Top Reasons Candidates Fail the ABA Oral Boards
1. Disorganized or Illogical Clinical Reasoning
The exam is not just about “knowing” – it’s about thinking clearly under pressure.
Jumping to answers without explaining your reasoning
Failing to consider appropriate differentials
Not prioritizing urgent problems
Giving incomplete or disjointed plans
The board wants to see that you can think through complex scenarios methodically and safely.
2. Poor Crisis Management
A major red flag is being slow to recognize and treat critical situations.
Missed a tension pneumothorax
Didn’t call for help during a hemorrhage
Ignored signs of a difficult airway
Delayed response to anaphylaxis or malignant hyperthermia
The inability to act decisively in emergencies is one of the fastest ways to fail.
3. Inadequate Communication Skills
This exam heavily evaluates your ability to communicate, both with the examiner and hypothetically with patients or the care team.
Rambling, disorganized speech
Using medical jargon in patient explanations
Getting defensive or argumentative
Inability to clearly articulate a plan
Clear, calm, and professional delivery matters just as much as medical accuracy.
4. Failure to Adapt When the Scenario Changes
The cases often evolve. If you stick to your original plan despite new findings, it looks like you’re not thinking dynamically.
Ignoring a change in vitals, labs, or exam
Not adjusting anesthetic technique when the surgery changes
Sticking rigidly to a script
Clinical flexibility and reassessment are key skills examiners are watching for.
5. Ethical or Professionalism Issues
Ethical reasoning, patient advocacy, and teamwork are all assessed—even in hypothetical form.
Not respecting a patient’s DNR inappropriately
Failing to disclose an error
Mishandling conflict with a surgeon or colleague
Saying “I’d just wing it” or “It’s not my problem”
Professional behavior is a pass/fail gate—no matter how smart you are, poor ethics = fail.
6. Inability to Handle Uncertainty or Ambiguity
Sometimes you won’t know the answer—and that’s okay, if you respond professionally.
Making something up confidently instead of admitting uncertainty
Freezing when presented with an unfamiliar scenario
Failing to say “I’d consult a senior colleague / surgeon / guidelines”
Examiners are okay with “I’m not sure, but I would...” if it shows maturity and safety.
7. Too Many Minor Mistakes That Add Up
You don’t have to be perfect, but if you accumulate too many minor concerns, it can push you into failing territory.
Omitting key steps in pre-op evaluation
Missing opportunities to optimize a patient
Forgetting to mention post-op pain control
Inconsistent answers between parts of the case
The exam is holistic—enough small red flags can cost you the pass.
8. Failure to Demonstrate Independent Practice Readiness
At the core, the ABA is asking:
“Would I feel safe letting this person take care of my family in a real OR?”
If your performance makes the examiners question your judgment, your adaptability, or your ability to safely manage the OR—you won’t pass.
What You Need to Pass
Sound, structured clinical thinking
Calm and professional demeanor
Clear, organized communication
Strong crisis management
Awareness of your limits and judgment
Ethics, empathy, and safety-first decision-making
TL;DR: You’re More Likely to Fail If You…
Red Flag Impact Ramble or speak in disorganized fashion Lowers confidence in your thinking Miss or mismanage a crisis Immediate red flag Can’t explain your rationale Seems unsafe or shallow Seem rigid or panicked Not ready for independent practice Fail to demonstrate professionalism Can override other strengths