Reply to "Fellowship Board Pass Rates Rising: Analysis of Pathology Subspecialty Examination Performance".

The American Board of Pathology (ABPath) publishes annual performance data for the anatomic pathology (AP) and clinical pathology (CP) board examinations, as well as for ABPath subspecialty examinations. Overall board pass rates for all AP and CP board examinees have increased during the past decade; however, no study has analyzed the board pass rates for pathology subspecialty examinations, and whether these follow the same trend. To evaluate ABPath subspecialty examination pass rates to assess the trend in certification. We analyzed the total number of first-time test takers and board pass rates for 11 pathology subspecialties recognized by the ABPath from 2007 to 2021, acquired from annual reports published by the ABPath. We compared the pass rates in 5-year intervals (2007-2011, 2012-2016, 2017-2021) for each individual specialty. We also analyzed the pass rate of CP subspecialties compared with AP subspecialties. The overall mean pass rate for ABPath subspecialty examinations during the previous 15 years was 89% (range, 78.9%-100%), with the overall pass rate being significantly higher in 2017-2021 (P = .02). The contemporary overall rate of passing was significantly higher for AP subspecialty examinations (P < .001) and was higher, though not significantly, for CP subspecialties (P = .13). There were significant differences between first-time test takers' mean pass rate (92.1%), repeat test takers' mean pass rate (54.5%), and the overall rate (P < .001). Contemporary pathology subspecialty board examination pass rates are significantly higher than historic rates, possibly reflecting continuously improving and readily available preparatory materials.

This article was migrated. The article was not marked as recommended. IntroductionThe national pass rates for the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP) Certification Exams (CE) has declined for combined internal medicine-pediatric (Med-Peds) residents. The lower board pass rate is especially evident in smaller institutions like our own.Methods We instituted a board preparation assistance program where each resident is stratified into a color zone according to their in-training exam (ITE) scores.ResultsThe ITE results of 67 residents from 12 classes were analyzed. 65.7% were graduates of medical schools within the United States (US) and 85.1% were allopathic graduates. Mean scores for USMLE step 1 and step 2 were 213 and 217 respectively. Mean ITE scores increased in each post-graduate year.Our first time ABIMCE board pass remained constant at 73% before the intervention and 75% after the intervention with 84% of residents ever passing the ABIMCE prior to the intervention and 81% after. Our first time ABPCE board pass rate is much improved from 46% to 75% and our overall pass rate improved from 57% to 93% (p=0.0121). On multivariate analyses there was no association between passing either the ABIMCE or ABPCE and any of our measured variables.ConclusionsIt is encouraging that our ITE scores and ABPCE and ABIMCE pass rates are improving although this seems to be due to factors other than our intervention. Other institutions that struggle with poor board pass rates may be interested in our approach.

58. ENTER THE MATRIX; A STANDARDIZED, ACCOUNTABLE APPROACH TO RESIDENT BOARD PREPARATION

102. CARPE DIEM MEDIUM: MAKING THE MOST IMPACT IN AN ACADEMIC HALF DAY

The US internal medicine workforce relies on international and osteopathic medical graduates to fill gaps in residency. Little is known about the distribution and impact of IMGs, DOs, and USMDs concentrating in different types of IM programs. Determining the extent to which USMDs, DOs, and IMGs concentrate in different types of IM programs and comparing Board pass rates by program concentration. This survey study used data from the AMA's FREIDA database for 476 non-military IM programs in 2017-2018, and 2016-2018 ABIM exam pass rates for 388 accredited programs. Outcomes were (1) program concentration based on percentage of residents who were USMDs, IMGs, and DOs in 2017-2018 and (2) 2016-2018 program ABIM pass rates as proxies for program quality. Key independent variables were hospital type (community-based, community-based university-affiliated, or university-based) when program concentration was the outcome, and program concentration when Board pass rates were the outcome. Twenty-five percent of programs were "USMD-dominated," 17% were "DO-dominated," 42% were "IMG dominated," and 16% were "integrated." The chances that a university hospital was USMD-dominated were 32 percentage points higher than that for a community hospital (AME = 0.32, baseline probability = 0.11, 95% CI, 0.17-0.46, P < .001). USMD-dominated programs also had significantly higher pass rates by 4.0 percentage points (AME = 0.04, baseline proportion = 0.90, 95% CI, 0.02-0.06, P < .001) than integrated programs, while DO-dominated programs had significantly lower pass rates (AME = - 0.1, baseline proportion = 0.90, 95% CI, - 0.15 to - 0.04, P < .001). USMDs and non-USMDs systematically cluster in certain types of residency programs and their training may not be equal, as measured by board pass rates.

37. NEEDS ASSESSMENT OF BOARD PREPARATION CURRICULA AND CERTIFICATION RATES AMONG U.S. PEDIATRIC RESIDENCY PROGRAMS

Several aspects of medical training may contribute to the ultimate goal of producing excellent physicians whose patients will have the best possible outcomes. However, the relative importance of education, evaluation and feedback, duty hours, practice structure, and program culture in achieving this goal is unclear. This study assessed associations among in-training exam performance, Accreditation Council for Graduate Medical Education (ACGME) Resident Survey responses, and American Board of Medical Specialties (ABMS) national board exam performance. Residency training programs at a university teaching hospital were classified as having 5-year first-time ABMS pass rates above (n=12) or below (n=3) the national average for their specialty. These groups were compared by ACGME Resident Survey data and in-training exam performance. Surveys were collected from 484/543 eligible residents (89%), including 177 surveys from programs with below-average board pass rates and 307 surveys from programs with aboveaverage board pass rates. In-training exam performance was similar between groups. Aboveaverage programs had stronger agreement with statements that their culture reinforced patient safety (4.72 vs. 4.30, p=0.006) and that information was not lost during transitions of care (4.14 vs. 3.63, p=0.001). Although the occurrence of interprofessional teamwork was similar between groups, above-average programs had stronger agreement with the statement that interprofessional teamwork was effective (4.60 vs. 4.17, p=0.003). Residency programs emphasizing patient safety and effective interprofessional teamwork had above-average first-time national board pass rates.

39. REACHING 100%: STRATEGIES FOR IMPROVED ACADEMIC PERFORMANCE IN GENERAL PEDIATRICS BOARD EXAMINATIONS

Is USMLE Step 1 score a valid predictor of success in surgical residency?

This multiple mediation analysis explores the relationship between accreditation compliance and board pass rates, mediated by management of school resources, quality of academic programs, and student engagement, among the selected Local Universities and Colleges (LUC) in the Philippines. Anchored in the Institutional Theory, the study delves into the impact of the Association of Local Colleges and Universities Commission on Accreditation (ALCUCOA) compliance across diverse institutions, examining its nine accreditation areas as stringent evaluators of predetermined standards. The results highlight the significant influence of accreditation compliance on board pass rates, particularly at higher standards and underscores the positive impact of effective management of school resources and quality academic programs. Furthermore, it emphasizes the importance of student engagement in achieving favorable outcomes. The full model underscores their interconnectedness, explaining 44.0% of the variability in board pass rates. These values highlight the profound influence of accreditation compliance and its mediating factors on academic outcomes, emphasizing the need for institutions to strategically uphold and enhance accreditation standards. Implications for institutions include the importance of strategic accreditation planning, resource management enhancement, quality academic program development, fostering student engagement, and comprehensive accreditation training.

Competing Incentives: For-Profit Hospitals Add Complexity to Graduate Medical Education (Commentary).

Feasibility and efficacy of gamification in general surgery residency: Preliminary outcomes of residency teams

324 A 10-Year Look at Emergency Medicine/Critical Care Medicine Fellows: Comparison of Standardized Exams Results

e21011 Background: The increasing complexity of Hematology and Oncology necessitates board-certified specialists to ensure baseline clinical competence. However, an average 8% failure rate for first-time test takers suggests, achieving certification is challenging. Fellows often rely on costly, independent board review courses, adding financial and time burdens. Research indicates that curriculum-based teaching approaches enhance exam readiness. We sought to develop and assess the effectiveness of a standardized board review curriculum for Medical Oncology, offering a scalable model for both community and university-based fellowship programs. Methods: Curriculum design was informed by a fellow needs assessment survey, In-Training Examination (ITE) scores, and board pass rates. A structured board review series, aligned with the American Board of Internal Medicine (ABIM) Medical Oncology blueprints, was scheduled from September 2024 to May 2025. Faculty and chief fellows led monthly Zoom sessions featuring high-yield topics were developed from existing board review resources . Monthly topic-based tests reinforced learning. Effect will be assessed using a Qualtrics survey to measure fellows’ confidence pre and post-series, alongside analysis of ITE and board scores. Descriptive statistics summarize study variables. Results: 22 of 29 fellows (75%) completed the pre-board review survey. Most respondents (74%) were aged 30–34, and 63% identified as female. The survey included 89% of first, 60% of second, and 80% of third year fellows. Most fellows (79%) planned to pursue dual certification in Hematology and Medical Oncology, with 11% opting for Medical Oncology alone. In terms of study habits for boards, at the time of the pre-survey, 10% studied daily, 25% weekly, 30% monthly, 15% less than monthly, and 20% had not started preparing. ASCO-SEP and ASH-SAP were the primary study resources for 88%. Most fellows (88%) expressed neutral or partial agreement regarding the adequacy of the fellowship board preparation curriculum. Confidence in answering board-related questions was low to intermediate across all levels of training. Compared to our prior unstructured review curriculum, participation in our revised curriculum increased from 10% to over 50% in 2024–2025. Monthly test participation increased from 3% to 53%, with most fellows answering nearly 95% of questions correctly. Conclusions: While in the early phases of implementation, preliminary results suggest that a structured, curriculum-based approach may enhance board exam readiness among fellows. We plan to evaluate the effect of our board review series through pre / post surveys, as well as by comparing ITE scores and board pass rates. Additionally, we aim to assess the longitudinal curriculum’s sustainability within our program. This model holds potential for adoption across other specialties to improve certification outcomes.

BackgroundThe American Board of Surgery (ABS) In-Training Examination (ABSITE) scores are predictive of passing the ABS qualifying exam and have become a marker of residency education success. A competitive team-based approach to encourage self-studying and didactic participation is a novel method of ABSITE preparation. We aimed to determine if this method significantly improves residents' percentile performances on the ABSITE.MethodsRetrospective review of ABSITE percentile scores were compared before and after implementation of a purchased online question bank (TrueLearn LLC, Mooresville, NC), a team-based competition, and a virtual format of the team-based competition.ResultsThe median ABSITE percentile at the program level increased from 40.0 (IQR 21.0-67.0) in 2011 to 77.0 by 2022 (IQR 60.0-91.0) (P < 0.0001). After implementation of the team-based competition, ABSITE median percentile rose significantly from 67.0 (IQR 31.5-85.5) to 84.5 (IQR 60.8-91.0) (P = 0.026). This did not change significantly after a transition to a virtual format of the team-based competition in 2021 (P = 0.146) and 2022 (P = 0.335). There was no significant relationship between the number of TrueLearn questions taken and ABSITE scores specifically before and after implementation of the team-based competition (AUC = 0.0002, Spearman's r (67) 0.064, P = 0.605). Furthermore, the team-based competition was well received by residents and was believed to be beneficial to their studying.DiscussionThe team-based competition is easy to implement and improves ABSITE performance through means other than encouraging residents to take more practice questions. The team-based competition is well-received by residents and may prove beneficial to board examination preparation and pass rates.