What to Say When You Don't Know the Answer on the ABOS Oral Boards

It will happen. Somewhere during your four 30-minute exam periods, an examiner will ask you something you don't know. Maybe it's an obscure physical exam test. Maybe it's a classification system you haven't reviewed. Maybe it's a follow-up question that pushes you past the edge of your knowledge.

The question isn't whether this moment will come. The question is: what do you say next?

What Failing Candidates Do

There are three common responses that hurt candidates — and all three come from the same place: panic.

The Freeze

You go silent. Ten seconds pass. The examiner waits. You feel the silence growing. The longer it lasts, the harder it becomes to break. Those ten seconds don't just cost you that answer — they rattle you for the questions that follow.

The Bluff

You project confidence in an answer you're not sure about. The examiner senses the uncertainty and follows up with harder questions on that exact topic. Now you're defending a position you don't believe in, and the hole gets deeper with every answer.

The Argument

The examiner tells you your approach is wrong. Instead of acknowledging it, you push back. You try to make your case. You may even be right — but arguing with the examiner is never the winning move. The exam tests composure, not debate skills.

What Passing Candidates Say

“I'm not certain, but here's my approach...”

This is the single most valuable phrase you can practice for the oral boards. It does three things simultaneously:

• Acknowledges honesty — you're not pretending to know something you don't
• Shows your thought process — even without the specific answer, you demonstrate how you reason through clinical problems
• Keeps the conversation moving — you don't freeze, you don't stall, you transition smoothly to what you do know

Examiners respect intellectual honesty far more than a confident wrong answer. They've seen thousands of candidates. They know when someone is bluffing. And they know when someone is genuinely reasoning through an unfamiliar problem — which is exactly what they want to see from a surgeon.

“I'm not familiar with that specific test, but I can describe the concept...”

Sometimes the examiner asks about something by a name you don't recognize, but you know the underlying concept. This phrase lets you demonstrate knowledge even when you don't know the terminology.

For example: you might not remember the name “wrinkle test” — but you can describe the concept of testing autonomic function in the hand by immersing it in water and observing skin wrinkling. The examiner gets the answer they wanted, and you showed clinical reasoning rather than pure memorization.

“I would consider these options and lean toward...”

When you're not sure which specific answer is correct, lay out the options you're considering and explain your reasoning for leaning one direction. This demonstrates that you have a framework for approaching the problem — even if you don't have the answer memorized.

Framework-based reasoning is resilient. Memorization is fragile. The examiners are specifically testing whether you can think through problems you haven't encountered before. Showing your framework is more valuable than guessing the right answer.

The Rule: Never Freeze, Never Bluff

These two responses are the most damaging things you can do in the oral exam. A freeze costs you time and composure. A bluff invites follow-up questions on your weakest topic.

If you know, say it with confidence. If you think you know, take a measured stab. If you don't know, say so honestly and move on.

The examiners move on quickly. A single “I don't know” followed by a strong answer on the next question is far better than a bluff that unravels across three follow-ups.

How to Practice This

The phrases above need to be automatic on exam day — not something you think about in the moment. Here's how to train them:

• During mock oral exams, have your practice examiner intentionally ask questions outside your comfort zone. Practice responding with the phrases above instead of freezing or guessing.
• Say the phrases out loud, dozens of times, in different contexts. Your mouth needs to learn them, not just your brain.
• After each mock exam, review: how many times did you freeze? How many times did you bluff? Track your progress across sessions.

By exam day, responding to uncertainty should feel as natural as responding to a question you know cold. That's the standard you're training toward.