What Behavior is the Oral Board Examiner Actually Looking for in a Candidate?

What is the goal of the exam?

Candidates often misunderstand the goal of the examination. The goal of the Surgery Oral Board Exam is: for a candidate to demonstrate surgical judgment, clinical reasoning, and problem-solving skills.

So what is the examiner looking for in a candidate? The examiner wants a candidate to demonstrate judgment, reasoning, and problem-solving ability.

What do these terms mean?

To understand these terms more thoroughly, " demonstration " refers to high-level communication. Considering "surgical judgment, clinical reasoning, and problem-solving skills," these can be summarized as process thinking. Candidates must have sophisticated communication skills and excellent process thinking, and, more importantly, the candidate must dynamically integrate those two skill sets under exam conditions to achieve the goal.

The American Board of Surgery defines what the examiners look for in two locations on the website as of January 2023. Both emphasize the focus on testing the reasoning demonstrated by the candidate.

"Candidates should be able to answer not only what they would do and how, but why."

A few sentences later, it reads that you, the candidate, should tell the examiner:

"what you would do, not what you think they [the examiners] want you to say. Be prepared to defend your plans and actions with acceptable logic."

Your answer must go beyond "what" and "how."

Candidates should be able to answer not only what they would do and how they would do it – but why.

You must listen carefully to each case the examiner presents and respond with your own plan or actions to resolve it. The examiners want to find out what you would do in your own practice. You must explain what you would do, not what you think they may want you to say. Be prepared to defend your plans and actions with acceptable logic.

What behaviors are essential?

Exactly what behaviors must a candidate display to achieve the goal of the exam? The American Board of Surgery describes them as "Essential Attributes of a Certifiable Surgeon."

When grading, examiners will assess your performance according to these Essential Attributes of a Certifiable Surgeon:

• Demonstrates an organized approach and solid rationale for planned actions.
• Rapidly determines and interprets key findings in a clinical presentation.
• Effectively and efficiently uses clinical knowledge to solve clinical problems; effectively addresses key management points.
• Avoids errors and critical fails (omission and commission) associated with the case.
• Recognizes personal limitations in knowledge and expertise when diagnosing and treating clinical problems.
• Reacts in a prompt but flexible manner to alterations in the patient's course, e.g., disease or treatment complications.
• Overall, demonstrates appropriate surgical judgment, clinical reasoning skills, and problem-solving ability.

Most candidates we have worked with initially think, "Seven lines, seven skill sets. Sounds simple." Unfortunately, it is more complicated. A careful analysis of the "Attributes" indicates just how nuanced the nature of the exam. The list above contains over 20 distinct applications of high-level thinking processes and complex communication skills. There are other candidate abilities that examiners are accessing. For a comprehensive list, see the second revised edition of the book, Demystifying the Surgery Certifying Exam.

2 Categories of skillsets

The "essential attributes" of a Certifiable Surgeon can be summarized as skills that fall into two major categories:

1. Rapid, high-level thinking processes of decision-making, reasoning, logic, rationale, clarity, interpretation, determination, assessment, organization, and prioritization.
2. An extensive set of complex communication skills that allows you to demonstrate the above thought processes under high time pressure and high emotional pressure in a high-stakes exam while in an unfamiliar environment of a Zoom meeting with six examiners in three different "rooms" with 12 exam scenarios.

Consider what these words convey about what you need to do as a candidate to perform well. The exam is far more than a testing of a candidate's content knowledge. The list of attributes provided by The American Board of Surgery does not give any insight into how to acquire these attributes and actually demonstrate them to a Board examiner. Yet, every candidate must go beyond the typical surgeon's skillset to demonstrate rapid process thinking under intense pressure.

Just as every surgeon learns clinical surgery and operative technique in the guided setting of residency training, every candidate can learn to recognize and demonstrate their thought process efficiently and effectively under experienced guidance.