What the Anesthesiology Oral Board Exam Is Actually Like

About this account

This first-person account was submitted anonymously. It reflects one candidate's personal experience and should not be read as a description of every candidate's exam day or result.

There is plenty of information available about the structure of the ABA APPLIED Exam. You can learn how the Standardized Oral Examination works, what the OSCE is designed to assess, how long the examination takes, and how people recommend preparing.

What I had a much harder time finding was an honest description of what the experience itself actually feels like.

This is what I remember about the days leading up to the exam, the experience of sitting for it, and the post-test misery.

It is hard to even think about now.

The final few days

About a week before my exam, I was nervous but reasonably functional. If I had to put a number on it, my anxiety was probably a four out of ten. I felt prepared and confident that I had done my due diligence in preparing for the exam.

Then, three days before the exam, I took one final online live practice oral examination.

It went terribly.

The case the examiner chose did not test anesthesia knowledge; it was an exam of neonatal care at birth and in the NICU. At the end, the examiner made a comment to the effect of, "Wow, pain fellowship has been good to you, hasn't it? That was not good."

Whether it was intended as motivation or simply an attempt to recreate the pressure of the real examination, it had the opposite effect on me.

My confidence collapsed.

Now, with only days until my exam, my anxiety went from manageable to overwhelming. I stopped sleeping well. I woke up with night sweats. I was sick to my stomach. I was constantly thinking about anesthesia topics, things I might have forgotten, and my self-perceived weaknesses.

Instead of feeling increasingly prepared as the test approached, I became increasingly aware of everything I might not know.

People told me to stop studying for a day or two before the exam.

I could not.

Studying was one of the only things that temporarily relieved the anxiety and sense of doom. I studied in my free time, during my commute, on the airplane to Raleigh, in the hotel, and eventually on the morning of the exam itself.

Looking back, I am not sure how much additional knowledge I acquired during those last couple of days. But stopping felt impossible.

The day before the examination, I flew to Raleigh and arrived in the afternoon. I intentionally did not stay at the hotel where candidates checked in for the exam. I had this sense that the hotel was tainted, an edifice housing the deep fear and shame the ABA brings upon its examinees.

I stayed at a nearby Courtyard by Marriott instead.

I got dinner, went back to the room, called my wife, and continued studying. I tried intermittently to distract myself by watching sports, but mostly I reviewed OSCE material, pediatric dosing, and the small factual details that suddenly seem extraordinarily important when a board examination is less than 24 hours away.

I was a nervous wreck.

At that point, I was not even particularly excited to pass. I wanted the exam to be over.

Fortunately, I eventually slept. Because my examination time was not especially early, I probably got seven or eight hours that night. I woke earlier than I needed to and could not get back to sleep, but considering how poorly I had been sleeping in the preceding days, it could have been much worse.

One practical lesson from the experience: if you are traveling for this exam, stay somewhere quiet and comfortable. Spend the money. There are enough things keeping you awake already. You do not need traffic noise contributing to the differential.

Exam morning

My first waking moment was essentially fear.

I do not remember a specific thought. I remember the physical sensation of knowing that the thing I had been preparing for over months and, in some ways, over years was finally here.

I walked to a nearby grocery store and bought breakfast, caffeine, and snacks. Getting outside and walking around was probably one of the better things I did that morning. For a little while, at least, I was doing something other than sitting in a hotel room thinking about anesthesiology and my hatred for the ABA.

About twenty minutes before my scheduled arrival time, I ordered an Uber and went to the hotel where the ABA check-in was taking place.

I arrived about ten minutes early and sat in the lobby.

There was no dramatic announcement. Nobody emerged and said that the exam check-in was beginning. There was no pomp and circumstance for the most consequential exam of my life. Just the opening and closing of the automatic sliding glass door and complimentary lemon-infused water. More candidates trickled in and took a seat in the lobby.

Eventually, after the top of the hour passed without any announcement, I wandered back toward the conference area and found a line beginning to form.

We checked in, turned over our bags, and sat together waiting for instructions.

The other candidates looked remarkably calm.

I felt like a nervous wreck.

Of course, I suspect most of them felt exactly the same way. Everyone was simply doing what anesthesiologists are generally pretty good at doing: appearing calm while internally considering several catastrophic possibilities.

After fifteen or twenty minutes, we were directed onto a bus.

The bus took us to the ABA testing center, located on an upper floor of a nearby office building. We went through a secured elevator, checked in again, received instructions, and were eventually directed into a small conference room.

Each of us had an assigned chair.

When everyone was seated, we were told to begin.

Our first case stem was waiting on a clipboard.

That was the moment the exam became completely real.

Before the exam, I had a fear that in that exact moment I would choke. I would panic. I would have a non-epileptic seizure from the sheer terror. That did not happen. The anesthesiologist brain took over. The task was at hand.

Walking to the oral exam

After reviewing our stems and making notes, we were told to stand.

Then we walked together, single file, down the hallway toward the examination rooms.

As you walk, you pass door after door. Outside each room is an examiner waiting for a candidate.

You do not know which room is yours.

So you continue walking past these examiners, each of them looking at you as you pass, until eventually the person immediately in front of you stops.

That is your room.

That person is your examiner.

There was something surreal about it.

For months I had imagined the exam. I had practiced it. I had listened to other people take oral exams. I had answered questions out loud while driving. I had rehearsed what I thought the experience might be like.

Now I was simply walking down a hallway toward it.

There was nowhere else to go.

When I reached my room, the examiner introduced herself and invited me inside almost as if she were welcoming me into her home, which seemed wrong. A second examiner was already seated at the table. They introduced themselves and asked me to sit.

Then the examination started.

Once the questions started

I had expected the oral examination to move quickly, and it did.

But I did not feel as though the examiners were constantly pushing or dragging me through it. They asked questions. I answered. When they had enough information, they moved on.

What surprised me most was what happened to my anxiety.

It did not disappear. It remained.

But it moved somewhere into the background.

The closest comparison I can make is working a code. There may be anxiety underneath everything, but the immediate clinical problem becomes more important than how you feel about it.

That was what happened during the exam.

There was still fear underneath the surface, but there was now a question sitting directly in front of me that needed an answer.

So I answered it.

Then another question came.

And another.

Some answers felt very good. Occasionally the examination moved into areas where my recent fellowship training had prepared me particularly well, and I could give a concise answer and explain exactly why I would manage the situation that way.

The second oral examination

After the first oral examination, I actually felt reasonably okay.

I did not think I knew everything, but I felt like I had done the best I could. The examiners had been fair and respectful, and I felt that my preparation had translated reasonably well into the actual experience.

There was essentially no time to celebrate that feeling.

You leave the room, return to the preparation area, receive another stem, and begin again.

The second examination was much harder for me psychologically.

The first question was relatively open-ended and could have been approached in several ways. I gave my answer, and the examiner reacted strongly and negatively. There was a loud sigh, followed by, "Really, you'd seriously do that? Don't just say anything that comes to your mind. You need to think before you answer," in a way that was overtly belittling. I still do not know whether that was purposeful, intended to put me on my heels, or whether my answer was genuinely that bad as to warrant the examiner's wrath. I do not like to think about it too much.

It immediately threw me off. My mouth suddenly felt dry. Sphincter tight. Eyes wide.

Instead of beginning the examination with the rhythm I had developed during the first session, I suddenly felt as though I had made a major mistake before the exam had really even begun.

From that point forward, I felt like the entire examination was being conducted through a haze of anxiety and unease.

The other examiner remained straightforward and professional. My experience with the first was different.

Regardless of whether that was intentional, it affected me.

That was probably one of the hardest parts of the day: having to continue reasoning and communicating while simultaneously feeling as though the examination might already be going badly.

There was no opportunity to reset. No pause button.

There was only the next question.

So I kept answering. I kept going.

The OSCE

The OSCE was different.

It was predictable.

I had spent substantial time learning the frameworks and ABA checklists, so when each scenario began I generally knew the structure I wanted to follow.

Much of the examination felt less like a traditional knowledge test and more like a test of communication: speaking with patients, families, or other clinicians and demonstrating that you could navigate those interactions clearly and professionally.

It still felt artificial in the way standardized-patient examinations always feel somewhat artificial, but it was not particularly strange.

I had been most concerned about the ultrasound portions. Fortunately, I was comfortable with finding the images they asked for.

By the end, I do not remember feeling particularly tired. I suspect I was operating almost entirely on adrenaline and caffeine by that point.

Then, suddenly, it was over.

Walking out

I had imagined that finishing the exam would bring immediate relief.

It did not.

If anything, my anxiety became worse.

During the examination itself, I had been forced to stay in the moment. There was always another question, another task, another station.

Once the exam ended, there was nothing left to do.

And my brain immediately began reviewing everything.

I walked out convinced that I had failed.

Not mildly concerned.

Not fifty-fifty.

I was certain.

I got on the bus afterward feeling like I had just attended my own funeral.

I initially did not even want to turn my phone back on. I did not want to talk to anyone. Eventually I texted my wife and essentially told her that it had been terrible and that I did not really want to talk about it.

The ABA bus took me to the airport.

At a bar there, I ran into a few other examinees waiting for flights. We sat together, ate, had a few drinks, and talked about the experience.

They also thought their exams had gone terribly.

The post-exam autopsy

The days afterward were worse than I expected.

I spent an enormous amount of time on Reddit and Student Doctor Network reading other people's experiences.

I searched for people who had walked out convinced they failed and later passed.

I compared their reactions to mine.

Every once in a while, I would find something reassuring.

The reassurance rarely lasted.

I replayed answers repeatedly. There were questions I thought about over and over again, trying to determine how consequential a particular mistake might have been.

Months later, I honestly cannot remember many of those specific answers anymore.

At the time, they felt unforgettable.

The uncertainty was made worse by the fact that I did not really understand how individual mistakes translated into the final result. I could identify answers that had been good and others that had clearly been poor.

What I could not determine was whether the bad answers were bad enough to fail.

At my lowest point, I was not merely wondering whether I would need to take the exam again.

I kid you not, I had researched and mapped out alternative paths and governing bodies from which I could obtain anesthesiology board certification.

I had drawn out a career without board certification.

I was reading accounts from people who had taken the examination a second or third time.

I was imagining waiting an entire year and having to go through the entire process again.

I was completely convinced I had failed an examination whose result had not yet been released.

Friends and colleagues who had been through the process would say, "I'm sure you passed," but there was always a barely perceivable inflection of uncertainty in their voices. They were not in that exam room. They did not know.

In retrospect, this was not especially rational.

At the time, it felt completely rational.

I talked it through with a therapist to find some solace, and that helped.

The sense of dread persisted for weeks.

The morning the result came out

Because I lived in the western United States, I knew results might be available early in the morning.

I could not sleep the night I expected them. I woke repeatedly and checked the ABA website. Midnight, 2 a.m., 4 a.m. Nothing.

At some point early that morning, I noticed something different.

The website was allowing me to sign up for MOCA.

I knew what that probably meant.

The results were up.

It was still dark.

The house was quiet.

My wife and kids were asleep.

I opened the result.

I had passed.

I let out an audible gasp.

I am not someone who shows a lot of emotion. If anything, I have a tendency to avoid emotional moments, but I cried.

Months of preparation, the escalating anxiety before the exam, the experience itself, and the weeks afterward when I had convinced myself that I had failed all released at once.

The relief was immediate.

And then, somewhat unexpectedly, I felt angry.

I had spent weeks feeling terrible.

The examination had consumed an enormous amount of my attention and taken a real amount of joy out of my life. I had replayed conversations, criticized myself, imagined failure, and mentally prepared for another year of waiting.

Then a webpage displayed a passing result.

And suddenly it was over.

In the days afterward, I continued thinking about how much psychological weight I had allowed the exam to carry. I was angry about the practice examination immediately beforehand that had shattered my confidence. I was angry about my perception that the exam did not test an anesthesiologist's abilities or aptitudes. I was angry at the ABA.

But mostly I was struck by how quickly something that had occupied so much mental space simply disappeared.

One moment I was lying awake in the dark wondering whether I had failed my boards and what might come of my career.

A moment later, I had passed.

Looking back

What stands out to me now is not any particular clinical question.

Most of those have faded.

What I remember is the experience.

I remember sitting alone in the hotel room the night before.

I remember walking to the grocery store that morning because I needed to get out of my own head.

I remember sitting in the hotel lobby watching other candidates appear far calmer than I felt.

I remember the bus ride to the testing center.

I remember standing up with the other candidates and walking single file past the examination rooms, waiting to discover which examiner would be mine.

I remember the strange transition from overwhelming anxiety to the almost automatic focus that occurred once the first question was asked.

I remember walking out certain I had failed.

I remember feeling terrible for weeks.

And I remember sitting in a dark, quiet house several weeks later, crying after seeing that I had passed.

That is what taking the oral boards felt like to me.

Not a triumphant demonstration of everything I had learned during residency.

Not a clean progression from preparation to performance to relief.

It was messy, stressful, imperfect, and far more emotionally consuming than I expected.

Nothing I write can relieve your apprehensions and stresses, but if you are somewhere in this ABA APPLIED Exam process, just know that we have all been through it. You will make it out.

What It Is Actually Like to Take the Anesthesiology Oral Board Exam