By Scarlett Hao
A behemoth of a test awaits every surgery resident each January. The dreaded ABSITE (American Board of Surgery In-Training Exam) is a standardized exam with 250 plus multiple choice questions given over five long hours and graded on a percentile curve by year of graduation. More details can be found on the American Board of Surgery website. The details here are to guide you on your journey towards preparing for the test. It’s a marathon, not a sprint. No amount of last-minute cramming can replace longitudinal, dedicated study and review, but a few tips and tricks can help you maximize knowledge gained for time spent and set you up for success for when January comes around.
There’s three types of mental exercises that your brain needs to jump through.
- Knowledge Base. You need a solid foundation of knowledge. All of the pre-med classes in college, the first two years of medical school, and the information tested on shelf exams and the USMLE Step exams have prepared you. Trust the system. But now you have to add to that the entirety of a surgical textbook (Have you seen the size of Sabiston’s?). That takes time and investment of effort. Many programs will either provide you an actual textbook or some way of accessing them (i.e. ClinicalKey.com). There is no one best book. Choose one and stick with it. But if you know textbooks do not work for your studying style, find another comprehensive compendium of information such as SCORE or SESAP.
- Knowledge Recall. The test essentially asks you to recall the knowledge you have learned and apply it. Just like any sport or instrument or performative assessment, you need to practice, practice, practice! Find a source of questions, either an online question bank or book. Do as many questions as possible and do them consistently. Even a small quizlet of 10-15 questions every day will help keep your mental muscles well-exercised. There are only so many ways to ask about the same topics. Although preparation in the same atmosphere is ideal (i.e. on a computer in a quiet place), it is not necessary and should not be an excuse to not do questions. Any pocket of time is acceptable: walking to your car, waiting for your case to roll back, between lectures, on the toilet, etc.
- Impossible Knowledge. This is the stuff that refuses to stick. A great deal of knowledge and concepts are learned and relearned while being a clinical surgery resident making decisions, taking care of patients, and operating. But some bits of information are so rarely used, yet are easily testable. These include, but are not limited to, cancer staging schema, genetic mutations, and statistical formulas. Although knowledge base and knowledge recall will serve you well, spending a little time getting the impossible knowledge into your head (even if only temporarily) will earn you some easy questions. Review them right before the test!
The Year Before
You finished the ABSITE several weeks ago, had a post-ABSITE celebration, and just got your score back. Good or bad, it’s time to get cracking on next year. Your score report will include a list of topics based on the questions you got wrong. Use this to start making your study plan. Alternatively, if you have never taken the ABSITE before, you can take a practice test and use those missed topics to plan.
- Your plan should cover all topics, but focus most on your areas of weakness in order to maximize your study efforts. If your program follows a curriculum like SCORE, you can try to arrange your topics of review around the weekly SCORE topics. This is a great and free resource even if your program doesn’t use the curriculum.
- Make a broad plan and be flexible. You may find certain topics are more amenable to different study methods, or find that your preferred study method changes over time.
- Set reachable and adaptable goals. If you anticipate doing a large number of questions per week and then find your clinical schedule becomes extra busy, studying can become a dreaded additional expenditure of effort when all you want to do is eat and fall asleep. Facing a 10 question block is much easier than facing a 30 page chapter at the end of the day.
- Include some review. What you learn six months before the test may be forgotten in the two months before the test. Some options include re-testing an older topic closer to the exam, or taking good notes when mastering a KNOWLEDGE BASE and then using the notes for review instead of going back to the source material or textbook.
- Use your clinical experience. If you know you’re going to be on the surgical oncology rotation in March, arrange to review those topics during that time. When prepping for a case, review not just the case but the related ABSITE material. Take five minutes to teach an ABSITE subtopic (i.e. benign breast disease) to your medical student. You’ll both benefit. In addition, you’ll be surrounded by experts! Use your attendings’ knowledge of their specialty. Ask them what topics are most commonly covered or if they have their own tips/tricks on learning the material.
- Get a buddy. Share your plan with someone. Hold each other accountable. Run friendly competitions. Quiz each other over lunch. You are not alone.
The Month Before
At this point, most of your time will be spent on KNOWLEDGE RECALL rather than building your KNOWLEDGE BASE. Practice doing larger sets of questions if you have a dedicated space of time to mimic the exam setting. Review wrong questions and learn from them. If you choose to retest yourself with questions that you got wrong previously, be sure you are choosing an answer with a good reasoning of “why I am choosing this answer” rather than the memory of “that was the correct answer.” This is also a good time to work through the IMPOSSIBLE KNOWLEDGE, whether through rote memorization, flashcards, or using related test questions. If you have never taken the ABSITE before, this is also a good time to review the technical details, like where the exam is held, what are the food and drink policies, where the bathroom is located, etc.
The Night Before
Eat. Sleep. This is not the time to study or learn new things. Rest as much as you can. Calm your nerves and trust your brain. You have spent this much effort to make it here. It will be okay.
The Test Day
Eat. Breathe. Trust your knowledge and your gut. Try not to change your answers. Keep a steady pace. You’ve got this!
- Do not procrastinate your studying. It is TRULY impossible to cram the huge breadth of knowledge required for this exam.
- Do not attempt to use every possible resource. There are endless resources. Choose one or two for KNOWLEDGE BASE and KNOWLEDGE RECALL. What works for one person is not guaranteed to work for you. If you find it didn’t help, choose something else next year.
- Do not ignore your weak topics. It is painful to face things you don’t like, but they will become less painful when, instead of topics of weakness, they become topics of strength!
- Do not discount the value or importance of this exam (internal program monitoring, fellowship applications).
- Do not set your body up for failure by not sleeping or eating well.
- Do not cheat.
This is not an exhaustive list of the available resources but hopefully can get you started.
- Sabiston’s Textbook of Surgery: Extremely comprehensive and dense. Heavy emphasis on basic science and evidence.
- Cameron’s Current Surgical Therapy: Less comprehensive (does not go into subspecialty topics) but some find the writing more straightforward and easier to digest
- Schwartz’s Principles of Surgery: Also very comprehensive. Intended to be accessible by medical students as well.
- Greenfield’s Surgery: Scientific Principles and Practice: A little more clinically practical than conceptual.
- Fischer’s Mastery of Surgery: Two volumes! Organized by pathology and procedure rather than organ site, suitable for upper-level and practicing surgeons.
- ABSITE Review (FISER)
- Mont Reid Surgical Handbook
- Behind the Knife Podcast Companion
- ABSITE Slayer
- Clinical Scenarios in Surgery
- Surgical CORE modules
- Behind the Knife Podcast
- SSAT ABSITE Review Course
- Free Webinars (SAGES, SSAT)
- ABSITE Daily Facebook Group (free to join, daily question)
We look forward to our joint Association of Women Surgeons/Society for Surgery of the Alimentary Tract TweetChat on December 21st at 8PM EST!
Join @womensurgeons along with our moderators Dr. Timothy Vreeland (@vreelant), Dr. Scarlett Hao (@ScarlettHaoMD), Dr. Mackenzie Morris (@MackMorrisMD), and Dr. Rebecca Williams-Karnesky (@TheZenOfSurgery). This tweetchat is co-sponsored by the Society for Surgery of the Alimentary Tract (@SSATNews). The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtag #AWSchat. If you haven’t participated in a tweetchat with us before, check out this tutorial written by Dr. Heather Yeo (@heatheryeomd) to know more. We will be discussing the following topics during our tweetchat:
- What resources did you find the most helpful with preparing for the exam?
- What are your tips and tricks for studying for the ABSITE? Do you have any advice on developing a study plan?
- What do you recommend reviewing the day before or day of the exam?
- What are your go-to mnemonics for ABSITE material? All mnemonics appreciated!
- How does studying for ABSITE and the boards differ? Any advice on preparation for the written boards exam?
Dr. Hao is a PGY-4 general surgery resident at the Brody School of Medicine at East Carolina University. She graduated from the University of Maryland School of Medicine. Her academic interests lie in surgical oncology, health care disparities, and resident and physician wellness.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.