I’ve been thinking: the surgery in-training exam is really like a recitation of legends, orally recounted histories, not too closely related to facts, that define our community.

The test runs through a long series of stories, which are so familiar to surgeons and surgeons-in-training, that we only have to mention a few words of the story, to have the whole thing immediately recognized and understood.

These are some of the legends: gallbladder cancer, incidentally discovered after lap chole, invading through the lamina propria (snap answer: resect a surrounding rim of normal liver tissue); projectile vomiting in a 4wk old male (pyloric stenosis, hypokalemic hypochloremic metabolic alkalosis); medullary thyroid cancer (MEN 2; check for pheochromocytoma before resecting); knee pain and blue toes in a 50-yr old smoker (popliteal aneurysm; resect and bypass, and check for a contralateral aneurysm and AAA); mesenteric thickening after total colectomy for FAP (desmoid tumor; chemo only, no surgery).

That isn’t even English, and it certainly bears little relationship to what we actually see and do; but those are the legends that we all recognize. In that light, the ABSITE is an exercise in intergenerational transfer of epic tales. . . like the Iliad and Beowulf and Hansel and Gretel. . . That’s my explanation for the high incidence of rare diseases, the lack of correlation between what we practice in real life, and the right answer on the test, and the way the residents go around for a week afterward trading key words and comparing answers. This is our oral tradition.

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