Okay all, here’s my updated thoughts on passing the ABS QE and CE exams:
QE:
The ABS has recently opened up the opportunity to take the QE after your PGY4 year and before your chief year, if you meet certain requirements including case numbers. If you are eligible to do this, I would strongly encourage you to do so. I will elaborate in a minute on my thoughts on why.
First things first - what they say is true. The best predictor of success is the ABSITE. I took the ABSITE 7 times. My scores on the ABSITE ranged from a 60th percentile (intern year) to as high the 90s (research years). I never had any trouble or fell below the 50th percentile mark. And I passed the CE just fine.
I also felt like the ABSITE was also a representative exam of what the real thing will be like. Once I got over my nerves on the day of the exam, it was very easy to just fall into a comfortable rhythm and the exam was over before I knew it. It is because of this that I recommend taking the QE after PGY4. If you’ve done well on the ABSITE as a resident, you will do well on the real thing.
What resources would I recommend for the exam?
- SESAP: It’s a must. It’s written by the same people who write the EXAM, and it covers the majority of the relevant content. I found the answer explanations to be well written and helpful. I know there are bootlegs out there, but do yourself a favor and buy the latest edition. One thing I didn’t realize in advance was that the ABS exams are very “political”. They are testing the things that the board very strongly believes should be within the scope of practice of a general surgeon. This emphasis has shifted in recent years so it means that the older editions of SESAP may not hit the right points as much.
- Cameron’s: This is the best textbook to prepare for both the QE and the CE. I would recommend trying to read it over the course of your chief year. Short, relevant chapters. Easy to read and digest.
- SCORE: I’ve written some complaints about SCORE in the past. But I think it is the best option out there, especially in terms of the volume of questions. Over the course of the final 2 years of training I did all the SCORE questions as part of my ABSITE preparations.
- True Learn: It’s a pretty cheap month subscription, so I signed up for it in late June. Has a lot of questions and I used it for some extra repetition. It’s not perfect, but I thought the questions covered a broad range of topics. The question stems are way longer than the real exam and I thought it hit some esoterica, but still decent.
CE:
This is a different beast. The best preparation for this test, by far, is your chief residency year. You can study for this exam all you want, but your best preparation is real life experience.
I would point out that this exam has changed. A lot. The days of Hiram Polk walking into the bathroom in the middle of your exam and taking a piss while continuing to pimp you on the intricacies of a Whipple are gone. The exam is standardized. The examiners have some leeway, but they also have a script and standardized grading metrics. This is good, because it means that you can better prepare for the exam. It is bad because, as the “scripts” are increasingly figured out by the test takers, the ABS feels the need to twist the script every so often.
I strongly recommend the Osler course. I know it is expensive, and it is a time commitment. But it is also three days of intensive prep right when you need it. There is a good chance that you’ve been off in your CT fellowship for six months at this point and haven’t thought about the belly or a breast cancer case since the end of chief year. The prep course will throw out 90% of the scenarios you will get in the exam. So the day of the exam, when you get asked about that transmediastinal GSW, you’ll remember hearing the mock exam walking you right through what to do.
The course is not perfect. Some of the examiners are better instructors than others. But it is worth the cost. It also gives you three days to get away from the pressures of fellowship or practice and get your mind right for the exam. One thing I was not told or mentally prepared for - the course is LONG. They cram 30 hours of mock exams into those three days. The first two days of the course go until 7 or 8 pm.
For the CE, if possible, I would recommend two things: take it in one of the fall dates. In my mind, the sooner the better. Second, take it with some of your co-chiefs. These are your friends, you’ve been through a lot with them. You can bounce ideas and questions off them beforehand. The night before when you are all stressing out, you can grab a beer together and chill out at least a little. More so than if you were on your own.
Other resources for the exam:
-Dimick book (Clinical scenarios): I thought this was very helpful. It breaks down the most common scenarios for the exam. For most operations it gives you the “key steps” in a quick bullet point fashion, which is all people are going to want to ask.
-How to win: My god, can't agree with
@SLUser11 more. I had a free copy of this, but it annoyed me to no end. His fake speech "script" was incredibly grating. Typos everywhere. Some of the answers are downright bad, especially anything critical care related.
My advice for the exam itself:
-The guiding principle for the board is
that they want to see if you are a “safe” surgeon. It’s okay to err on the conservative side. No one is going to give you bonus points for saying you’ll do something laparoscopically or with some other advanced technique. One of the Osler instructors said: "We better not hear the word Robot come out of your mouths". If you keep your answers simple, you can avoid potential traps. But safe does not mean timid or indecisive.
-For the most part I really felt like the examiners are not trying to trick you. If you are going down a bad path, they are probably going to throw you a bone to try and get you back on track. Pay attention to those verbal (and nonverbal) cues from the examiners.
-That said, the examiners will sometimes ask you questions which to me felt like they are just trying to see if you will stick to your guns.
-Since there is a lot of oncology on the exam: Try to keep things simple. You don’t have to be the world’s expert on the newest neoadjuvant therapy. For example for melanoma - don’t even bring up ipilimumab and the other new targeted therapies, unless you are
SURE you can discuss all the intricacies of when to give them.
-Don’t focus too much on the history portion. For the most part they are going to give you the history. Say something to the effect of “I would conduct a focused history, asking questions specifically about xxx risk factors” (such as radiation exposure if it’s a neck mass question, or family history if it’s a colon cancer question, etc). The examiners want you to get to management, not spend the whole time dragging you through the H&P
-Be systematic. Don’t rush. Most scenarios are going to get you into the operating room, but don’t dive in without the appropriate work up. If it’s a GI bleed, yes, they are probably going to make you operate on that person, but that doesn’t mean it’s the appropriate first step in management.
-Remember your ABCs, vitals, etc. Say you will start antibiotics. I liked one of the Osler instructors - he said - “act like you’re talking to your intern. If you don’t tell them to do it it doesn’t get done”.
-If (or rather when) you get stuck: a moment of silence is your best friend. Regroup. Don’t fall into the trap of word vomiting.
-When in doubt, tell the examiner what you would do in real life. Don’t spend too much time trying to figure out what the “board answer” is. You’re a well trained surgeon. Rely on that training.
). Some have resorted to hiding a bottle of water in the hallway between rooms.
