Cara Cipriano, MD | Joshua Patt, MD, MPH, FAOA
July 24, 2019
Are you worried about taking your oral boards? You are not alone! We all remember the stress of our board collection period and preparing for the American Board of Orthopaedic Surgery (ABOS) Step II oral board exam. Approaching exam preparation strategically can help you minimize anxiety while developing important career skills. Try the following tips to navigate your board collection, help you prepare, and succeed on the exam.
Stay organized, pay attention to detail, and document thoroughly. Ensure that every workup is complete. Develop a checklist or other system that prevents important details from falling through the cracks.
If a resident, fellow, or physician extender writes a note on your behalf, you do not need to write a separate note containing the same information. However, make sure to thoroughly read and review all notes to ensure accuracy and completion prior to addending and signing them. Beware of pre-populated notes and auto-text. If every note looks the same, your examiners will notice. In addition, even if your institution does not require you to personally sign surgical consents, you should make every effort to do so.
Keep in mind that if you perform surgery on a patient during your board collection period, the patient’s entire medical record is subject to examination, including any prior surgeries.
Follow your patients as well as you can, understanding that perfect follow up may not always be feasible. Patients may move, transfer to hospice, or be lost for various other unavoidable reasons. The important thing is to do your best and document accordingly. One potential exception is surgeries you perform on call. If the trauma team routinely manages these patients at your institution, it’s okay to allow that transfer of care.
Bottom line: document, document, document!
2Know your indications
Decision-making is as important as surgical skills. Be able to explain the reasoning behind all of your interventions, and be familiar with any literature available to guide your decisions (however, you should not document the literature in the medical record). Always clearly document what non-operative treatment was done before you decided to operate.
Describe your indications and patient conversations when you document informed consent. Anticipate risks and discuss them with your patients. Even for standard procedures such as hip replacements, if a patient has a specific risk related to some element of their history, mention it and discuss the implications. It is important to document that you discussed the indications, risks, benefits, and alternatives (as well as the risks and benefits to the alternatives) with the patient.
3Don’t hesitate to ask for help
Whether it is about the indication or the surgery itself, recognizing when you can benefit from a second opinion is a sign of maturity and insight, not weakness or indecision. Identify peers, senior colleagues, or residency/fellowship mentors who can serve as thought partners, and/or review cases in a group setting such as an indications conference. Document the fact that you had these conversations in your notes. Likewise, when you are performing a challenging surgery, ask one of your partners to join you or be available to help if needed.
After your cases have been selected for the exam, set aside time to review them with your mentor(s). Additional perspectives will help you identify questions that might be asked and direct your preparation. The practice sessions do not have to be exclusively with mentors in your specialty, as you may often get a strong outside perspective from a colleague with a different orthopedic background. These mock exams from your mentors are one of the best prep strategies you can employ.
4Acknowledge your complications and learn from them
Do not be afraid of complications! We all have them, even your examiners. As much as possible, minimize your risk through careful patient selection, workup, and management. That said, for non-elective cases, revisions, and other challenging referrals, surgery may be indicated in spite of higher risks. The examiners will take this into account, understanding that your complication rate will be higher if you manage sick patients with bad problems that require surgery.
When a complication does occur, do not hide from it or ignore it. Document and deal with it. Consider the contributing factors and whether you could have done anything differently. This provides the examiners an opportunity to assess your thought process and ability to manage challenging situations.
Accept criticism gracefully and do NOT get defensive. Arguing with your examiner is the quickest way to find yourself not moving forward the following year! Be honest, be humble, and show that you have learned from your experiences; be sure to consider how these experiences have changed your practice and be able to discuss this.
The board exam is designed to ensure that we are practicing according to the professional standards of our careers. The examiners are not there to fail you! They are there to make sure you are practicing to the standards of a Board Certified Orthopaedic Surgeon. Approach the boards as a phase of career development that will help you succeed throughout your career.
DISCLOSURES: Dr. Cipriano KCI: Paid consultant, Link Orthopaedics: Paid consultant, Musculoskeletal Tumor Society: Board or committee member Dr. Patt American Orthopaedic Association: Board or committee member, North American Spine Society: Board or committee member.
Read the AAOS Discussion Group Terms, Conditions and Disclaimers HERE