What ABOS Part II Examiners Actually Score (And What They Don't)

Most candidates walking into the ABOS Part II have the same blind spot: they assume the exam is testing what they know. It is not. The exam is testing how they present what they know, and there are exactly nine categories where examiners are keeping score.

The 9 Categories (And Why Order Matters)

Every examiner uses the same rubric. Each category is scored on a 0 to 3 scale. Understanding what falls into each one changes how you prepare.

1. Data Gathering (History and Physical)

Did you ask the right questions? Did you perform or document the relevant physical exam findings? Examiners are not looking for an exhaustive review of systems. They want to see that you gathered the information that actually mattered for this patient and this diagnosis.

2. Imaging and Diagnostics

Did you order the right studies? Can you interpret them correctly? If you ordered an MRI, can you explain what you saw and why it changed your management? Saying “the MRI showed a tear” is not enough. You need to describe what you saw and connect it to your decision.

3. Diagnosis

Can you articulate a clear differential and defend your final diagnosis? The examiners will push on this. If you cannot explain why you ruled out other conditions, you will lose points here regardless of whether your final answer was correct.

4. Applied Knowledge

This is the “do you understand the science” category. Can you discuss the biomechanics, the pathophysiology, the relevant anatomy? One question that comes up constantly: “What is the natural history of this disease?” If you cannot explain what happens without intervention, you are signaling a shallow understanding.

5. Surgical Indications

Why did you operate? Was there a conservative trial first? Can you justify the timing? Examiners are looking for sound clinical judgment, not just the right procedure. If you jumped to surgery without documenting a trial of conservative management, be ready to explain why.

6. Technical Skill

This is assessed through your operative note and how you describe the procedure. A well-written operative note with clear steps, positioning, approach, and implant choices demonstrates competence. A vague note raises questions.

7. Complication Management

Complications happen. The examiners know this. What they want to see is that you recognized the complication, managed it appropriately, and learned from it. Trying to hide a complication or minimize it is far worse than owning it and walking through your response.

8. Outcomes and Follow-up

How did the patient do? Did you follow them appropriately? Can you discuss the outcome honestly? If the outcome was not ideal, the examiners want to hear what you would do differently next time.

9. Communication and Professionalism

This is the category that separates candidates who pass from candidates who know just as much but fail. Are you organized? Are you calm? Do you respond to pushback with composure or defensiveness? Do you communicate like a surgeon who inspires confidence?

Where Most Points Are Lost

Candidates rarely fail on categories 1 through 6. Those are the clinical knowledge categories, and most orthopedic surgeons who made it through residency and fellowship have the knowledge base to score well.

The points are lost on categories 7 through 9: complication management, outcomes, and communication. These are the categories that require practice, not studying. You cannot cram composure. You cannot memorize how to handle pushback gracefully.

That is why the candidates who practice presenting out loud, under pressure, with someone who challenges them, pass at higher rates than candidates who just study harder.

What Examiners Do NOT Score

A few things that candidates worry about that do not directly affect their score:

• Subspecialty depth: You are not expected to be a fellowship expert in every area. You are expected to demonstrate sound general orthopedic judgment.
• Perfect outcomes: The exam is not looking for cases where everything went perfectly. It is looking for cases where you demonstrated good decision-making, even when things got complicated.
• Memorized facts: Rattling off textbook answers does not impress examiners. They can tell when you are reciting versus when you actually understand.

How to Use This Information

Go through each of your cases and score yourself honestly on all 9 categories. Where are your gaps? For most candidates, the answer is the same: communication, complication management, and the ability to present under pressure.

Those are skills that improve with practice, not with more reading.