Dr. Aji's advice on the ABS Certifying exam
The oral Board exam is unique in many aspects. It is given in a strange city to you, in a strange hotel, under very strict rules. It requires immediate responses and ready information. The personal impression received by your examiners is very important which adds to its stress.
In many courses you may attend, they advise you to be very brief, to avoid "unnecessary mistakes" and to answer only what you are being asked. My advice to you is the following:
Prepare well for the oral Board. This exam needs more preparation than the written qualifying exam. A book like this, at least in my judgment, is extremely helpful, and if you have already read it, you will agree with me after you take the oral Board.
Wear comfortable , yet respectful and conservative clothes and try not to look terribly anxious, but confident and humble.
Think in a systematic and logical manner; stay on solid ground (don't make up stuff) and err to aggressiveness in trauma cases. There are no "trick questions" and there are no weird, rare syndromes... all questions are real, approved and reasonable.
Expand on topics that you have more knowledge about. Show that you care about the patient's feeling and well being and try to live the scenario.
Being "brief" and "stiff" does not help. If you know something about a subject, say it.
Try to be deliberate and accurate, assume a reasonable pace in your talk but don't try to slow the process of the exam, they hate it when you do that.
Give them a quick summary of what you know. Ask few questions, they will buy you some time to organize your thoughts and don't hesitate to ask for consultation from another specialty..even if they tell you, it's not available...it'll buy you also some time and show them that you're safe and accustomed to team work.
If you are surprised during the exam by a new question not covered in this book, just follow the logical thinking and the principles of good surgical management.
As an example, one of the board examinee was asked the following question:
After a laparotomy for elective colon resection and on the third day postoperatively, you discover that your patient has a wound dehiscence with necrotizing fasciitis involving a large portion of the abdominal wall surrounding your laparotomy incision. What would you do?
Of course, in these type of questions, the examiner is trying to test your management of this ,otherwise, catastrophic and unusual postoperative complication.
Again, follow the logical thinking. The wound infection is caused by a necrotizing fasciitis-forming organism (Clostridium, anaerobic, streptococcus, etc.) which could be caused either by intraoperative contamination the wound or as a result of postop anastomotic dehiscence.
With this logical thinking in mind, proceed with preparing this patient for immediate surgery after a very short rehydration and correction of his/her electrolyte imbalance and broad-spectrum antibiotic coverage.
In the OR, again follow the principles of good surgical management. All devitalized tissues have to be debrided, including whatever it takes to get to healthy tissue, which may mean creating a large defect in the entire thickness of the abdominal wall. Check the bowel anastomosis and treat any problem there.
You have to anticipate the next question of your examiner in this case, which is:
So, what would you do with the large defect you created in the abdominal wall, and how would you cover it? Again, following the logical thinking of good surgical management, you should not fall into the trap of placing a foreign body -mesh- in a heavily contaminated incision. Therefore, use the omentum to cover the bowel and suture it securely to the healthy edges of your debrided fascia, and leave the wound open and pack it with non-adhesive layer on the omentum side and place a Montgomery strap on the abdominal wall in preparation for frequent moist packing changes, and let the wound close by secondary intention or by placement of a Gore-Tex mesh under some rotation flaps at a later date when the infection is controlled and the wound cultures are negative.
This is just an example of an unusual question about an unusual situation which required also an unusual management. I give it as an example to make my point about logical thinking and adhering to good surgical management principles. It certainly applies to many other questions that your examiner may elect to come up with during the course of your exam. More than 90 percent of the questions asked otherwise, are covered in one way or another in this book.
One more thing: Each question on the Board exam has four stages answer; the history, the physical exam, the investigations, and the management. Try not to skip one of them. Develop in your mind before the exam some routine history questions for, let's say, thyroid patients, breast patients, abdominal pain patients, etc. This will help you during the exam to cover the first part of your answer well.
Do not be afraid of asking (in your answer, that is) for consultation (oncologist, cardiologist, etc.); this is within safe practice standards. When they tell you no consultant is available, then try your best.
Try to review the ATLS booklet and especially the antiarrhythmia drugs, and don't underestimate the electrolyte imbalances I describe in this book; they have been asking about them regularly.
If you have any comment or question before or after your exam, please do not hesitate to send me an e-mail: firstname.lastname@example.org