How Many Cases Should You Submit for the ABOS Part II?

Every candidate asks the same question early in their prep cycle: how many cases should I put on my list? It's the wrong question — or at least, it's the second question. The first question is whether every case you submit is one you could defend cold in front of two examiners who are specifically looking for reasons to push back.

Because here's the part candidates sometimes forget: you don't pick which cases you present. The ABOS case selectors do.

How Case Selection Actually Works

The structure is straightforward. You collect cases from your practice during the designated collection period, format them according to ABOS requirements, and submit the full list. Then the case selectors review your list and assign twelve cases for you to defend on exam day — across four 30-minute sessions with rotating examiners.

You don't get to lobby for the cases you feel best about. You don't get to quietly omit the ones with messy follow-up or the ones where a complication stretched the plan sideways. Whatever you put on the list is fair game. The selectors look at your collection, choose twelve, and those twelve become your exam.

Which means the real question isn't “how many” — it's “would I be comfortable if any single case on this list got picked?”

What the ABOS Says About the Number

The minimum and maximum case counts, along with the required category breakdown, are published in the current ABOS Part II Oral Examination guidelines. Verify them directly with ABOS before you finalize your list — requirements get revised, and the ABOS Candidate Guide is the only authoritative source.

That said, the number itself is rarely the thing that gets candidates in trouble. What gets candidates in trouble is padding the list to hit a target — throwing in cases they don't love, don't remember cleanly, or didn't document well — because they're worried about being under the bar.

If you have to choose between being comfortably above the minimum with twenty cases you'd defend happily, or right at the minimum with every case truly exam-ready — the second option is safer. Fewer cases means fewer surfaces where the selectors can find your weakest work.

Think about it probabilistically. If the selectors pick twelve cases from a list of fifteen, the odds that any given case gets picked are high — roughly four in five. If your list is thirty cases, each individual case has a lower chance of being assigned, but every questionable case you added is still a loaded chamber. It only takes one weak case landing in front of an attentive examiner to blow up a session.

The goal isn't to minimize exposure through volume. The goal is to make exposure irrelevant by ensuring every case on the list is one you want on the list.

The Test: Would You Defend This Case?

Before a case goes on your list, run it through a simple filter. If the answer to any of these is no, the case doesn't belong:

1. Is the documentation clean? Op report, clinic notes, imaging, follow-up visits — is it all there, and does it tell a consistent story? Examiner 2 reviews your PDFs silently while Examiner 1 questions you. Inconsistencies in the chart turn into pointed questions you didn't prepare for.

2. Can you own the outcome? Bad outcomes are not disqualifying. Bad outcomes you can't explain, or bad outcomes where you can't demonstrate appropriate consultation and follow-up, absolutely are. You can pass with a complication if you show good judgment around it. You cannot pass if you look like you're hiding from your own chart.

3. Is the indication defensible? Did the patient fail conservative measures? Was there a shared decision making conversation documented? Would a reasonable examiner look at the indication and nod — or would they start wondering about your judgment?

4. Would you be glad this case got picked? This is the final gut check. If the selectors assigned this case for your exam, would you feel lucky or unlucky? If the honest answer is unlucky, take it off the list.

Why Candidates Inflate Their Lists

The impulse to pad is understandable. You're anxious, you're trying to demonstrate a robust practice, and you're worried about hitting the category requirements. So you reach for borderline cases to fill gaps — the one with incomplete imaging, the one where the patient moved and you lost follow-up, the one with an outcome you'd rather not relitigate.

The problem is that every borderline case you add isn't filler — it's an eighth, or a twelfth, or a fifteenth of your total list. Which means it has a real probability of landing in your exam. The selectors don't know that case was a gap filler. They may well pick it precisely because it looks interesting on paper.

The candidates who do this to themselves are one of the personality types that tend to fail: the ones who try to hide things in plain sight, hoping no one looks too hard. Examiners look hard. That's literally the job.

The Better Framing: Build the List You Want to Defend

Start with your strongest work. The cases where you remember the decision making clearly, where the imaging is complete, where follow-up is documented, where you'd be genuinely proud to walk an examiner through your reasoning. Those are your core.

Then fill in the required categories with the next tier — good cases that aren't necessarily showstoppers but are fully defensible. Clean documentation, owned outcomes, clear indications.

Stop when you've hit the requirements with cases that all pass the defensibility test. Do not keep going just to pad the number. A tighter list of bulletproof cases will always beat a longer list with soft spots.

Start Early, Curate Ruthlessly

The candidates who build the best lists started thinking about this on day one of their collection period — not at the deadline. They built a scribe system, they kept their documentation tight in real time, and by the time submission rolled around they had the luxury of choosing the best cases from a much larger pool.

The candidates who struggle are the ones who backfill at the end, scrambling through EMRs, reconstructing notes, and submitting whatever they can pull together in time. That's how borderline cases end up on the list in the first place.

Treat your case list like the curated portfolio it is. Every case on it is a case you're volunteering to defend. If you wouldn't volunteer for it, it doesn't go on.

A Final Gut Check Before You Submit

Before you hit submit on your list, sit down with it and do one honest pass. Read each case title, picture the chart, picture the imaging, picture yourself walking a skeptical examiner through the decision making. Then ask: is there any case on this list that, if it got assigned tomorrow, would make my stomach drop?

If yes, take it off. The deadline pressure and the urge to hit a target number will tell you to leave it on. Ignore that. The only person who pays the price on exam day is you, and the selectors will find exactly the case you were hoping they'd skip.

The candidates who walk in confident on exam day aren't the ones with the longest lists. They're the ones who can look at their twelve assigned cases and think: good, I wanted to talk about these. That's the standard. Build the list backward from there.