Preparing for Part 1 of the ABOS certifying examination
In my experience, to succeed on Part 1 of the ABOS exam, there are a few things you absolutely need to do. First, you have to learn how to be the best test-taker you can be. What does that mean? That means you need to figure out how to process multiple-choice questions. That means learning the different multiple-choice formats, learning what distractors are, and not necessarily concentrating on content in the beginning, but concentrating on pure test-taking strategy. Read each question very carefully. Read each possible answer carefully. Eliminate answers you know to be incorrect. Conservative care is almost always a good first treatment. To succeed on the part one exam, you must demonstrate the ability to succeed on a multiple-choice exam.
Having said that, you must have the ability to access your working fund of knowledge of orthopedic surgery during a high-stakes exam. That is, what you know about orthopedics should be easily referenced. This is actually a skill that comes in handy throughout your career as a surgeon. How do you get that? You read all the time. You read, not necessarily review books, but real honest-to-goodness books, articles, and any information that is likely to show up on board exams. Rereading seminal articles is also key. Many of these are available on the ABOS WLA recertification website, which includes a list of pertinent articles in each subspecialty over the past several years.
Remember, at the time you take the part 1 exam, it includes information that came out about 2 years ago. It’s unlikely that you’d see any information that’s been out in the past year, because the exam must be created and validated and that takes time. You must have a very facile working knowledge of every subspecialty and advances within them. I would not necessarily focus on esoterica, but ideally the nuts and bolts of all orthopedic subspecialties. I would tailor your study program to the Part 1 blueprint available on the ABOS website. Basically, the questions come from these 6 domains: General Principles, Adult Spine, Upper Extremities, Lower Extremities, Pediatrics and Neoplasms.
Lastly, I would say you need to make a very detailed study schedule. This may entail your entire chief year. Stick to this schedule and study smaller amounts all the time. It may be just in little increments, but I recommend preparing like you’re taking this exam for 6 to 12 months straight.
The results curve is very tight. Passing is usually about 70% of the questions correct and all test-takers are smart and competitive. Be one of those people. The way you do this is by doing as much preparation as possible during the year prior to your exam. Review as many questions as you can, as many pertinent articles as you can read, and make sure that you have a good ability to access a fund of knowledge covering the breadth of the field. Remember, questions will require you to interpret clinical information, laboratory tests, imaging, and management of operative AND non-operative treatments.
If you have access to previous OITE questions, those are probably the most representative questions to those you’re likely to see on the exam. That’s why your score is usually representative of what’s going to happen on the boards. If you have trouble with the in-training exam, be concerned. If you do well on the in-training exam, I think that portends a good result. There are other sources of questions from review materials like OrthoBullets, and at this point, a majority of orthopedic residents are familiar with that. Certainly, the Maine Orthopaedic Review has a question bank that is unavailable elsewhere and available between April and the exam each year when you attend the course. The AAOS sells self-assessment exams and other review materials as well.
If you have thus far done poorly on the OITE, I would suggest a real heart-to-heart with your chairman and/or residency director. I would go over the exams you took with a granular view and see if there is a solvable issue. Some people are just not up to date with information, and they just need to add more to their knowledge base. Some people have trouble parsing questions correctly. I think either way, get on a remediation program, either to get you up to speed on a particular subject or up to speed on better ways to take a multiple-choice exam. There are people who are tremendously successful on exams and know the secrets. They know the different types of multiple-choice questions, and they know how to spot distractors in the answers. It’s important to be able to do that when the time comes. If you have concerns, talk to your educators about them if they haven’t already done so.
For some who do not know for Part 1, you take it towards the end of your 5th year of residency. If you are unsuccessful, you must reapply and re-take the exam. Hopefully, you will pass, then be board-eligible to move on to take part two, the oral board exam.
Preparing for Part 2 of the ABOS certifying examination
Passing Part 2 of the ABOS exam is the final hurdle to Board Certification. This portion of the exam is given each summer in Chicago, although an alternative date has been instituted should you have an arguable hardship that prevents you from taking the exam on the specified date in Chicago. The best way I can sum up Part 2 is that the board takes its mission very seriously. Its mission is to ensure that orthopaedic surgeons are qualified and competent. The ABOS works for the good of the public and they take this mission seriously. They are extremely focused on your ability to be safe and ethical and Part 2 has to do with these most important factors. There are strict eligibility requirements that are beyond the scope of this piece, but available on the ABOS website. However, this is the best advice I can give on how to plan for success on the oral boards.
Number one: Know the scoring rubric—the ABOS scoring rubric—which is on their website. You should be very familiar with how the ABOS gathers information during your exams, in terms of making the right diagnosis, gathering the correct data, synthesizing that data, doing the correct operation, technical abilities, and patient outcomes. So, I would say number one is to familiarize yourself with the scoring rubric, which includes these topics: data gathering, diagnosis and interpretive skills, treatment plan, surgical indications, technical skill, surgical complications, outcomes, ethics and professionalism, and applied knowledge.
Number two: Be conservative. Unless you’re treating a trauma patient, everybody deserves a trial of non-surgical care unless there’s an arguable reason not to. The eventual operation that you perform should be tried-and-true, proven, and successful. You should know the surgical anatomy, steps of the surgical technique and the implant inside and out.
My advice during the case collection period: be thoughtful, conservative and organized. Document meticulously. If you’re concerned at all, seek advice from one or several senior surgeons. Don’t worry about complications; every surgeon has them (unless you have many, in which case there may be an underlying problem you need to think through). You are bound to be talking in Chicago about some complications. Don’t fret. Make sure that you have a clear understanding of why they occurred and well thought out processes about how you handle them. Everybody faces cases or complications that they haven’t seen before, especially if you’re an early-career surgeon. Seek advice. Don’t be afraid. Instead, handle and document them in a careful and thoughtful manner. Document like you’re a medical student. Do not take anything for granted. Be thorough and make sure that your documentation is precise, accurate, and also available when it comes time for you to access that later on.
Number three: You should demonstrate that you are a safe surgeon, that you know surgical indications, that you know surgical anatomy, and that you do good work. You should demonstrate that you are caring for the patient as a person and conveyed any and all necessary information in a complete and timely manner.
Number four: You must be ethical. Information about your diagnoses, your billing, patient outcomes, and patient outcomes scores. So, it’s very important that you are on the up and up, and everything you do is in the best interest of the patient. Actually, this shouldn’t even be an issue at this point, but over the years it’s come up. Treat your patients in ways that are non-controversial avoid detriment. Be the most above-board surgeon you can be.
Number five: Know your selected cases completely, inside and out. Know all the pearls and pitfalls of each particular case. Know the orthopaedic problem and any substantive medical problems your patients have. Know what the consultants recommended if they’re on the case, such as cardiologists, pulmonologists, anesthesiologists, etc. Know every classification system available. Know all surgical indications and which implants are available. Know why you chose the ones you chose and they’re pros and cons.
Number six, have a successful and cogent presentation for each of your selected cases. Tell a story about your patients that’s focused and compelling. Don’t wander and don’t fill the air with extraneous material. You have less than 2 hours to get through all your cases. Be efficient and artful in your presentation. Show the examiners that you are being the best doctor you can be.
Do all of these things for each case and you have a near guarantee that you will pass the boards.