General Surgery Oral Boards Critical Fails

[SpecterGT260]

Has anyone ever come across (or simply know offhand) a list of the critical fails for typical scenarios? For example, I was doing some mock orals and got an iatrogenic perf in achalasia. I was so focused on remembering to say that I'd divide the muscle to expose the entire mucosal defect that I forgot to do a myotomy on the opposite side after the repair to deal with the achalasia. Apparently forgetting this step is a critical fail in the scenario.

Anyone have other examples of these or a good list of things just to remember to touch on to avoid unnecessary scenario fails over little (yet vital) details?

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[dpmd]

Has anyone ever come across (or simply know offhand) a list of the critical fails for typical scenarios? For example, I was doing some mock orals and got an iatrogenic perf in achalasia. I was so focused on remembering to say that I'd divide the muscle to expose the entire mucosal defect that I forgot to do a myotomy on the opposite side after the repair to deal with the achalasia. Apparently forgetting this step is a critical fail in the scenario.

Anyone have other examples of these or a good list of things just to remember to touch on to avoid unnecessary scenario fails over little (yet vital) details?

The review courses tend to go over this sort of thing. I think you might find reluctance to share specific stuff here because revealing exam content is not allowed and sdn will shut it down if they see it happen. Basically you have to think of the stuff that will kill a patient or cause a bad outcome in whatever you do.

 

[deleted50541]

The one thing to keep in mind when preparing for oral boards is that you're being tested on being a safe surgeon and on your decision making process.

As in the example you provided, though you repaired the iatrogenic injury from your initial myotomy, by failing to myotomize the opposite side of the esophagus, you have done nothing for the patient's achalasia and subjected them to the risks of general anesthesia and surgery with no benefit. Thus, a critical failure.

This is how you need to think with every scenario you review and learn their corresponding key points that could be a critical failure if forgotten. I won't cite other specific examples either for reasons dpmd cited.

As an aside, if you're in the chest, you can technically close just the mucosa, leak test it, and then tack an intercostal flap to the edges of your initial myotomy without needing to mobilize the other side. But that's not the board answer, which is what the examiners are looking for. Orals are not the time to be creative. Provide the safe answer.

 

[dpmd]

The one thing to keep in mind when preparing for oral boards is that you're being tested on being a safe surgeon and on your decision making process.

As in the example you provided, though you repaired the iatrogenic injury from your initial myotomy, by failing to myotomize the opposite side of the esophagus, you have done nothing for the patient's achalasia and subjected them to the risks of general anesthesia and surgery with no benefit. Thus, a critical failure.

This is how you need to think with every scenario you review and learn their corresponding key points that could be a critical failure if forgotten. I won't cite other specific examples either for reasons dpmd cited.

As an aside, if you're in the chest, you can technically close just the mucosa, leak test it, and then tack an intercostal flap to the edges of your initial myotomy without needing to mobilize the other side. But that's not the board answer, which is what the examiners are looking for. Orals are not the time to be creative. Provide the safe answer.

I got the sense that if you admitted you don't do something so you try to obtain a specialist consultation (they are all out of town) or contact a senior surgeon (they don't answer) and then say you would review a textbook or otherwise remind yourself of appropriate steps that they give a little more leeway on forgetting a step (maybe I just didn't forget a critical step). Regardless, I think it is good to let them know when you wouldn't just boldly forge ahead in real life.

 

[deleted50541]

I got the sense that if you admitted you don't do something so you try to obtain a specialist consultation (they are all out of town) or contact a senior surgeon (they don't answer) and then say you would review a textbook or otherwise remind yourself of appropriate steps that they give a little more leeway on forgetting a step (maybe I just didn't forget a critical step). Regardless, I think it is good to let them know when you wouldn't just boldly forge ahead in real life.

Definitely. During my CT boards, I got asked about a congenital surgery I wasn't as familiar with and had never done in training. But as was practiced and discussed in the review course, I said this wasn't a surgery I did regularly and would consult with a congenital heart surgeon. I then outlined what I thought were the appropriate steps for a re-do adult congenital operation and the examiners seemed fine with it.