CHESTThought Leader BlogSlow Is Smooth and Smooth Is Fast: My Journey in Preparing for My Pulmonary Board Certification

Slow Is Smooth and Smooth Is Fast: My Journey in Preparing for My Pulmonary Board Certification

As a young pulmonary and critical care fellow, I recall walking into the beginning of a very busy ICU night shift—two consultations in the emergency room pending to be seen, one unstable ICU patient who needed immediate bedside assessment, and a Code Blue on the medical floor the operator had just called overhead. As I entered the elevator with my very calm attending, I stood quietly wondering how he could be so composed amidst all the chaos. After noticing I was stressed, he looked at me and said, “Just remember this—slow is smooth and smooth is fast.”

At first, I was left to ponder the phrase and figure out what it meant at a later time. This phrase, typically coined by special forces in the military, encourages the concept of being deliberate and intentional with your actions, even if they are slower, to ultimately achieve a favorable outcome. In a medical discipline that is fast-paced and fosters the development of quick critical thinking skills, the thought of slowing down is unsettling. Little did I know that I would live by that phrase over the next 3 years of my fellowship.

To say my fellowship experience was an untraditional one would be an understatement. After surviving the front lines of a worldwide pandemic, becoming a new mother, assuming a leadership role as Chief Fellow, and keeping up with the daily demands of fellowship was truly a balancing act. The cherry on top was waking up one day and finding myself in my third year of fellowship, now having to prepare for my American Board of Internal Medicine (ABIM) pulmonary disease board certification. What is true pulmonary medicine? I feel like everything I knew revolved around severe COVID-19 ARDS and the RECOVERY trial for the last 2 years. Where would I find the time to study while fulfilling clinical duties? Will I be able to study and be able to spend time with my daughter? What if I don’t pass?

A whirlwind of self-doubt set in, and I found myself getting caught up in fast, chaotic thoughts. Then something took me back to that moment in the elevator with my attending. Slow is smooth and smooth is fast. After slowing down in much needed self-reflection, I decided to take the same approach that carried me through fellowship and apply it directly to my board preparation. My strategy: Take it slow. Here are eight tips that will hopefully help your board preparation go smoothly.


  1. S: Self-Assessment: Utilize a self-assessment tool to ensure knowledge retention and identify weak points and strong points. Utilizing the CHEST SEEK™ Library worked for me to evaluate daily where I was in my board prep.
  2. L: Learn one thing every day: The pulmonary disease boards have an abundance of details. Focus on learning one new thing every day. Eventually, it’ll add up over time.
  3. O: Organize yourself: Taking the boards while being a third-year fellow on clinical duty is demanding. Stay organized. It will allow for a clear headspace when it comes down to studying efficiently when time is limited.
  4. W: Website: Use the ABIM website and search the Pulmonary Disease Certification Exam. Download the exam blueprint and use it to guide your study plan. Focus on commonly tested, high-yield topics, and identify areas you may need improvement.
  5. F: Find your style: Access CHEST education. Listen to audio lectures at the gym or on your way to work. Attend an in-person board review. Study alone or in a group. Find a style of studying that works for you and stick to it.
  6. A: Agenda: Make a study agenda/schedule and stick to it. Visualizing a timeline helps with meeting long-term goals.
  7. S: Self-Care: Stay healthy. Exercise. Spend quality time with family. Take breaks. Do something fun you enjoy. And never study the day before the boards.
  8. T: Time Management: Set dedicated time to study, even if it's only 10 minutes between patients to do five questions. It’ll pay off in the end.

With those tips, I am happy to say I am now a board-certified pulmonologist. I hope to apply the same strategy to my critical care boards at the end of the year. Good luck!

Michele Iguina, MD

Michele Iguina, MD

Dr. Michele Iguina is a third-year Chief Fellow of the Pulmonary Disease and Critical Care Medicine Fellowship program at HCA Florida Aventura plans to work as an intensivist serving the South Florida community upon completion of her training. Dr. Iguina’s clinical and research interests include integration of palliative care practices in the ICU, medical education, and advanced cardiovascular ICU management with a particular interest in extracorporeal membrane oxygenation and other systems of mechanical circulatory support.