Novel Study Guide Preps Surgical Residents for Oral Board Demands

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By Dr. Sujit Vijay Sakpal

Surgeons choose the ultimate hands-on profession.

To become a board-certified surgeon requires graduates of surgery residency to detail established surgical protocols and in-the-moment decisions to navigate complications. But that doesn’t take place in the now-familiarity of the operating room, where perhaps you’re outfitted in scrubs and can demonstrate your surgical craft and skills. No, you’re in a hotel conference room in front of a panel – comprised of accomplished, and at times acclaimed, surgeons with significant expertise – that will scrutinize every word of your response.

This is the American Board of Surgery (ABS) Certifying Examination, better known as the oral board. As a follow-up to a comprehensive written exam, the oral exercise is another tool to confirm you are capable of taking care of patients with common surgical diagnoses, using standardized treatment and management strategies. The goal is to assess your clinical skills as you diagnose surgical problems, determine the right therapy and safely care for your patient.

It’s unlike anything you’ve ever experienced in all those formative years of education and hands-on surgical training. It was my failure at first attempt that led me to rethink and strategize on how to study and prepare for this all important viva voce.  During my surgical training, I would make detailed notes alongside hand-drawn sketches to simplify and learn various complex concepts. However, I realized exhibition of knowledge accrued over years of surgical training via a concerted dialogue between the examinee and the examiner in a stepwise fashion with organized thinking and skillful delivery of responses is the unique requirement needed to succeed during this exam experience.

My hand-written notes and sketched illustrations became the foundation for Surgery Vade Mecum: A Guide for General Surgery Residency and the Oral Board Exam. It’s a first-of-its-kind oral board prep published this spring as a new resource to support students and residents of surgery to pursue certification following residency training.

Each year, about 1,250 students take the ABS Certifying Examination, with an 85% first-time pass rate in 2020 – nearly 10 percentage points lower than the pass rate for the written test. Getting to the oral board is the culmination of the real-world development of surgical skills. Currently, more than 31,000 surgeons are ABS certified.

Rethinking oral board preparation

Surgery Vade Mecum is not only a guide for advanced surgical residents or board-eligible general surgeons, but could also have utility through the initial years of surgical education to help students and residents of surgery garner a disciplined approach to surgical patients. Last year, about 9,200 medical school graduates were in general surgery residencies.

During medical school and residency training, we share a common curriculum and textbooks across academic institutions and hospitals. Organizations, such as the ABS, drive the adoption of validated, standardized diagnostics and therapeutics, and, in general, best practice management globally. None of the existent general surgery oral board prep resources unify all the information strategically – which is the lack of a problem-solving, methodical, algorithmic approach with thorough explanations for each patient-based case scenario.

I wanted to create a comprehensive study guide to fill this void, and help students and residents to learn to synthesize their medical knowledge and surgical craft to competently and confidently apply it toward their patients’ care at bedside – and to successfully conquer the oral board exam. Surgery Vade Mecum presents 140 patient-based case scenarios across 13 chapters (with an additional 100+ practice cases), inclusive of all relevant general surgery topics. Each scenario is presented with a step-by-step process to assess the patient’s pertinent history and physical exam, to identify necessary modalities in ruling out differentials to narrow down a diagnosis, and to provide therapeutic guidelines with detailed surgical techniques and procedures.

An oral board exam is unnerving, especially when the examiners are accomplished senior surgeons who will question everything you say. Indeed, you’re driving the bus because you’re managing the patient case in that exam room. The examiners want to hear in less than 2 minutes how you would work up a 65-year-old woman who comes to your office with a breast mass or in 60 seconds the key steps of the operation you would perform to resect your patient’s colon cancer. Remember, all things about the oral board … are surgery!

In this single regard, you find a parallel to the operating room because it’s the surgery mindset. When you’re making life-and-death decisions, you must be concise and quick. You explain you’ll want to do this step, then that step – and the examiners will interject to say, “OK, well, why would you do it?” In a way, that’s the only thing to ask. That’s your moment to make your success story. You’re defending your actions dictated by the root of the problem, not the future plan of the patient.

While no study resource could cover everything, Surgery Vade Mecum starts with presenting potential differentials and guides to arrive at a core diagnosis using relevant laboratory tests and imaging studies, and further informs treatment strategies. Aligned with expectations for that exam room, the book serves up patient-based case scenarios that prepare you to concisely relay your medical plan and surgical decisions.

Innovation takes many forms

I think learning the science of medicine equips us to become scientists. However, I believe those of us who relentlessly strive in the pursuit of excellence in clinical medicine to provide the best possible care to each and every patient truly are some degree of scientists. Thinking outside the box is essential for patient care as we learn how to identify and decipher signs. We need to constantly think beyond what we know and never accept the status quo. That’s what drives innovation, and this book is just one example.

I brought my notebooks with hand-written notes and drawings to Jay Meyers, the Innovation Lab’s Engagement Lead at Avera Health. The Lab team recognized the gap in oral board training, and the Surgery Vade Mecum bridges this gap. The creativity of’s Tim Murray brought to form the meticulous design and layout integrating the science and art of surgery. Norman Ong, Technology Commercialization Executive at the Innovation Lab, helps innovators in protecting intellectual property and advises on the copyright process, which was essential as we explored how to deliver this content.

Because of the daily demands on residents, we decided early on to make the book available in both print and digital formats, so users can quickly call up a case on mobile devices when they have even a 10-minute study window. The Latin in Surgery Vade Mecum means just that: “go with me.

Everyone can be an innovator

I’m in the early stages of my surgical career, which makes this the right time for me to channel energy into ideas and opportunities for progressive transformations I wish to embrace to continually better the care for my patients. As my knowledge of the space, and its needs, has grown, I’ve begun work on various new ideas relating to surgical tools, techniques, processes and procedures, which is a more traditional approach to innovation. I’m driven by “what can be” and solving for the obstacles I come up against.

Innovation presents itself in different forms as we work our way through our career. The key is being observant to the challenges we perceive as we work our way through those stages. My first contribution as an innovator is Surgery Vade Mecum: A Guide for General Surgery Residency and the Oral Board Exam, now available on Amazon, both as a paperback and for Kindle, and Apple iBooks. Order your copy now.

Sujit Vijay Sakpal, MD, FACS, FICS, is a American Board of Surgery and Surgical Critical Care Certified Transplant Surgeon & Intensivist, and the Director of Kidney & Pancreas Transplant Surgery at Avera Transplant Institute in Sioux Falls, S.D.