ABOS Orthopaedic Surgery common mistakes
ABOS Orthopaedic Surgery · Understand the traps and how to avoid them.
On Part I, committing to an answer on a fracture-classification or nerve-anatomy item based on pattern recognition without checking the decisive detail (e.g., answering a Salter-Harris type from the radiograph description before confirming which side of the physis the fracture exits).
High-volume, time-pressured multiple-choice items reward fast recognition; candidates trained on rapid recall stop reading once a familiar keyword appears, and the single distinguishing phrase later in the stem goes unread.
What to do instead
Adopt a fixed two-pass stem protocol: first pass identify the decision being asked, second pass scan for qualifiers (age, open vs closed physis, medial vs lateral, acute vs chronic) before selecting; practice with timed blocks where you must state the qualifier aloud before answering.
On Part I biomechanics and implant items, selecting the answer that matches a memorized number (e.g., a plate or screw dimension, a bearing wear rate) rather than deriving from first principles when the stem changes a parameter.
Basic-science material is often learned as isolated facts; when the item perturbs one variable, the memorized value no longer applies but still feels familiar and gets chosen.
What to do instead
For each biomechanics topic, build a one-page derivation sheet (bending stiffness vs length and radius, stress = force/area, moment arms) and answer practice items by computing rather than recalling; verify the computed value against the memorized one.
On Part I, failing to eliminate the plausible-but-wrong distractor that is correct in a different clinical context (e.g., choosing a treatment appropriate for an adult for a pediatric stem, or vice versa).
Distractors are written to be true statements; candidates judge each option for truth in isolation instead of testing it against the specific patient described in the stem.
What to do instead
Convert every option into a full sentence including the stem's patient and mark it true or false against that patient; only options surviving the full-sentence test are eligible.
On Part I, running out of time or leaving items blank because of over-investment in a small number of hard calculation or image-based questions.
Perfectionism plus fear of guessing leads to long stalls; candidates also misjudge the pacing of a long exam and do not build in review time.
What to do instead
Practice full-length timed blocks with a hard per-item cap (e.g., 90 seconds), mark and move on, and reserve the final minutes for flagged items; never leave an item blank since there is no penalty for a reasoned guess.
On Part II, answering the examiner's question with a stream of associated facts rather than committing to a diagnosis, a plan, and a rationale.
Oral candidates fear being wrong and hedge by demonstrating breadth; examiners read indecision as lack of a safe clinical plan.
What to do instead
Structure every answer as a three-part statement: leading diagnosis, next step, and the reason; rehearse this format aloud with a partner until it is automatic, then add detail only if asked.
On Part II case stems, skipping the history and physical details offered and jumping to imaging or surgery, missing the finding that changes management (e.g., a systemic symptom, a neurovascular deficit, an open wound).
Candidates rehearse procedures and operative detail and treat the stem as a prompt to display knowledge, not as a clinical encounter to be worked through.
What to do instead
Verbally summarize the provided history, exam, and studies back to the examiner before proposing a plan; explicitly state what you would ask or examine that is not yet given.
On Part II, failing to describe complications, alternatives, and informed-consent content when presenting a surgical plan.
Attention is concentrated on the technical steps of the operation; the nontechnical and risk-disclosure components are under-rehearsed.
What to do instead
Use a standing checklist for every operative plan: indications, alternatives including nonoperative, specific risks (infection, nerve injury, hardware failure, nonunion, DVT), and how each would be recognized and managed.
On Part II, becoming defensive or argumentative when the examiner challenges a decision or implies a complication occurred.
The oral format feels adversarial; candidates interpret probing as an attack and either dig in or collapse, losing the chance to demonstrate safe reasoning.
What to do instead
Treat challenges as invitations to re-reason: acknowledge the concern, restate your reasoning, and describe how you would modify the plan if the new information is confirmed; practice with a partner instructed to push back.
On Part II, giving vague or non-committal management answers ("consider imaging," "would get consultants involved") without specifying the study, the timeframe, or the responsible clinician.
Fear of being pinned to a wrong specific leads to deliberately broad answers; candidates also lack a rehearsed default workup for common presentations.
What to do instead
Prepare specific default pathways for high-yield presentations (e.g., suspected compartment syndrome, septic joint, open fracture, cauda equina) with named studies, timings, and escalation triggers, and state them concretely.
On Part II, misjudging the scope of the question and volunteering operative detail when asked about evaluation, or basic science when asked about management.
Candidates anticipate the next question rather than answering the one asked, and nerves push them toward showing maximum knowledge.
What to do instead
Pause, restate the question internally to confirm its category (diagnosis, workup, nonoperative, operative, complication), answer only that category, and stop; let the examiner direct the next step.