From the Guidelines
The most high-yield topics for the Surgery COMAT exam include acute abdomen, trauma management, pre and post-operative care, surgical infections, and gastrointestinal disorders. Focus particularly on appendicitis, cholecystitis, bowel obstruction, hernias, and trauma assessment using the ATLS protocol 1. Fluid and electrolyte management is crucial, especially understanding maintenance requirements (typically 1.5-2L/day for adults) and replacement strategies for surgical patients. Wound care principles, including wound classification (clean, clean-contaminated, contaminated, and dirty) and appropriate antibiotic prophylaxis timing (within 60 minutes before incision), are frequently tested. Some key areas to focus on include:
- Surgical complications like DVT/PE, surgical site infections, and anastomotic leaks appear regularly, along with their prevention strategies
- Shock management (hypovolemic, cardiogenic, distributive) and burn care calculations using the Parkland formula (4mL × kg × %TBSA) are important
- Understanding the pathophysiology behind these conditions will help you connect symptoms to diagnoses and appropriate management plans on the exam. The ERAS Society recommendations for perioperative care in elective rectal/pelvic surgery also provide valuable insights into enhanced recovery after surgery, although this may not be directly applicable to the COMAT exam 1.
From the Research
High-Yield Topics for the Surgery Comprehensive Assessment (COMAT)
The following topics are considered high-yield for the COMAT:
- Acute appendicitis: risk factors for superficial surgical site infections, such as antimicrobial therapy within the previous 30 days, CRP >50 mg/L, open surgical procedures, presence of intra-operative abdominal drain, and intra-operative findings of complex appendicitis 2
- Intra-abdominal sepsis: definitions, clinical standards, and treatment, including the Surviving Sepsis Campaign guideline 3
- Emergency general surgery: guideline summaries for acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis, and small bowel obstruction 4
- Sepsis after appendectomy: risk factors, such as age 60 years or more, African American race, morbid obesity, acute renal failure or dialysis, disseminated malignancy, and open appendectomy 5
- Surgical education: the use of games, such as surgical jeopardy, to improve knowledge retention and ABSITE scores 6
Key Concepts
Some key concepts to focus on include:
- Risk factors for surgical site infections and sepsis
- Definitions and treatment of intra-abdominal sepsis
- Guideline summaries for common emergency general surgery conditions
- Risk factors for sepsis after appendectomy
- Innovative methods for surgical education and knowledge retention
Relevant Studies
Studies have shown that knowledge of these topics is essential for surgical residents, and that innovative methods, such as surgical jeopardy, can improve knowledge retention and ABSITE scores 2, 3, 4, 5, 6