Living the Board
How I studied for every exam of the General Surgery Board, year by year, and what I would tell any colleague starting today.
Where I started
I began my first year completely clueless. I have since met colleagues in their third and fourth years who still did not know how to study for the Board. The books were never the problem. What was missing was a plan, so this is mine, written down for you.
The five years
The program in Saudi Arabia is five years long and starts on 1 October. The first three are the junior years. The last two are the senior years, when you run the admissions, lead the ward and teach the juniors.
Junior years. 24 months in general surgery and 12 months on rotations: ICU and the emergency department for about 12 weeks each, then vascular, paediatric and plastic surgery and an elective for about 6 weeks each.
Senior years. 24 months in general surgery, with more independence every month.
Research. You are expected to publish at least one paper before the final exam. Start it in your junior years.
The exams
One paper on the principles of surgery, around June or July of first year. About a minute a question. Pass mark 65%.
Every year, around July. 100 questions, about a minute each, pass mark 60%, and an oral exam of 4 stations.
The final. Two papers of 100, about a minute and a half each, pass mark 70% of both together. Then the oral exam, 6 to 8 stations.
In fifth year there is one more promotion exam before Part 2. It is oral only, 4 to 6 stations.
What each exam covers changes from year to year. Before you start reading, check the official blueprint of the exam for the year you sit it, and plan around that.
The books
Fiser, The ABSITE Review. My foundation in first year. I used the 6th edition. Use the latest one.
Sabiston or Schwartz. The core textbook from second year on. I loved Sabiston, and some of my colleagues loved Schwartz. Both are excellent, so choose one and stay with it.
Current Surgical Therapy. For fifth year. Its management and decision pathways are clearer than any textbook's.
Papers. From fourth year, the studies and techniques behind what you see on the ward.
First year
Everything is new: the hospital, the systems, the work. Give yourself time to settle, then start reading gently.
Skim Fiser from the first week. I did not study it yet. I only got to know it: what is in it and how it is laid out.
From the second or third month, read case by case. If we admitted an acute appendicitis that day, I gave it one hour from Fiser before bed, then closed the book. If I did not finish, I carried on the next night. Every case I met got its hour, and over the months it added up.
For Part 1, start three months ahead. One month can be enough, so if that is all you have, do not panic. First year is heavy, though, and three months of slow, light reading is far more comfortable.
How I studied for it. I read a subject in Fiser, solved questions on that subject, then went back to the reading, again and again. The recalls I solved back then are now in FinalPass Q Bank, polished and rewritten: 6,000 questions, each in K1 and K2, every answer checked against the books.
Second year
Open your textbook. I kept reading case by case, now in Sabiston, highlighting as I went.
Weekends are for chapters. On weekends I took one whole chapter and finished it over two of them. Weekdays stayed case by case.
Go past the textbook sometimes. A paper, a new technique or a new study on something I had seen that week.
For the promotion exam, I mostly solved questions. I already had Fiser behind me, so I only reread the subjects I was weak on.
Third year
The same rhythm, with more chapters. I kept adding chapters and rereading the ones I had forgotten or that a new edition had changed, and I worked on remembering them over the years.
Fourth year
The first senior year. My reading was at its lowest, because this was the year of the ward and the theatre, and that is how it should be.
Read for Part 2 already. I reread the chapters Part 2 covers and highlighted them again, and kept reading case by case beside the clinical work.
Read papers. The studies and the finer points behind the textbook answers.
Fifth year and Part 2
Do not study for Part 2 alone. We were four. Have at least one or two colleagues with you.
Months one to three: read and write your notes. I read Sabiston religiously, only the chapters Part 2 covers. By then I knew the material, so it went quickly. Then Current Surgical Therapy for management. I highlighted both and turned the highlights into my own notes.
Months three to four: the notes, again. I reread my notes until they were mine.
Months five to six: questions with colleagues. We solved and discussed questions together and kept strengthening the notes. Anything a question taught me that was not in my notes went back to the book first, then into the notes.
The last two to three weeks: full mock exams. 200 questions over two papers, under real conditions. I started at 7 or 8 in the morning, sat the first paper, took a 30-minute break, then sat the second. About a minute and a half a question, no longer and no shorter. I did not worry about the mark. I was training my mind for the length of the day, because in my second papers fatigue had been costing me.
Mock Exam in FinalPass is built for exactly this: Part 1, Part 2 and Promotion papers with the real timing, a break between the two Part 2 papers, and a full report at the end.
How to solve a question
The way I solve single best answer questions came from reading the research on how these questions are written and how they are best answered. I put the whole method into one short film, The Cheat Code.
If a question asked about a specific complication of acute cholecystitis, I went back to that complication in the book and in my notes and reread it until I knew it by heart. If the question showed me something new, I read the whole paragraph or the whole subject until it was solid. When I got one wrong, I corrected it and wrote down where in the book the answer was.
The oral exam
This applies to every oral, the promotion exams and Part 2.
The oral is about practice more than knowledge. By then you know enough. What you need is to say it well under pressure.
Examine each other. With my friends, they examined me and I examined them. We looked for each other's weak points and critiqued each other honestly.
Finish each station in 7 to 8 minutes. A station is ten minutes. The two you save are your margin on the day, if you blank or the nerves take over.
When your friends are not around, the Simulation Lab does the same job: a voice examiner takes you through a station, asks for the results you would request, and marks you against the checklist. 121 stations, ten minutes each.
What I would add today
Everything above is what I did. Looking back, these are the things I would add.
Keep a list of the questions you got wrong. Go back to them after a day, a week and a month. The ones you miss twice are your real gaps. In FinalPass, the Incorrect pool keeps that list for you.
Spend your time where the marks are. Let the official blueprint of your exam decide what you read first.
Know why you were wrong. A missed word in the stem, the right treatment in the wrong order, the first step when they asked for the best one. The same mistake keeps coming back until you name it. Fault Taxonomy in FinalPass reads the option you chose and names the fault behind it.
Answer every oral in the same order. History, examination, investigations, diagnosis, management, the operation, after the operation, complications and follow-up. One order for every station keeps you calm and complete.
Protect your sleep in the last week. No new chapters. Sleep at the time you will sleep the night before the exam, and wake at the time it starts.