than pembrolizumab (category 1). The takeaway point here would be differentiating pembrolizumab from other agents as a category-1 recommendation.
Segal: I would recommend that pharmacists who are preparing for board certification spend time reviewing the most current ASCO and NCCN guidelines for supportive care as well as survivorship management. Last—though it may sound silly to say this—as a pharmacist, you must know your drugs. It is imperative that pharmacists have a thorough understanding of each anticancer agent’s mechanism of action, dosing, administration dose-limiting toxicities, potential dosing modifications because of renal or hepatic impairment, and adverse-effect profile. Residents should start building a library of information on available anticancer agents and refer to it often. For practice questions, I found that the past sample test questions from BPS were a useful resource for how questions might be framed. Answering the ACCP/ASHP review course questions is also an effective way to test your knowledge.
Studying with a group may be an effective way to stay on track and will allow you to consult other colleagues about specific disease management. If you have difficulties finding a study partner, I encourage you to post on the HOPA listserv. Other pharmacists are often also in need of study partners and are more than willing to study remotely with you.