Study Guide

ABS Certifying Exam Day: What to Expect

Since the COVID-19 pandemic, the General Surgery Certifying Examination has been delivered virtually via Zoom rather than at a centralized in-person testing center. The format is now stable and is expected to remain virtual. This guide walks through exactly what to expect — from the day before, through check-in, the three sessions, and the post-exam period — based on the published ABS protocol.

Before Exam Day

Three weeks out:Your admission letter posts to the ABS portal. It contains your exact exam date, scheduled start time, Zoom meeting link, and check-in instructions. Read it carefully — the assigned time is irrevocable.

Mandatory Technology Interview Session: Before you receive your exam-day meeting link, you must complete a tech check with the ABS. This is not optional and not just a formality. The session verifies your camera, microphone, internet bandwidth, and physical room setup. Failing the tech check delays your exam.

Workspace setup: The ABS requires a quiet, private room. Your desk surface must be visible to the camera and must be clear of all materials except water, paper, and pen. Phones, smartwatches, tablets, books, second monitors, and any wearable technology must be out of reach. You will share your screen for the entire exam to confirm no other applications are running.

The night before: Sleep is more valuable than last-minute review. The single most consistent advice from people who have taken the CE is that final-night cramming hurts performance because fatigue degrades verbal fluency, which is what the exam tests. Eat a reasonable dinner, lay out clothes (business casual is conventional), test your audio and video, and go to bed at a normal hour.

Check-In

Log in at the time stated on your admission letter — not at the scheduled exam start time. The check-in process is built in before the exam. You will enter a Zoom waiting room and be admitted by a host. During check-in you will:

  • Display a government-issued photo ID to the camera.
  • Show all four walls of your room and your desk surface.
  • Run any required security scan and confirm screen sharing.
  • Acknowledge the rules of the examination.

Once check-in is complete you wait briefly in the Zoom meeting for the first session to begin.

The Three Sessions

The exam is three consecutive 30-minute sessions. Each session is led by a different team of two examiners and contains four cases, for 12 total cases. With ~30 minutes of examiner-facing time per session, each case lasts approximately seven to eight minutes.

A case begins with a brief clinical stem. The examiners may ask you to work up the patient, identify the operation, walk through the operation, or manage a postoperative complication — or all of the above, often within the same case. They will introduce changes (“The patient’s blood pressure drops to 70 in the OR. What do you do?”), challenge your reasoning (“Why that and not the alternative?”), and may ask you to defend a different management plan than the one you initially proposed.

Topic distribution follows the SCORE Curriculum Outline, weighted toward Core procedures with some Advanced topics. The three sessions are typically organized around broad categories such as alimentary tract / abdominal, trauma / critical care, and a third covering breast, endocrine, vascular, thoracic, head and neck, skin and soft tissue, and pediatric surgery. The exact grouping is not announced in advance and may vary year to year.

What the Examiners Are Scoring

The ABS describes the exam as testing “surgical judgment, clinical reasoning skills, and problem-solving ability.” In practice, examiners are evaluating five things in parallel as you speak:

  1. Organized approach.Do you have a system — ABCs, primary survey, structured workup — that you apply consistently regardless of the case?
  2. Rapid interpretation of key findings. When given a clinical detail, do you identify why it matters?
  3. Clinical problem-solving. Can you generate a management plan and articulate why it is the right plan?
  4. Error avoidance. When the examiner introduces a curveball, do you adapt without abandoning sound principles?
  5. Appropriate judgment. Do you know when to operate, when to wait, when to call a consultant, when to transfer?

The pass/fail decision is the aggregate of all six examiners’ assessments — not a preset percentage. There is no curve, no ranking, and no question count. Two examiners scoring you adequately is not enough; the panel as a whole has to agree.

Energy and Timing Management

The full exam is ~90 minutes of examiner-facing time, plus check-in. Three 30-minute sessions sound short, but the cognitive load is intense; candidates routinely report exhaustion after session two. Three practical points:

  • Eat something before you log on.Hypoglycemia at minute 60 is real. A protein-and-carb breakfast 1–2 hours before check-in is the safe pattern.
  • Water is permitted— use it. A quick sip resets your voice and your thinking between cases.
  • Do not carry session 1 into session 2.If a case went poorly in session 1, you cannot fix it in session 2 — you can only ruin session 2 by dwelling on it. Compartmentalize and start fresh with each new pair of examiners.

After the Exam

Results post within 10 business days. The decision is binary — pass or fail — with no numeric score released. If you do not pass, you may request feedback from the exam manager within 30 days. The feedback identifies broad categories where you fell short rather than case-specific detail, but it is enough to focus retake preparation.

For data on pass rates and the published predictors of first-time success, see our ABS Certifying Exam pass rate page. For preparation schedules, see our 3, 6, and 12-month study schedules.

References

  1. American Board of Surgery. General Surgery Certifying Examination — eligibility, format, virtual logistics, scoring. Link