What is the Goal of the Oral Surgery Certifying Exam? (It is not what you think …)

Why understanding the goal is critical

Understanding the goal of any exam is critical to being fully prepared to pass the exam. The Surgery Certifying Exam has many misconceptions that strongly influence how candidates do on their exam. By correctly understanding the goal of the CE, candidates can feel confident in their preparations.

What candidates think

When I ask my students in my individual or group courses, "what is the goal of the Surgery Certifying Exam?" I get an array of answers, almost all of which sound like these:

• "The goal is for me (the candidate) to prove I am a 'safe surgeon'"
• "The goal is to test content."
• "The goal is for me (the candidate) to give a 'safe answer,' 'right answer,' or 'board answer' "
• "The goal is for me (the candidate) to give the examiner what he wants to hear."

Sounds familiar to you?

Never has anyone said, "My goal as a candidate is to demonstrate my process thinking," because none of my candidates have ever heard those words. However, they have all read those words on the American Board of Surgery website.

The American Board Surgery Website Statements

Here is what the ABS says on its website about the objectives of the examination as of January 2023:

"Candidates have already demonstrated sufficient knowledge of surgery by their successful performance on the QE. The purpose of the CE is to assess your process thinking and judgment."

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This concept is further clarified on the page at the end of the Essential Attributes of a Certifiable Surgeon:

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

[there are six items before this, and the one below is the last on the list of seven items]

Overall, demonstrates appropriate surgical judgment, clinical reasoning skills and problem-solving ability."

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In two separate paragraphs on the ABS website, the examiners clearly state the goal of the Certifying Examination:

"The purpose of the CE is to assess your process thinking and judgement."

"Examiners will assess your performance according to these Essential Attributes of a Certifiable Surgeon: overall, [the candidate] demonstrates appropriate surgical judgement, clinical reasoning skills and problem-solving ability."

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Let's review the perceptions of candidates regarding the goal of the Certifying Exam and compare those perceptions to the reality of the exam:

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Candidate Perception 1: "The goal is for me (the candidate) to prove I am a 'safe surgeon'"

There is not a single mention of the word(s) "safe" or "safe surgeon" anywhere in the description of the goal of the exam on the ABS website.

Candidate Perception 2: "The goal is to test content"

The examiners explicitly state that "sufficient knowledge of surgery" (that is, content) was already "demonstrated" by "successful performance on the QE," the Qualifying (written) Exam." Therefore the Surgery Certifying Exam is not about content. Examiners know candidates have been tested on content issues for many years through ABSITE, and content was tested again in the Qualifying Exam. There is no reason for the examiners to test the candiate on content again in the Certifying Exam. I'm not suggesting that content is not important in the Certifying Exam, but it is not the objective of the certifying exam and is not the focus of the test. The Certifying Examination is geared to determine candidates' ability to use their knowledge and training to safely, effectively, and promptly manage a broad range of clinical problems. The manipulation of content with process thinking and then demonstrating that thinking to the examiner is the actual goal of the exam.

Candidate Perception 3: "The goal is for me (the candidate) to give a 'safe answer,' 'right answer,' or 'board answer' "

The goal of the CE is not to come up with a magical, memorized or guessed "safe," "right," or "board" answer.

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Candidate Perception 4: "The goal is for me (the candidate) to give the examiner what he wants to hear."

Finally, the goal of the exam is not to guess or mind-read the answer that the examiner wants to hear. Even if that were the goal, no one would be able to read the examiner's mind, and everyone would fail the exam. Therefore, mind reading is not a good plan for preparing for the last major exam that a surgeon will ever take in her/his professional career.

I have asked the question, "what is the goal of the oral exam?" for the last 25 years to thousands of surgeons in my courses. Not a single one of these candidates has ever said, "the goal of the exam is for me to demonstrate appropriate surgical judgment, clinical reasoning skills, and problem-solving ability."

The actual goal of the Surgery Certifying Exam

In summary, the answer to the question "What is the goal of the Surgery Certifying Exam?":

The goal is for a candidate to demonstrate process thinking.

Exactly what constitutes "the demonstration of process thinking" and how a candidate learns those skill sets is just as complex as the most sophisticated surgical procedure. The examiners give the slightest hint of what is required in the section of the ABS website describing "Essential Attributes of a Certifiable Surgeon."

Learning how to do well on the surgery oral board exam is like learning a complicated surgical procedure from an experienced surgeon. The high-level skills required on the oral board exam can be learned and mastered under experienced guidance to produce a comfortable, confident, consistent, clear, and capable performance.

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