American Board Of Surgery In-Training Exam Research Articles

Looking Beyond the Numbers: Increasing Diversity and Inclusion Through Holistic Review in General Surgery Recruitment

The purpose of this study is the examine the effect of a holistic review process on the recruitment of women and students underrepresented in medicine (UIM) in a general surgery residency program. A retrospective study comparing the proportion of women and UIM students ranked and matched into categorical positions from 2013 to 2020 before and after the implementation of the holistic application review process. United States Medical Licensing Exam (USMLE) scores and American Board of Surgery In-training Exam (ABSITE) scores were also compared between groups. General Surgery residency program at a tertiary, academic center. Medical students applying for and matriculated to categorical positions. After the implementation of holistic review in 2017, there was a statistically significant increase in the proportion of women (42% vs. 61%, p < 0.01) and UIM students (14% vs. 20%, p = 0.046) ranked in our program compared with the prior "traditional" approach. The proportion of matched female (33% vs. 54%, p = 0.11) and UIM applicants (14% vs. 21%, p = 0.48) also increased after holistic review, although the changes were not statistically significant. The median USMLE Step 1 scores were equivalent for both ranked (250 vs. 250, p = 0.81) and matched (250 vs. 249, p = 0.32) applicants before and after the intervention. The median ABSITE scores for the matched intern classes was lower after initiation of holistic review (519 vs. 483, p = 0.01). However, these scores were consistently above the national medians and subgroup analysis showed no difference between the median aggregate ABSITE scores for UIM and female categorical interns and non-UIM males (475 vs. 520, p = 0.09). Increasing emphasis is being placed on the diversification of residency training to reflect an expanding, diverse patient population. The incorporation of a holistic review process, providing broader assessment of applicants, can play a pivotal role in increasing the proportion of women and UIM students represented in the general surgery recruitment process.

Use of Learning Teams to Improve the Educational Environment of General Surgery Residency

Recent surgical education literature has focused on means of improving structured educational experience in residency, particularly in the context of limited working hours. In addition, prior studies have illustrated a void in training regarding leadership. Learning teams have been adopted in several medical schools with an aim to improve the educational experience. We instituted resident learning teams with a goal of improving resident education. In the 2015 to 2016 academic year, we implemented a team-based learning (TBL) system of 5 teams each led by 1 to 2 chief residents and containing an approximately equal number of residents from postgraduate year (PGY)1-4. The learning teams competed for points based on weekly quizzes, preparation of materials for resident teaching, and American Board of Surgery In-Training Exam (ABSITE) scores. After a full year of TBL, residents were surveyed on their view of the learning teams with respect to the educational experience in the residency with a series of Likert-type questions. Median ABSITE scores of categorical interns were compared between the 3 years after the implementation of the learning teams and the 4 years prior with a Mann-Whitney U test. Beth Israel Deaconess Medical Center, Boston, MA; Tertiary Care Center. All residents from 2011 to 2018. After TBL implementation, median ABSITE percentile scores of PGY2-5 residents increased (35-44, p = 0.04). PGY1 scores were not significantly changed. After TBL implementation, a majority of residents agreed or strongly agreed that they studied more consistently, felt more prepared for the ABSITE, were more prepared for resident school, learned more in resident school, and that the learning teams improved the educational experience of the residency. Learning teams subjectively improved the educational experience in our residency and engaged residents in studying and participating. In addition, PGY2-5 ABSITE scores were significantly improved. Learning teams are a program that can be easily adopted by surgical residencies elsewhere.

Factors that Predict an Intern's First ABSITE Score are Known by September

Previous studies offer conflicting relevance of a variety of factors to predict resident performance on the The American Board of Surgery In-Training Exam (ABSITE). With numerous stellar applicants scoring poorly on their first ABSITE, we sought to identify key factors that might allow us to tailor pre-emptive study efforts in the fall and early winter to enhance scores. General Surgery residents in our program from 2009 through 2016 were included in our cohort study. Specific trainee data (sex, prelim vs categorical, United States Medical Licensing Examination (USMLE) Step 1 and 2 scores, ABSITE scores, clinical rotations, biannual objective structured clinical examination OSCE-type scores, and in-house prep test [IHPT], etc.) were collected retrospectively. The data were analyzed using JMP pro 10 and MedCalc. ABSITE scores of our 110 trainees did not vary by sex or by categorical vs preliminary residents. USMLE step 1 and 2, IHPT and one objective structured clinical examination (OSCE) station (Sim-Based Trauma Exam) scores were positively correlated with ABSITE scores (p < 0.05; correlation coefficient (CC) = 0.6 [strong] for IHPT, 0.5 [moderate] for step 1 and 2 and [weak] 0.3 for Sim-Based Trauma Exam). The mean (standard deviation) ABSITE %tile score for residents scoring above 230 (USMLE 1 or 2) vs <230 were different: 81 (3) vs 56 (4) (p < 000.1). Of residents scoring lower than 230 in USMLE 1 or 2, their ABSITE performance had a strong positive linear correlation with their performance in the IHPT (CC = 0.7) and SBTA (CC = 0.5). Residents rotating twice on the Acute Care Surgery services before the ABSITE scored higher than those with 1 or zero rotations (p < 0.05). USMLE steps 1 and 2 are useful parameters in our program to predict subsequent resident ABSITE performance. An in-house 60-minute preparation test in September, a 6-minute simulation-based trauma assessment in July, and rotation schedule with 2 stints on Acute Care Surgery were surprisingly useful early intern year tools to predict ABSITE scores.

Can Deficiencies in Performance Be Identified Earlier in Surgical Residency? An Initial Report of a Surgical Trainee Assessment of Readiness Exam

Identifying gaps in medical knowledge, patient management, and procedural competence is difficult early in surgical residency. We designed and implemented an end-of-year examination for our postgraduate year 1 residents, entitled Surgical Trainee Assessment of Readiness (STAR). Our objective in this study was to determine whether STAR scores correlated with other available indicators of resident performance, such as the American Board of Surgery in-training exam (ABSITE) and Milestone scores, and if they provided evidence of additional discriminatory value. Overall and component scores of the STAR exam were compared to the ABSITE and Milestone assessment scores for the 17 categorical residents that took the exam in 2016 and 2017. Harbor-UCLA Medical Center, a university-affiliated academic medical center. Seventeen categorical general surgery residents. The STAR Total Test Score (β = 2.77, p = 0.006) was an independent predictor of the ABSITE taken the same year, and components of the STAR were independent predictors of ABSITE taken the following year. The STAR Total Test Score was lowest in the 3 residents who had at least 1 low Milestone score assessed in the same year; and 2 of these 3 residents had at least 1 low Milestone score assigned the next year after STAR. Lastly, the Patient Care 1 and 2 Milestones assessed in the same year as STAR were uniformly scored as appropriate for level of training, yet the corresponding STAR component for those milestones demonstrated 3 residents as having deficiencies. We have created a multifaceted standardized STAR exam, which correlates with performance on the ABSITE and early milestone scores. It also appears to discriminate resident performance where milestone assessments do not. Further evaluation of the STAR exam with longer term follow-up is needed to confirm these initial findings.

The pregnant female surgical resident.

BackgroundSurgery continues to be an intense, time-consuming residency. Many medical students decide against surgery as a profession due to the long work hours and family strain. The pregnant female surgical resident has an added stress factor compared to her male counterpart.MethodsWe distributed an electronic, online 26-question survey to 32 general surgery programs in the southwestern region of the United States. Each program distributed our survey to the female surgical residents who had been pregnant during residency in the last 5 years. Each program was re-contacted 6 weeks after the initial contact. Most questions were in a 5-point Likert scale format. The responses were collected and analyzed using the Survey Monkey website.ResultsAn unvalidated survey was sent to 32 general surgery programs and 26 programs responded (81%). Each program was asked for the total number of possible responses from female residents that met our criteria (60 female residents). Seven of the programs (27%) stated that they have had zero residents pregnant. We had 22 residents respond (37%). Over half of the residents (55%) were pregnant during their 2nd or 3rd year of residency, with only 18% pregnant during a research year. Thirty-one percent had a lower American Board of Surgery In-Training Exam (ABSITE) score. Ninety percent of the residents were able to take 4 weeks or more for maternity leave. Most of the residents (95%) stated that they would do this again during residency given the opportunity, but many of the residents felt that returning back to work with a child at home was the most difficult part.ConclusionOur preliminary study shows that the programs surveyed were accommodating to the female surgical resident. Nevertheless, despite adequate support from their program and an overall positive experience, many residents indicated that they had a decline in their education and performance.

Burnout is Associated With Emotional Intelligence but not Traditional Job Performance Measurements in Surgical Residents

To evaluate whether burnout was associated with emotional intelligence and job performance in surgical residents. General surgery residents at a single institution were surveyed using the Maslach Burnout Inventory (MBI) and trait EI questionnaire (TEIQ-SF). Burnout was defined as scoring in 2 of the 3 following domains; Emotional Exhaustion (high), Depersonalization (high), and Personal Accomplishment (low). Job performance was evaluated using faculty evaluations of clinical competency-based surgical milestones and standardized test scores including the American Board of Surgery In-Training Exam (ABSITE) and the United States Medical Licensing Examination (USMLE) Step 3. USMLE Step 1 and USMLE Step 2, which were taken prior to residency training, were included to examine possible associations of burnout with USMLE examinations. Statistical comparison was made using Pearson correlation and simple linear regression adjusting for PGY level. This study was conducted at the University of Alabama at Birmingham (UAB) general surgery residency program. All current and incoming general surgery residents at UAB were invited to participate in this study. Forty residents participated in the survey (response rate 77%). Ten residents, evenly distributed from incoming residents to PGY-4, had burnout (25%). Mean global EI was lower in residents with burnout versus those without burnout (3.71 vs 3.9, p = 0.02). Of the 4 facets of EI, mean self-control values were lower in residents with burnout versus those without burnout (3.3 vs 4.06, p < 0.01). Each component of burnout was associated with global EI, with the strongest correlation being with personal accomplishment (r = 0.64; p < 0.01). Residents with burnout did not have significantly different mean scores for USMLE Step 1 (229 vs 237, p = 0.12), Step 2 (248 vs 251, p = 0.56), Step 3 (223 vs 222, p = 0.97), or ABSITE percentile (44.6 vs 58, p = 0.33) compared to residents without burnout. Personal accomplishment was associated with ABSITE percentile scores (r = 0.35; p = 0.049). None of the 16 surgical milestone scores were significantly associated with burnout. Burnout is present in surgery residents and associated with emotional intelligence. There was no association of burnout with USMLE scores, ABSITE percentile, or surgical milestones. Traditional methods of assessing resident performance may not be capturing burnout and strategies to reduce burnout should consider targeting emotional intelligence.

Utilizing the American Board of Surgery in-training exam in a Rwandan surgical residency program: Alignment of exam topics with the University of Rwanda general surgery curriculum

Background: University of Rwanda (UR) increased postgraduate surgery training and assessment strategies are needed. We compared American Board of Surgery In-Training Exam (ABSITE) topics with UR surgery curriculum to determine the applicability of ABSITE in Rwanda. Methods: Topics are outlined in the Surgical Council on Resident Education (SCORE) curriculum whereas the UR utilizes a modular system. Diseases and conditions in SCORE were compared with UR surgery module content. Operation and procedures in SCORE were compared with operative procedures in UR surgery curriculum. Results: Overall, 72% of diseases and conditions from SCORE were covered in UR curriculum. Of this, 76% of medical knowledge and 71% of patient care content was covered in UR curriculum. 41% of operations and procedures from SCORE were identified in UR curriculum. 55% of core operations and 16% of advanced operations from SCORE were included in UR general surgery curriculum. Content identified in UR curriculum and not SCORE included infectious and tropical diseases, orthopedics, urology and neurosurgery. Conclusions: There is alignment between ABSITE topics and UR general surgery curriculum suggesting that the ABSITE can be used as an in-training examination for Rwandan residents. Understanding the limitations of the ABSITE exam can help utilization of this examination. Keywords: internship and residency, curriculum, Rwanda, global health

Surgical resident learning styles: faculty and resident accuracy at identification of preferences and impact on ABSITE scores

IntroductionAs a consequence of surgical resident duty hour restrictions, there is a need for faculty to utilize novel teaching methods to convey information in a more efficient manner. The current paradigm of surgical training, which has not changed significantly since the time of Halsted, assumes that all residents assimilate information in a similar fashion. However, recent data has shown that learners have preferences for the ways in which they receive and process information. The VARK model categorizes learners as visual (V), aural (A), read/write (R), and kinesthetic (K). The VARK learning style preferences of surgical residents have not been previously evaluated. In this study, the preferred learning styles of general surgery residents were determined, along with faculty and resident perception of resident learning styles. In addition, we hypothesized that American Board of Surgery In-Training Exam (ABSITE) scores are associated with preference for a read/write (R) learning style. MethodsThe Fleming VARK learning styles inventory was administered to all general surgery residents at a university hospital–based program. Responses on the inventory were scored to determine the preferred learning style for each resident. Faculty members were surveyed to determine their accuracy in identifying the preferred learning style of each resident. All residents were also surveyed to determine their accuracy in identifying their peers' VARK preferences. Resident ABSITE scores were examined for association with preferred learning styles. ResultsTwenty-nine residents completed the inventory. Most (18 of 29, 62%) had a multimodal preference, although more than a third (11 of 29, 38%) demonstrated a single-modality preference. Seventy-six percent of all residents (22 of 29) had some degree of kinesthetic (K) learning, while under 50% (14 of 29) were aural (A) learners. Although not significant, dominant (R) learners had the highest mean ABSITE scores. Faculty identified residents' learning styles accurately 41% of the time; more experienced faculty were better than less experienced ones (R2 = 0.703, P = 0.018). Residents had similar accuracy to faculty in identifying their peers' learning styles. Chief residents were more accurate than junior residents (44% versus 28%, P = 0.009). ConclusionsMost general surgery residents have a multimodal learning preference. Faculty members are relatively inaccurate at identifying residents' preferred learning styles; however, there is a strong correlation between years of faculty experience and accuracy. Chief residents are more accurate than junior residents at learning style identification. Higher mean ABSITE scores may be a reflection of a dominant read/write learning style.

Comparison of General Surgery Research Resident Absite Scores to Their Clinical Peers Reveals Need for a General Surgery Curriculum during Dedicated Research Time

Background: Approximately 40% of surgical residents pursue one to three years of dedicated research during residency. Research residents continue to participate in didactic conferences, are occasionally responsible for patient care, and continue to take the American Board of Surgery In-training Exam (ABSITE) each year. Most programs have a dedicated research curriculum for these residents; however, many do not have a formal general surgery curriculum for research residents. We sought to compare research and clinical resident performance on the ABSITE to determine if there might be a need for a formal general surgery curriculum for research residents, to keep pace with their clinical peers.

The Kolb learning cycle in American Board of Surgery In-Training Exam remediation: the Accelerated Clinical Education in Surgery course

Background Surgical training integrates the 4 steps of the Kolb learning cycle. Residents who scored at 30th percentile or less on the American Board of Surgery In-Training Exam (ABSITE) were enrolled in the Accelerated Clinical Education in Surgery (ACES) course that incorporated the Kolb cycle. Methods For concrete experience, Surgical Education and Self-Assessment Program (SESAP-13) was completed according to the syllabus. For reflective consideration, further reading was done on SESAP 13 topics and corresponding ABSITE Keywords. For the abstract hypotheses step; these keywords and topics were reviewed with the mentor. Active testing involved a required weekly on-line quiz based on the syllabus. Results Correct scores on the ABSITE increased for 78.6% of residents in the ACES course, with 28.6% scoring 30th percentile or greater. Senior percent correct scores increased by 7.3% and junior percentile scores by 12.5%. Conclusions Remediation using the Kolb cycle improved ABSITE performance for a majority of participants.

Directed postgraduate study result in quantitative improvement in American Board of Surgery In-Training Exam scores

Background The collective study habits of 1 group of residents involved in educationally distinct periods of time in a community-based general surgery residency program were evaluated. Methods American Board of Surgery In-Training Exam (ABSITE) score results of 31 residents were calculated during 3 distinctive educational time periods: resident independent, self-directed study; resident-directed study with weekly systematic textbook reviews; and faculty-directed study with additional formal basic science and clinical lectures. Results Aggregate higher scores were observed when ABSITE results for the directed study period were compared with those observed during the independent study period in mid-level resident years (postgraduate year [PGY] 2 to 4). Conclusions With limited faculty resources, community-based surgery residency programs have more challenges in opportunities for resident acquisition of cognitive knowledge and subsequent quantitative improvement in ABSITE scores. This study demonstrated a successful methodology particularly in the face of mandated limitation of weekly resident work hours and diminishing allocated education resources.

Remediation of Low ABSITE Scores

In 2000, a program was initiated to improve American Board of Surgery In-Training Exam (ABSITE) scores below the 40th percentile (PGY-1 and -2) and the 30th percentile (PGY-3 and -5) for categorical residents. The goal of this program is to maintain scores above this standard. One faculty member was designated to meet with each resident with ABSITE scores below the standard described above. In April, individual study plans were designed with each resident, which emphasized practice questions and strategic planning for study, and the ABSITE test structure and results were reviewed. Two subsequent meetings were held between November and December to monitor progress. Emphasis was placed on minimizing the stigma of poor scores and on maximizing the efficiency of study time. If the resident scored above-standard that year, further support was not required. From 2000 to 2004, 12 (9.5%) ABSITE scores were below-standard, which resulted in 8 (20.5%) residents receiving program support 9 times. All but 1 program encounter resulted in above-standard scores the following year (improvement range, 16 to 65 percentile points; average, 34 points). Two residents had recurrent below-standard scores in subsequent years despite above-standard scores immediately after the program. One resident did not participate in the program, despite it being designated as mandatory. During the same interval, the ABSITE scores of residents not involved in the program decreased by an average of 3.7 percentile points per examination (improved scores 31 times; 39.2%, range 1 to 46, average 13.5, worse scores 45 times; 57%, range 1 to 65, average 15.2, and no change 3 times, 3.8%). An individualized program that minimizes the stigma of poor test results, the time commitment required by the residents, and maximizes the benefits of a question-based study system and the knowledge of approach to the ABSITE resulted in significant improvements in scores the next year. However, maintenance of these results needs continued evaluation because 3 residents had recurrent poor scores in subsequent years.

Identification of high-risk residents.

Identification of high-risk residents allows remediation and support for administrative action when necessary. This study characterizes differences in documentation of marginally performing residents in a general surgery residency. High-risk residents were identified by the former program director. Twenty-four of one hundred fifteen residents over a 10-year period had one to four problematic areas: cognitive, synthetic, family/health, and interpersonal skills. Outcomes included finished (18), voluntary withdrawal (1), and involuntary withdrawal (5). A case-control study matching controls to cases by date of entry into the training program was used. Records were reviewed for demographics, preentry qualifications, American Board of Surgery In-Training Exam (ABSITE) scores, letters of complaint or praise, events of counseling, and monthly ratings. The records of 48 residents were reviewed. Ward evaluations were on eight categories with a 5-point Leikert scale (3-unacceptable to 7-outstanding). The evaluation score assigns points only to low ratings. High scores represent progressively poorer performance. A Wilcoxon signed ranks test was used to compare the cases and controls for continuous variables. The McNemar test was used in comparisons of categorical data with binary outcomes. Exact P values are reported. Objective data were similar for both groups. Study residents tended to score higher on monthly evaluations at Year 2 and by Year 3 this achieved significance (0.026). Study residents were more likely to have negative faculty letters (0.016) and events of counseling by a faculty member (0.017) and the program director (0.005). Identification of residents at risk should begin as early as possible during training. A combination of faculty evaluations and evidence of letters of counseling can detect high-risk residents. Programs may use such indicators to support decisions regarding remedial work or administrative action.

Factors affecting improvement on the American Board of Surgery In-Training Exam (ABSITE).

American Board of Surgery In-Training Exam (ABSITE) performance can be used to assess resident knowledge and to evaluate surgical curriculum. To determine factors that lead to improved resident ABSITE performance, a prospective study was performed. Thirty-four surgical residents in Program Years 2-5 completed pre- and a post-ABSITE questionnaires about their anxiety, self-efficacy, physical preparation, and academic preparation for the ABSITE. Department records were used to determine resident probationary status and conference attendance. A preliminary analysis of ABSITE scores indicated a significant improvement between 1998 and 1999 percentile scores (paired t = -2. 25, P = 0.03; m = 11.9, SD = 30.5, median = 7). An improvement in percentile rank score was calculated and used as the dependent variable in a stepwise regression analysis. The following served as independent variables: previous exam performance, anxiety, probationary status, amount of sleep before exam, confidence to score in the 25th and the 50th percentiles, and attendance at the three conferences rated most valuable by the residents. Results of the regression analysis demonstrate that all factors account for 62.3% of the variance in improvement scores. A stepwise analysis indicated that the combination of attendance (40.2%) and previous performance (18.3%) was significant in explaining 58.5% of the variance in improvement scores. Furthermore, Pearson's correlations indicated that probationary status (+.58, P = 0.001), anxiety (+0.53, P = 0.001), amount of study (+0.61, P = 0.001), past ABSITE performance (-0.60, P = 0.001), and conference attendance (+0. 56, P = 0.001) were correlated with ABSITE improvement. This study demonstrates that resident individual effort, past ABSITE performance, and academic conference attendance have led to resident ABSITE improvement.

Computer-based training initiatives for education in surgical decision making

PurposeTo determine how computer-based training (CBT) can be integrated into a general surgical residency education program for training and assessing decision-making skills in surgery. MethodsBecause of the emphasis on the American Board of Surgery In-training Exam (ABSITE) and Qualifying Exam preparation, traditional paper-and-pencil multiple choice quiz format testing predominates within most surgical programs. However, decision skills also require training and assessment for residents. Established methods of oral examinations for practice testing require a significant commitment of faculty time. Various CBT programs, with the necessary interactivity, are currently available for supplementing a residency’s education curriculum in the arena of decision making. Moreover, multimedia capability allows integration of new image technologies into training in decision making. One residency program is exploring new CBT systems to aid curriculum development and education in its subspecialty section curricula. ResultsThe divisions of cardiothoracic and vascular surgery have 2 concurrent and parallel CBT modules in place for service residents at the start of the 1998–1999 academic year. Both modules have flexibility that allows function as either testing or teaching modules. Either module can run when faculty are not available, requiring only a Windows-compatible computer. More important, both modules contain the requisite interactivity and branch-based decision trees that potentially model a certifying examination. The same decision branching also supports weighted scoring, allowing for emphasis and recording of certain responses. Each module also can integrate sophisticated multimedia, allowing exposure to medical imaging information. The enhanced and engaging feedback capabilities have generated high levels of resident acceptance. ConclusionsComputer-based training modules offer a promising new direction in decision-making-skill curriculum development for surgical education. It also allows integration of multimedia in creating tools for assessment and training of new image-intensive modalities in residency programs.