The ABOS Part II Scoring Rubric: What Examiners Actually Look For

The ABOS publishes the scoring rubric for the Part II oral examination. Most candidates know it exists. Few actually study it. That's a mistake — because understanding exactly what the examiners are scoring changes how you prepare.

Here's a breakdown of all 9 categories, what each score level means, and what it tells you about where to focus your preparation.

The Scale: 0-3

Each category is scored on a 4-point scale. The descriptions come directly from the ABOS rubric:

• 3 — Above Expected Level. You exceeded what the examiners anticipated for a candidate at your stage.
• 2 — Expected Level. You performed at the standard the ABOS considers baseline for certification. This is passing.
• 1 — Below Minimally Expected Level. Your performance fell short of the minimum standard.
• 0 — Unacceptable. A fundamental deficiency in this area.

You need an average of 2 or above across your cases to pass. The critical insight: a single 0 can sink an otherwise passing performance. Your goal isn't to be exceptional in one area — it's to avoid catastrophic scores across all areas.

The 9 Categories

1. Data Gathering

Does your workup demonstrate thorough, accurate data collection? At the expected level (score of 2), you record history and physical exam at the appropriate standard and use appropriate imaging and diagnostic studies. At the unacceptable level (0), records are inaccurate or grossly deficient.

What this means for prep: Your case summaries need to show a complete workup. If your documentation is missing key elements of the history or physical exam, the examiner sees it before you even start presenting.

2. Diagnosis & Interpretive Skills

Can you synthesize information into a correct diagnosis? At the expected level, you form an appropriate differential diagnosis and integrate information correctly. At the unacceptable level, your synthesis is fundamentally flawed or you form an incorrect diagnosis.

What this means for prep: Practice explaining your diagnostic reasoning out loud. The examiner wants to see how you think — not just what you concluded.

3. Treatment Plan

Is the patient informed of the plan? Is the treatment appropriate? Is follow-up adequate? At the expected level, the planned treatment is at the appropriate standard and includes informed consent. At the unacceptable level, there's no planned follow-up or the treatment is unacceptable.

What this means for prep: Your case summaries must document that the patient understood and consented to the treatment plan. Informed consent isn't just a legal requirement — it's a scoring category.

4. Surgical Indications

Was surgery justified? Did you try non-surgical options first? At the expected level, non-surgical treatment was considered, and the history, physical, and imaging sufficiently support the surgery performed. At the unacceptable level, the surgery is not indicated based on the workup.

What this means for prep: Every surgical case should document what conservative measures were tried or considered before proceeding to surgery. This is one of the most scrutinized categories.

5. Technical Skill

Does your documentation demonstrate competent surgical execution? At the expected level, pre-operative planning and execution of the procedure are evident from the examination records, radiographs, or other studies. At the unacceptable level, execution is unacceptable as evident from the records.

What this means for prep: Your operative reports and post-operative imaging tell the story of your technical skill. The examiners can see the quality of your fixation, your alignment, your implant positioning — all from your uploaded records.

6. Surgical Complications

Did you take measures to prevent complications? Did you identify them promptly? Did you manage them appropriately? At the expected level, identification is timely and management is appropriate. At the unacceptable level, complications are overlooked or managed unacceptably.

What this means for prep: Don't hide complications. A well-managed complication scores higher than a hidden one that the examiner discovers in your records. This category rewards honesty and competent management.

7. Outcomes

Is the patient satisfied? Are objective recovery measures documented? Is there continuity of care? At the expected level, patient satisfaction and follow-up are documented appropriately. At the unacceptable level, there's no attempt to maintain continuity of care.

What this means for prep: Document your follow-up. Show that you tracked the patient's recovery with objective measures, not just “patient doing well.”

8. Ethics & Professionalism

Was care safe, ethical, compassionate, confidential, and professional? At the expected level, all of these elements are present. At the unacceptable level, there's a lack of safe, ethical, compassionate, or professional care.

What this means for prep: This category is often assumed to be automatic, but it's not. Professionalism comes through in how you present cases, how you discuss complications, and how you describe your decision-making process. Patient-centered language matters.

9. Applied Knowledge

Do you demonstrate appropriate knowledge of evidence-based medicine, diagnostic methods, treatment alternatives, and expected outcomes? At the expected level, you show the expected knowledge. At the unacceptable level, you demonstrate an unacceptable lack of knowledge of best practices.

What this means for prep: This is the category closest to traditional “studying.” Know your evidence. Know the alternatives you considered. Know the expected outcomes for your chosen approach.

The Pattern: Documentation Drives Everything

Look across all 9 categories and a pattern emerges: at least 5 of them are evaluated largely based on your documentation — the case summaries, operative reports, clinic notes, and imaging you uploaded to the ABOS Scribe system months before the exam.

This is why case summary quality isn't just a “nice to have.” It's the foundation that most of your scoring rests on.

The examiners see your documentation before you walk in the room. If it's organized, thorough, and honest — you start from a position of strength. If it's sloppy, incomplete, or evasive — you're fighting uphill before you say a word.

Download the Rubric

The full scoring rubric is available on the ABOS website: abos.org/certification/part-ii/scoring-rubric. Download it, print it, and use it as a checklist for every case you prepare. If you can look at each of your cases and honestly score yourself a 2 or above in all 9 categories — you're ready.