Predictive Factors of First Time Pass Rate on the American Board of Surgery Certification in General Surgery Exams: A Systematic Review

Abstract

General Surgery residency programs are evaluated on their American Board of Surgery (ABS) Qualifying examination (QE) and Certifying examination (CE) pass rates. This systematic review aims to evaluate predictive factors of ABS QE and CE first time pass rates. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, the following electronic databases were searched: PubMed, Embase, JAMA Network, and Google Scholar. Studies available in the English language published between January 2000 and July 2020 were deemed eligible. Articles that did not assess either of the ABS board examinations performance and pass-rates as outcomes were excluded. The Oxford Centre for Evidence-Based Medicine was used to determine the quality and risk of bias of each study. A total of 31 publications were included for analysis. Undergraduate medical education variables associated with first-time pass rates on the QE and CE include USMLE score, AOA membership, and class rank. Program factors affecting pass rates include program size, geographic location, and Program Director turnover. There is strong correlation between ABSITE and QE. Evidence supports the utility of mock oral examinations (MOEs) in predicting CE success. ABSITE scores demonstrated higher correlation with QE pass rate than CE pass rate. MOEs have a positive association with first-time CE pass rates. Nonmodifiable factors such as race/ethnicity, marital status, and geographic location were also found to be predictors. Delaying board certification examination beyond 1 year after residency graduation significantly reduces first-time pass rate.