“I graduated this July and took the QE (written general surgery boards) on July 19th. I got my results today, and I failed. Not only did I fail but my score placed me in the 5th percentile. Needless to say, I’m disappointed. You hear stories about CE (oral exam) failure but never about QE failure. I never blew the ABSITE out of the water (50, 29, 20, 34, 38), but I never would have expected to perform so poorly. Rather than search for blame I’d like to form an effective strategy so that I pass the second time around.”

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I am sorry to hear of your misfortune. I can’t imagine how you must be feeling.

In your time as a program director did you have a resident or residents fail the QE? Several residents failed the QE. The most notable was a guy who never got below the 60th percentile on the ABSITE. To this day, I cannot understand how that happened.

What became of these people? You will be happy to learn that nearly everyone eventually passed. Patients never ask you how many times it took you to pass the boards. They don’t know about that sort of thing. As far as I know, failing the boards on the first attempt has no long term ramifications except for your program which is judged by the percentage of residents who pass the boards on their first attempt.

Any advice on how to avoid another failure? (In order to help you answer the last question I will tell you that I went through SESAP 15 once. I listened to the audio as well. I stuck to high-yield sources and UpToDate to supplement SESAP. I avoided reading any formal textbooks but I did read Cameron front to back during residency.)  I have found that everyone learns in different ways. There is no single path to success.

One thing you said caught my attention: “I avoided reading any formal textbooks.”

I think that would be a good place to start. You need to get a basic full-sized surgery textbook and read it carefully all the way through. I would advise you to take notes, make flashcards, or whatever else you think might help you to remember important points. Cameron is a great book but in my opinion, it is more suited to studying for the oral boards because it is more clinically focused.

SESAP is geared more toward surgeons doing recertifying exams and is probably not worth spending time on for the QE.

Many of my residents used books of practice questions which may help, but only after you have done a lot of reading.

After you have studied your textbook and are feeling fairly comfortable, you should think about taking an intensive review course a few weeks before the exam. That may help solidify your knowledge. Taking a review course without studying beforehand probably won’t work because it is so much information over a short period of time that you will not be able to retain it all.

Study hard because the last thing you need is to fail the QE again. That would put tremendous pressure on the third attempt. You don’t want to be in that position.

I hope this helps. Good luck.

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.  This article originally appears in Physician’s Weekly.

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