Using the 20- and 10-minute stem review
Why examiners ask this
The stem review is the only unscored time in the SOE, and what I do with it decides how the scored time goes. Session 1 gives 20 minutes with the first stem in the orientation room; session 2 gives 10 minutes with the second.1 In the ABA sample, the first stem is a full history, examination and laboratory panel, and the second is a single paragraph.2 The stem is written backwards from the questions: every detail in it is there because an examiner plans to ask about it. A candidate who reads the stem as a case report walks in with a general plan; a candidate who reads it as a question map walks in with answers already structured. The difference shows up as organization and judgment in the first two minutes of the session.
The 60-second answer
I read the stem three times. The first pass is fast and whole, to know the case: who, what operation, what urgency. The second pass is a hunt: I mark every abnormal finding, every medication, every number and every throwaway phrase, because each one is a planned question. A murmur, a potassium of 3.1, a dose of clopidogrel, "lives alone," "recent cough": each is an examiner's note to self. The third pass turns the marks into a map. For each one I write the question it will generate, my one-sentence answer, and the inject it sets up. Then I write the anesthetic plan in the order of the session blocks: preoperative issues and what I would optimize, induction and maintenance choices with reasons, the two complications I expect, and the postoperative disposition. I spend the last two minutes saying the first answer out loud in my head, because the first answer sets the tone.
Decision points and the "why"
- Hunt for the abnormal, not the normal — a normal potassium is filler; an abnormal one is a question about delaying surgery. I spend my minutes on what is wrong, because that is where the questions are.
- Treat every drug as a question — anticoagulants set up neuraxial timing; beta-blockers set up continuation; a steroid sets up stress dosing; an MAOI sets up drug interactions. The question is why the drug is in the stem.
- Read the urgency line twice — "emergent," "urgent," "elective" decides whether optimization is on the table. The examiner will test whether I know the difference between delaying an elective case for a potassium of 3.1 and proceeding with a ruptured viscus.
- Write the inject before the examiner does — for each abnormal finding I write the complication it predicts: the murmur predicts hypotension on induction, the sitting position predicts air embolism, the fresh stent predicts thrombosis if I stop the antiplatelet. Knowing the inject is coming converts adaptability from a test into a rehearsed answer.
- Plan in block order — in the ABA sample, session 1 goes intra-op then post-op, and session 2 goes pre-op then intra-op, each followed by additional topics.2 I organize the plan in the order I will be asked, so I am not searching my memory.
- Build the map, then memorize it — exam staff hand out the materials and the orientation room has pens; personal pens and papers stay in the locker.1 I make a one-page map with the stem findings down the left and my answers to the right if the materials allow writing, and I follow the proctor's instructions on what goes into the exam room, so I plan as if the map must live in my head.
The complication they will inject
The method breaks when the stem contains something I do not understand: an unfamiliar syndrome, a drug I do not know, a lab value I cannot interpret. I do not spend five minutes on it. I write the principle the examiner is after: an unfamiliar syndrome is a question about airway, cardiac and metabolic implications, so I plan to ask about and examine for those three; an unfamiliar drug is a question about its class and interactions, so I plan to say what class it belongs to and what I would check before giving an anesthetic. The second failure is running out of time because I wrote too much on the first finding. I set checkpoints: the first pass done by minute 3, the hunt by minute 10, the map by minute 17, and the last three minutes for the opening answer. In session 2 the checkpoints are 2, 5 and 8.
Pitfalls that cost points
- Writing a full anesthetic record instead of a question map; the examiner does not want the record.
- Assuming a detail is irrelevant; nothing in the stem is irrelevant.
- Planning only the ideal anesthetic and not the alternatives; the examiner will remove my first choice.
- Reading the stem once; details I missed become questions I cannot answer.
- Walking in without a rehearsed first sentence.
Rapid-why
Q: Why is the second session's stem shorter? A: The 10-minute short stem tests a different skill: planning from less information and asking the right questions in the preoperative block.
Q: Do I state what I would ask the patient preoperatively? A: Yes, briefly and prioritized by the stem's findings; the examiner then supplies the answers or says the patient is already in the room.
Q: What if the stem has no abnormal findings? A: Then the questions are about the operation and the inject; I plan around the procedure's known complications and the patient's age.
Q: Can I ask the examiner about something unclear in the stem? A: Yes, in the first block, as a focused clinical question; it reads as judgment if it is relevant and as stalling if it is not.
Numbers to know
| Item | Value |
|---|---|
| Session 1 review | 20 min, long stem1 |
| Session 2 review | 10 min, short stem1 |
| Reading passes | 3: whole, hunt, map |
| Session 1 checkpoints | First pass by 3 min, hunt by 10, map by 17 |
| Session 2 checkpoints | 2, 5 and 8 min |
| Rehearsal of the opening answer | Last 2–3 min |
Links
- How the SOE is scored: what examiners grade, Structuring an answer in 45 seconds, Handling the mid-case complication, The additional-topics block: three minutes per topic, OSCE day: stations, timing, who is in the room
- ABA APPLIED Exam Manual; ABA Sample Standardized Oral Exam Questions
Sources
- 1.What to Expect for Your APPLIED Exam (APPLIED Exam Manual) · ABA, 2026 · theaba.orgRevised July 2026.
- 2.Sample Standardized Oral Exam Questions · ABA · theaba.orgPublic sample; block names and minutes are taken from the sample sessions.
Facts on this page were checked against these sources on Oct 14, 2026. Guidelines change; confirm doses against current institutional protocols.