Orthopedic Surgeon’s Guide to the ABOS Oral and Written Exams

Introduction: Why the ABOS Exam Matters More Than Ever

Earning board certification from the American Board of Orthopaedic Surgery (ABOS) is one of the most defining milestones in an orthopedic surgeon’s career. This rigorous process is not just about passing an exam—it’s about validating years of surgical training, clinical knowledge, and professional readiness.

In 2025, the competition is more intense, the expectations are higher, and the exam structure is more dynamic. If you're reading this, you're likely somewhere along the stressful but rewarding path toward board certification. The good news? With the right approach, strategic planning, and tailored study resources, you can not only survive the ABOS exam—but ace it.

What Is the ABOS Exam? A Quick Overview

The ABOS offers two primary examinations:

• Part I: Written Exam – Usually taken after the completion of an accredited residency program.
• Part II: Oral Exam – Taken after 20 months of independent practice, where candidates present a surgical case log.

Both parts test more than rote knowledge. They challenge decision-making, ethics, patient outcomes, and professional judgment—hallmarks of a safe, competent, and modern orthopedic surgeon.

Understanding the ABOS Part I Written Exam

Exam Format

• Computer-based test
• 350 multiple-choice questions
• Duration: 8 hours
• Subjects Covered: Trauma, Sports Medicine, Pediatrics, Oncology, Spine, Hand & Wrist, Shoulder & Elbow, Foot & Ankle, Basic Science, and General Principles

The Blueprint: Know What You’re Tested On

The ABOS publishes a content outline—don’t ignore it. It’s your bible. Approximately:

• 25% of questions are trauma-related
• 10–15% focus on pediatric ortho
• Another 10–15% target spine and sports medicine
• 15% test general ortho principles

Scoring and Passing Rates

Historically, pass rates hover around 85–90% for first-time takers. But don’t let that comfort you—those who pass usually dedicate 4–6 months of focused study.

Mastering the ABOS Part II Oral Exam

This portion of the exam can be more intimidating for many. It evaluates how you handle real-life scenarios from your own surgical practice.

Requirements to Qualify

• 20 months of independent practice
• Submission of 12 consecutive months of surgical cases
• You’ll need to select 10 cases from your logs and defend them during the oral exam.

What They’re Looking For

• Justification for your treatment decisions
• Pre-op planning
• Surgical approach
• Post-op care
• Complication management
• Ethical decision-making

Tip: Keep your operative notes and imaging meticulously organized from Day 1 of independent practice.

How to Study Effectively for the ABOS Exam

1. Start Early (Ideally 4–6 Months Out)

Do not cram. The material is extensive, and deeper understanding is key—not memorization. Make a structured schedule and commit to 10–20 hours per week.

2. Use Trusted Study Resources

Here’s a curated list of the most recommended resources by top scorers:

• AAOS ResStudy (Board Preparation)
• Orthobullets: Free and widely used for concise topic reviews and quizzes
• OITE Questions: Although for residents, these help identify weak areas
• Miller’s Review of Orthopaedics
• Review of Orthopaedics by Mark D. Miller and Stephen R. Thompson
• Green’s Operative Orthopaedics: Excellent for surgical techniques
• Journal of Bone and Joint Surgery (JBJS): For staying current

Bonus: Use OrthoBullets Daily Quizzes and customize your practice questions by weak areas.

3. Join Study Groups or Forums

Connecting with peers provides accountability and broadens your perspective. Consider:

• Reddit’s r/orthopaedics
• Orthobullets Study Plan forums
• ABOS Facebook and LinkedIn peer support groups

Top Test-Taking Strategies for ABOS Part I

A. Practice Like It’s the Real Thing

Simulate exam conditions. Do 100–200 questions in timed sessions. Learn to manage fatigue, distractions, and pacing.

B. Use the 3-Pass Method

• First pass: Answer the easy questions
• Second pass: Tackle moderate ones
• Third pass: Spend more time on the toughest

C. Avoid “Overthinking Syndrome”

Stick to first instincts unless you find evidence in the question that proves you’re wrong.

Best Practices for the ABOS Part II Oral Exam

1. Meticulous Case Log Documentation

• Include pre-op imaging, post-op follow-up, complications, and outcomes
• Use ABOS templates
• Avoid ambiguous notes

2. Anticipate the Hard Questions

You will be grilled on your most complicated cases. Prepare answers to:

• Why you chose one procedure over another
• How you managed an infection or complication
• Whether you considered non-operative management

3. Practice with Mentors

Sit down with experienced board-certified surgeons. Practice your oral defense. Get critical feedback.

Common Mistakes to Avoid

• Underestimating case log prep for Part II
• Neglecting trauma topics (big on both exams)
• Reading too passively – always test yourself after each topic
• Cramming in the final month – slow and steady wins the race
• Skipping imaging review – key for oral defenses

Maintaining Mental and Physical Health During Prep

• Sleep: Vital for retention
• Nutrition: Stay energized with balanced meals
• Exercise: Keeps you mentally sharp
• Breaks: Schedule rest days to avoid burnout

What Happens If You Fail?

If you don’t pass Part I or II:

• You can reapply and retake the exam the following year
• Review your performance report carefully
• Seek coaching or mentorship for weak areas

Failing doesn’t define you—resilience does.

The Long-Term Payoff: Why Board Certification Is Worth It

• Career Advancement: Board-certified surgeons are preferred in hospitals and academic centers
• Patient Trust: Certification boosts credibility
• Higher Earnings: Certified surgeons may command higher salaries
• Lifelong Learning: The process encourages staying current

Final Words: You’ve Got This

Acing the ABOS exam isn’t about being the smartest in your cohort—it’s about consistency, smart studying, and mastering your clinical judgment. Treat it like a marathon, not a sprint.

Thousands of surgeons have passed before you. With the tools, strategies, and mindset we’ve outlined, you’re more than capable of joining their ranks.