How to Present Complications on the ABOS Part II Without Losing Points

You have a case with a complication. Maybe an infection. Maybe hardware failure. Maybe an unexpected outcome that required revision. Your instinct is to leave it off your case list or minimize it during presentation.

That instinct is wrong. And following it is one of the most common ways candidates lose points on the ABOS Part II.

What the Rubric Actually Says

The ABOS scoring rubric includes an entire category dedicated to Surgical Complications. The examiners specifically evaluate three things:

1. Prevention — Did you take expected measures to avoid the complication? At the expected level (score of 2), you demonstrate standard preventive measures. At the above-expected level (3), your prevention efforts exceed the norm.
2. Identification — Did you recognize the complication in a timely manner? At the expected level, identification timing is appropriate. At the unacceptable level (0), complications are overlooked entirely.
3. Management — Did you handle it appropriately? At the expected level, management is at the appropriate standard. At the unacceptable level, management is fundamentally inadequate.

Notice: the rubric does not penalize you for having a complication. It evaluates how you prevented, identified, and managed it. Complications happen in surgery. The examiners know this. What they want to see is a surgeon who handles them competently.

Why Hiding Complications Backfires

In the exam room, one examiner leads the questioning while the other reviews your uploaded documentation — operative reports, clinic notes, imaging. If your records show a complication that you didn't mention in your presentation, the conclusion is devastating:

This candidate is either unaware of their own complication or intentionally concealing it. Either way, that's unacceptable.

A hidden complication that gets discovered doesn't just score poorly in the Surgical Complications category — it undermines your credibility across every other category for that case. The examiners start questioning everything you've presented.

How to Present Complications as Strengths

Be Forthright

Bring up the complication yourself, proactively, as part of your case presentation. Don't wait for the examiner to find it in your records. When you disclose it on your own terms, you control the narrative.

Show Your Thought Process

Walk through how you identified it: what signs prompted your concern, what workup you ordered, how quickly you acted. The rubric specifically evaluates timeliness of identification. Demonstrating that you caught it early — or that you had systems in place to catch it — scores well.

Document the Response

Show that you consulted the right specialists when appropriate. Show that you followed the patient closely after the complication. Show the outcome of your management — even if it required revision or additional procedures.

A case where you identified an infection early, obtained appropriate cultures, initiated targeted antibiotics, performed a timely washout, and followed the patient to resolution is a strong case. It demonstrates exactly what the rubric is looking for.

Stay Humble About Outcomes

When discussing outcomes — even good ones — maintain a measured tone. “Overall, I was satisfied with the outcome given the circumstances” reads better than “the patient did excellent, great result.” Examiners respond to humility. Overconfidence about outcomes, especially in cases with complications, invites pushback.

Cases You Should NOT Avoid

Some candidates try to submit only clean, uncomplicated cases to the ABOS. This strategy has two problems:

• You miss a scoring opportunity. The Surgical Complications category exists whether you have complications or not. A case with a well-managed complication gives you the chance to demonstrate competence in an entire rubric category. An uncomplicated case doesn't.
• It looks unrealistic. Every practicing surgeon has complications. A case list with zero complications raises questions rather than inspiring confidence.

The Bottom Line

You can pass the ABOS Part II with cases that had bad outcomes. You cannot pass it by hiding complications that the examiners discover in your records.

Be honest. Be proactive. Show your clinical judgment. Complications aren't failures — how you handle them reveals the kind of surgeon you are.