Common misconceptions of candidates who fail the Surgery Certifying Exam

The Certifying Exam is fraught with mystery, and candidates in training hear various conflicting opinions about all facets of the exam from well-meaning faculty.  This is the most common source of information that creates each candidate’s Exam Mindset, beliefs, and emotions associated with the exam and the examiners.  Because of these conflicting anecdotal stories, candidates are unsure what to expect about many facets of the exam process, including: 

• The exam’s objectives
• How to prepare?
• What to read and how to read it?
• What to expect from the examiners?
• What to do and not do during the exam?
• What are the best ways to present information?  

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Many candidates also believe that the Certifying Examination is simply an extension of the Qualifying Examination, causing them to underestimate the exam.  These candidates have incomplete preparation and a lack of familiarity with the complexity of actual exam performance skills.

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Failing the exam can produce a variety of responses

In my experience, having taught over 1,000 surgeons who failed before they came to work with me, candidates view failure from one of two ends of a spectrum.  One response is that the result was a fluke and had nothing to do with the candidate’s performance. The other, more common, reaction is a high degree of self-doubt and self-criticism. These candidates frequently compare themselves with candidates who have passed and wonder what their shortcomings are compared to other surgeons.  Candidates also try to reconcile how they could do well on written examinations like the ABSITE and Qualifying Examination and have been good residents in training, yet not be able to pass the oral examination. The self-doubt increases test anxiety and compromises preparation and performance on the next exam.        

Because they don’t understand the exam process and/or their approach to the exam, candidates who have failed before are typically unaware of why they failed and assign incorrect reasons for failing, preparing for the next exam on their own both more difficult and less likely to succeed than the preparation for the previous attempt(s).  

When retaking the exam, these candidates also tend to relive the previous failure(s), not only repeating behaviors that contributed to their failure(s) in the previous exam(s) but also focusing on the prior scenarios rather than current ones, compromising their performance further.  

More than one prior failure further increases candidate uncertainty and anxiety, compromising future performance even more. Because they don’t understand what happened in the exam, these candidates cannot learn from prior negative experiences and unknowingly perseverate ineffective and counterproductive behaviors.

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Dissecting what happened in the exam is difficult

If the examiners believe you have achieved the exam goals, you pass and are considered Board certified.  If the examiners believe you have not attained the exam goals, you fail and, at the very least, have to take the exam again.  In either case, the ABS does not explain why a candidate passes or fails an exam.

Regardless of whether you pass or not, you are likely to have only the slightest hint of what really happened in the exam. This is not surprising because the exam is usually an intensely stressful, anxiety-provoking hour and a half.       

The candidate with prior exam experience is at even greater risk of having difficulties with the next exam for various reasons.  The candidate who failed in the past must understand not only the behaviors that contributed to the outcome but also the Exam Mindset (the expectations, emotions, and beliefs associated with the exam) that produced those behaviors.                     

Candidates already understand the professional implications of failing the Certifying Exam. Personal consequences associated with failing also have an impact on subsequent exam performance.

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