This is the story of that exam—the preparation, the terror, the failure, and the strange redemption of proving you can keep a patient alive when the simulator throws a curveball. Before the exam, there is the wait. The average anesthesiology resident finishes four years of grueling training—months of 80-hour weeks, nights spent tubing premature infants, days spent managing post-op pain in a PACU that never sleeps. They have intubated in the dark, resuscitated in the elevator, and pushed propofol into veins so fragile they belonged to grandmothers and trauma victims alike.
But she is reflective, too. “The exam taught me something uncomfortable. In residency, I thought being a good anesthesiologist meant knowing the drug doses. The exam taught me it means knowing how to think when you’re terrified. And you cannot learn that from a textbook. You can only learn it from a simulation that lets you fail.” Critics call the board exam archaic. They point out that no other medical specialty requires live OSCEs with actors after residency. They note the financial burden—thousands of dollars in fees, travel, coaching. They argue that a seven-hour exam cannot capture the nuances of a real OR. anesthesiology examination
You are given a scenario. It begins innocently: “A 32-year-old healthy female for knee arthroscopy.” This is the story of that exam—the preparation,
That phrase haunts candidates for years. The pass rate for first-time takers of the ABA Applied Exam hovers around 85%. That sounds high. But to the 15% who fail, it is a catastrophe. They have intubated in the dark, resuscitated in
Dr. Hersh, our Boston resident, passed on her first try. She is now Dr. Hersh, board-eligible, soon to be board-certified. “I walked out of the SOE certain I had failed,” she says. “I told my husband to prepare for me to retake it. When I saw the green checkmark, I screamed so loud my dog ran under the bed.”
You do. You compress. You push epinephrine. But the mannequin does not wake up. Because in this simulation, you already made the fatal error 90 seconds ago. The exam is not about rescue. It is about prevention.
“You induce. The LMA doesn’t seat. You try twice. Now the SpO2 is 88%. The patient is desaturating. What next?”