Surgery In-Training Examination Research Articles

Elimination of the Percentile Score From the Surgical ABSITE—The Resident Perspective

This Viewpoint describes the elimination of the percentile score from the American Board of Surgery In-Training Examination (ABSITE) from the resident’s perspective.

Elimination of the Percentile Score From the Surgical ABSITE—The Program Director Perspective

This Viewpoint discusses the elimination of the percentile score from the American Board of Surgery In-Training Examination (ABSITE) from the program director’s perspective.

Elimination of the Percentile Score From the Surgical ABSITE—The Fellowship Director Perspective

This Viewpoint describes the elimination of the percentile score from the American Board of Surgery In-Training Examination (ABSITE) from the fellowship director’s perspective.

Non-Designated Preliminary to Categorical Resident: Is It All About the ABSITE?

Obtaining a categorical general surgery residency position is recognized as a highly challenging process, and many aspiring surgeons find themselves matching into a preliminary position. The American Board of Surgery In-Training Examination (ABSITE) is relevant as a discriminator, as it is the only national evaluation metric that compares residents between programs. This study examines the correlation between ABSITE performance and the likelihood of obtaining a categorical position for non-designated preliminary surgery residents. Retrospective analysis of preliminary residents who completed the ABSITE between 2011 and 2021 at a single academic training program. 108 preliminary residents were included. Among preliminary residents who were successful in securing a categorical position, the average ABSITE percentile was 59 (SD = 26.7). In contrast, those who were not able to secure a categorical position, the average ABSITE percentile was 23.6 (SD = 25.3). There was a strong significant correlation between ABSITE percentile and securing a categorical position (P < 0.001). There was a significant association between citizenship and gaining a categorical position, with US citizens being significantly more likely to successfully gain a categorical position (P = 0.01; OR 3.32 (95% CI 1.28-8.56)). There was not a significant correlation between citizenship and ABSITE score. This study presents compelling evidence that ABSITE percentile score is positively associated with the probability of securing a categorical position for preliminary general surgery residents. It is therefore imperative that both preliminary residents and their programs place a high value on ABSITE performance to enhance successful career progression.

Burnout is not associated with trainee performance on the Vascular Surgery In-Training Exam

ObjectiveThe Vascular Surgery In-Training Examination (VSITE) is a yearly exam evaluating vascular trainees’ knowledge base. Although multiple studies have evaluated variables associated with exam outcomes, few have incorporated training program-specific metrics. The purpose of this study is to evaluate the impact of the learning environment and burnout on VSITE performance. MethodsData was collected from a confidential, voluntary survey administered after the 2020 to 2022 VSITE as part of the SECOND Trial. VSITE scores were calculated as percent correct then standardized per the American Board of Surgery. Generalized estimating equations with robust standard errors and an independent correlation structure were used to evaluate trainee and program factors associated with exam outcomes. Analyses were further stratified by integrated and independent training paradigms. ResultsA total of 1385 trainee responses with burnout data were collected over 3 years (408 in 2020, 459 in 2021, 498 in 2022). On average, 46% of responses reported at least weekly burnout symptoms. On unadjusted analysis, burnout symptoms correlated with a 14 point drop in VSITE score (95% confidence interval [CI], −24 to −4; P = .006). However, burnout was no longer significant after adjusted analysis. Instead, higher postgraduate year level, being in a relationship, identifying as male gender with or without kids, identifying as non-Hispanic white, larger programs, and having a sense of belonging within a program were associated with higher VSITE scores. ConclusionsDespite high rates of burnout, trainees generally demonstrate resilience in gaining the medical knowledge necessary to pass the VSITE. Performance on standardized exams is associated with trainee and program characteristics, including availability of support systems and program belongingness.

Scheduling surgical success: Early minimally invasive surgery rotations as a predictor of ABSITE performance

IntroductionThe American Board of Surgery In-Training Examination (ABSITE®) serves as a benchmark for assessing resident knowledge and comprehension in surgery training programs. While previous studies have examined factors such as USMLE Step 1 and Step 2 performance in ABSITE® preparation, the impact of rotational schedule on ABSITE® performance remains underexplored. MethodsWe retrospectively investigated the independent influence of rotational schedule on ABSITE® performance among interns at a single academic institution over an 11 year period. ResultsEarly exposure to minimally invasive surgery rotations and specialty rotations such as surgical oncology and vascular surgery during the winter or just before ABSITE® was associated with higher ABSITE® percentiles when controlled for USMLE Step 2 performance. ConclusionThis study underscores the significance of rotational scheduling in optimizing ABSITE® performance and suggests potential strategies for enhancing resident preparation and success on this examination.

Using resident performance on Step 2 to predict surgical residency success

ObjectiveTo determine whether performance on Step 2 CK can be used to predict adverse academic outcomes in surgical residency. MethodsSurgical resident data from a single institution was used. Step 2 scores of each resident were normalized against the average Step 2 CK score for each cohort's application cycle (ie, resident who scored 246 on a year with a national average of 246 would have a normed score of 1; resident with a score >246 would have a normed score >1 etc). All adverse events were classified, and logistic regression analysis was used to determine the effects of the Step 2 scores. Adverse academic outcomes were defined. ResultsNinety-two surgical residents were evaluated with 7,182 faculty evaluations reviewed. Lower Step 2 CK scores demonstrated an increased likelihood of lower American Board of Surgery In-Training Examination performance <25% (P = .011). The remaining adverse events, including passing the Qualifying Examination (P = .998), passing the Certifying Examination (P = .778), early withdrawal from the surgical residency program (P = .565), failure on mock orals during postgraduate years 4 and 5 (P = .731; P = .600), as well as selection of administrative chiefs (P = .565), all demonstrated no correlation. ConclusionEmphasis has historically been placed on board examinations like Step 2 CK to predict overall success in residency and is used as an important metric during the interview process. However, these findings demonstrate that although lower scores on Step 2 CK correlate with a lower quartile on the American Board of Surgery In-Training Examination during general surgery residency, the examination cannot predict success in all areas of surgical residency.

Pregnancy and Parenthood Among US Surgical Residents

The ability to pursue family planning goals is integral to gender equity in any field. Procedural specialties pose occupational risks to pregnancy. As the largest procedural specialty, general surgery provides an opportunity to understand family planning, workplace support for parenthood, obstetric outcomes, and the impact of these factors on workforce well-being, gender equity, and attrition. To examine pregnancy and parenthood experiences, including mistreatment and obstetric outcomes, among a cohort of US general surgical residents. This cohort study involved a cross-sectional national survey of general surgery residents in all programs accredited by the Accreditation Council for Graduate Medical Education after the 2021 American Board of Surgery In-Training Examination. Female respondents who reported a pregnancy and male respondents whose partners were pregnant during clinical training were queried about pregnancy- and parenthood-based mistreatment, obstetric outcomes, and current well-being (burnout, thoughts of attrition, suicidality). Primary outcomes included obstetric complications and postpartum depression compared between female residents and partners of male residents. Secondary outcomes included perceptions about support for family planning, pregnancy, or parenthood; assisted reproductive technology use; pregnancy/parenthood-based mistreatment; neonatal complications; and well-being, compared between female and male residents. A total of 5692 residents from 325 US general surgery programs participated (81.2% response rate). Among them, 957 residents (16.8%) reported a pregnancy during clinical training (692/3097 [22.3%] male vs 265/2595 [10.2%] female; P < .001). Compared with male residents, female residents more frequently delayed having children because of training (1201/2568 [46.8%] females vs 1006/3072 [32.7%] males; P < .001) and experienced pregnancy/parenthood-based mistreatment (132 [58.1%] females vs 179 [30.5%] males; P < .001). Compared with partners of male residents, female residents were more likely to experience obstetric complications (odds ratio [OR], 1.42; 95% CI, 1.04-1.96) and postpartum depression (OR, 1.63; 95% CI, 1.11-2.40). Pregnancy/parenthood-based mistreatment was associated with increased burnout (OR, 2.03; 95% CI, 1.48-2.78) and thoughts of attrition (OR, 2.50; 95% CI, 1.61-3.88). Postpartum depression, whether in female residents or partners of male residents, was associated with resident burnout (OR, 1.93; 95% CI, 1.27-2.92), thoughts of attrition (OR, 2.32; 95% CI, 1.36-3.96), and suicidality (OR, 5.58; 95% CI, 2.59-11.99). This study found that pregnancy/parenthood-based mistreatment, obstetric complications, and postpartum depression were associated with female gender, likely driving gendered attrition. Systematic change is needed to protect maternal-fetal health and advance gender equity in procedural fields.

Contemporary Evaluation of Work-Life Integration and Wellbeing in US Surgical Residents: A National Mixed-Methods Study.

The demands of surgical training present challenges for work-life integration (WLI). We sought to identify factors associated with work-life conflicts and to understand how programs support WLI. A cross-sectional national survey conducted after the 2020 American Board of Surgery In-Training Examination queried 4 WLI items. Multivariable regression models evaluated factors associated with (1) work-life conflicts and (2) well-being (career dissatisfaction, burnout, thoughts of attrition, suicidality). Semi-structured interviews conducted with faculty and residents from 15 general surgery programs were analyzed to identify strategies for supporting WLI. Of 7,233 residents (85.5% response rate) 5,133 had data available on work-life conflicts. 44.3% reported completing non-educational task-work at home, 37.6% were dissatisfied with time for personal life (e.g., hobbies), 51.6% with maintaining healthy habits (e.g., exercise), and 48.0% with performing routine health maintenance (e.g., dentist). In multivariable analysis, parents and female residents were more likely to report work-life conflicts (all p<0.05). After adjusting for other risk factors (e.g., duty-hour violations, and mistreatment), residents with work-life conflicts remained at increased risk for career dissatisfaction, burnout, thoughts of attrition, and suicidality (all p<0.05). Qualitative analysis revealed interventions for supporting WLI including (1) protecting time for health maintenance (e.g., therapy); (2) explicitly supporting life outside of work (e.g., prioritizing time with family); and (3) allowing meaningful autonomy in scheduling (e.g., planning for major life events). Work-life conflicts are common among surgical residents and are associated with poor resident well-being. Well-designed program-level interventions have the potential to support WLI in surgical residency.

A Comparative American Board of Surgery In-Training Examination (ABSITE) Performance Analysis Between International vs. Domestic Graduates and Doctor of Medicine (MD) vs. Doctor of Osteopathic Medicine (DO) Medical Degrees.

Introduction The American Board of Surgery (ABS) plays a pivotal role in certifying surgeons in the United States, with the American Board of Surgery In-Training Examination (ABSITE) serving as a critical assessment tool for general surgery residents aspiring for certification. The aim of this study is to compare the performance of international medical graduates (IMGs) to their domestic counterparts and assess the impact of different medical degrees on ABSITE scores. Notably, ABSITE scores often dictate the trajectory of a surgical career, including opportunities for fellowship placements in specialized fields such as plastic surgery. Methods This study focused on general surgery residents enrolled at Marshall University from 2014 to 2022. Data encompassing ABSITE scores, TrueLearn quiz percentages, and TrueLearn mock exam results were collected for analysis. Descriptive statistics summarized sample characteristics, and linear mixed models were employed to address correlations. Statistical analyses were conducted using the Statistical Analysis System (SAS) (version 9.4; SAS Institute Inc., Cary, NC, USA), with significance defined by a two-sided test with p < 0.05. Results Among the 48 participants, comprising 24 non-international medical graduates (nIMGs) and 24IMGs, IMGs demonstrated superior performance across various metrics. They exhibited higher quiz percentages (67% vs. 61%; p = 0.0029), mock Exam 1 scores (64% vs. 58%; p = 0.0021), mock Exam 2 scores (66% vs. 58%; p = 0.0015), ABSITE scores (560 vs. 505; p = 0.010), and ABSITE percentages (74% vs. 68%; p = 0.0077) compared to nIMGs. Analysis between Doctor of Osteopathic Medicine (DO) and Doctor of Medicine (MD) participants revealed no statistically significant differences in performance metrics, highlighting the comparability of these medical degrees in the context of ABSITE scores and related assessments. Discussion/conclusion This study underscores the superior performance of IMGs over nIMGs in ABSITE examinations, shedding light on the critical role of ABSITE scores in shaping surgical careers. Higher scores correlate with enhanced opportunities for coveted fellowship placements, particularly in specialized fields like plastic surgery. Understanding these dynamics is crucial for resident training and navigating the competitive landscape of surgical sub-specialization. Future research endeavors can delve deeper into the factors influencing ABSITE performance, thereby facilitating the development of targeted interventions to support residents in achieving their career aspirations.

Navigating the American Board of Surgery In-Training Examination (ABSITE) Success: Insights From Pre-assessment Practices in Preparing Surgical Residents for Competitive Sub-specialties.

Introduction The American Board of Surgery In-Training Examination (ABSITE) is a critical tool in assessing surgical residents' readiness for board certification and clinical practice. While various factors influencing ABSITE performance have been examined, the impact of innovative educational resources, such as TrueLearn, remains underexplored. TrueLearn's adaptive learning algorithms and comprehensive question banks offer a promising adjunct to traditional study methods. This study investigates the relationship between TrueLearn utilization and ABSITE performance among general surgery residents. Methods This retrospective study, ethically approved by the Marshall University Institutional Review Board (IRB No. 2097669-1), analyzed the performance of general surgery residents at Marshall University from 2014 to 2022. Data were collected on ABSITE scores. Additionally, quiz percentages (Quiz %) and scores from two mock exams (Exam 1 and Exam 2), all provided by the TrueLearn platform, were included in the analysis. Descriptive statistics summarized the sample characteristics. Linear mixed models were employed to examine the associations between TrueLearn engagement and ABSITE performance, accounting for the correlated nature of the data and addressing any missing data at random. Statistical analyses were conducted using the Statistical Analysis System (SAS, version 9.4; SAS Institute Inc., Cary, NC), with significance defined as a p-value < 0.05. Results The study cohort included 58 residents from 2016 to 2022. Linear mixed model analysis revealed significant positive correlations between TrueLearn Quiz %, Exam 1 scores, and Exam 2 scores with ABSITE performance. A 1% increase in Quiz % was associated with a 0.77-point rise in ABSITE scores (95% CI: 0.65, 0.89; p < 0.0001). For Exam 1, each point increase corresponded to a 6.36-point increase in ABSITE scores (95% CI: 5.01, 7.7; p < 0.0001), while Exam 2 scores showed a 3.8-point increase per point (95% CI: 2.74, 4.86; p < 0.0001). Discussion and conclusion Our findings underscore the significant impact of TrueLearn engagement on ABSITE performance, with higher quiz percentages and mock exam scores predictive of better ABSITE outcomes. This suggests that regular use of TrueLearn's educational resources enhances residents' knowledge and exam readiness. These results advocate for the integration of innovative educational tools such as TrueLearn into surgical training programs to optimize study strategies and improve exam performance. However, the study's retrospective design and single-institution focus limit the generalizability of the findings. Future research should explore these relationships in diverse settings and specialties and consider additional factors influencing ABSITE performance. This study highlights the positive association between TrueLearn utilization and ABSITE performance among general surgery residents, emphasizing the importance of innovative educational resources in surgical training. By enhancing engagement with platforms such as TrueLearn, surgical programs can improve residents' readiness for high-stakes examinations, ultimately contributing to the development of proficient surgical practitioners.

Performance of ChatGPT on American Board of Surgery In-Training Examination Preparation Questions

IntroductionChat Generative Pretrained Transformer (ChatGPT) is a large language model capable of generating human-like text. This study sought to evaluate ChatGPT’s performance on Surgical Council on Resident Education (SCORE) self-assessment questions. MethodsGeneral surgery multiple choice questions were randomly selected from the SCORE question bank. ChatGPT (GPT-3.5, April-May 2023) evaluated questions and responses were recorded. ResultsChatGPT correctly answered 123 of 200 questions (62%). ChatGPT scored lowest on biliary (2/8 questions correct, 25%), surgical critical care (3/10, 30%), general abdomen (1/3, 33%), and pancreas (1/3, 33%) topics. ChatGPT scored higher on biostatistics (4/4 correct, 100%), fluid/electrolytes/acid-base (4/4, 100%), and small intestine (8/9, 89%) questions. ChatGPT answered questions with thorough and structured support for its answers. It scored 56% on ethics questions and provided coherent explanations regarding end-of-life discussions, communication with coworkers and patients, and informed consent. For many questions answered incorrectly, ChatGPT provided cogent, yet factually incorrect descriptions, including anatomy and steps of operations. In two instances, it gave a correct explanation but chose the wrong answer. It did not answer two questions, stating it needed additional information to determine the next best step in treatment. ConclusionsChatGPT answered 62% of SCORE questions correctly. It performed better at questions requiring standard recall but struggled with higher-level questions that required complex clinical decision making, despite providing detailed responses behind its rationale. Due to its mediocre performance on this question set and sometimes confidently-worded, yet factually inaccurate responses, caution should be used when interpreting ChatGPT’s answers to general surgery questions.

Flipping the Classroom in Residency Didactics Leads to Higher American Board of Surgery in-Training Examination Scores

Didactic education in General Surgery (GS) residency typically follows a nationally standardized curriculum; however, instructional format varies by institution. In recent years, GS residents at our institution expressed discontentment with weekly didactics and were not meeting their goals on the American Board of Surgery In-Training Examination (ABSITE). We sought to develop improvements in our didactic curriculum to increase resident satisfaction and ABSITE scores of GS junior residents (Jrs). In a quality improvement project, we changed the weekly didactic curriculum format from hour-long lectures in the 2018 to 2019 academic year (AY) to a partially-flipped classroom in the 2019 to 2020 AY, involving a 30-minute faculty-led presentation followed by 30 minutes of resident-led practice questions. The outcomes measured were ABSITE scores taken in 2019 and 2020 and resident opinions via an anonymous survey. This study was conducted at the University of Minnesota (Minneapolis, MN). The cohort for this study included all GS Jrs in our GS residency program, including postgraduate year (PGY) 1 nondesignated preliminary, PGY1 to 3 categorical GS residents, and residents in their lab time. Senior residents attended a separate didactics session. After curriculum changes, the ABSITE percentile scores for GS Jrs rose from 52% ± 5% to 66% ± 4% (p = 0.03). No categorical GS Jr scored <30% in 2020, compared to 20% (6/30) of categorical General Surgery residents in 2019. All residents preferred the new format overall and reported greater engagement in and preparation for didactics. After changing didactic education from hour-long lectures in the 2018 to 2019 AY to a flipped classroom model in the 2019 to 2020 AY including 30 minutes of faculty-led lecture followed by 30 minutes of resident-led practice questions, ABSITE scores and resident satisfaction at the University of Minnesota General Surgery Program improved.

ChatGPT Earns American Board Certification in Hand Surgery

PurposeArtificial Intelligence (AI), and specifically ChatGPT, has shown potential in healthcare, yet its performance in specialized medical examinations such as the Orthopaedic Surgery In-Training Examination and European Board Hand Surgery diploma has been inconsistent. This study aims to evaluate the capability of ChatGPT-4 to pass the American Hand Surgery Certifying Examination. MethodsChatGPT-4 was tested on the 2019 American Society for Surgery of the Hand (ASSH) Self-Assessment Exam. All 200 questions available online (https://onlinecme.assh.org) were retrieved. All media-containing questions were flagged and carefully reviewed. Eight media-containing questions were excluded as they either relied purely on videos or could not be rationalized from the presented information. Descriptive statistics were used to summarize the performance (% correct) of ChatGPT-4. The ASSH report was used to compare ChatGPT-4’s performance to that of the 322 physicians who completed the 2019 ASSH self-assessment. ResultsChatGPT-4 answered 192 questions with an overall score of 61.98%. Performance on media-containing questions was 55.56%, while on non-media questions it was 65.83%, with no statistical difference in performance based on media inclusion. Despite scoring below the average physician’s performance, ChatGPT-4 outperformed in the ‘vascular’ section with 81.82%. Its performance was lower in the ‘bone and joint’ (48.54%) and ‘neuromuscular’ (56.25%) sections. ConclusionsChatGPT-4 achieved a good overall score of 61.98%. This AI language model demonstrates significant capability in processing and answering specialized medical examination questions, albeit with room for improvement in areas requiring complex clinical judgment and nuanced interpretation. ChatGPT-4’s proficiency is influenced by the structure and language of the examination, with no replacement for the depth of trained medical specialists. This study underscores the supportive role of AI in medical education and clinical decision-making while highlighting the current limitations in nuanced fields such as hand surgery.

Structured Textbook Review and Individualized Learning Plans Successfully Remediate Underperforming Residents and Improve General Surgery Program Performance on the ABSITE.

We endeavored to create an evidence-based curriculum to improve general surgery resident fund of knowledge. Global and resident-specific interventions were employed to this end. These interventions were monitored via multiple choice question results on a weekly basis and American Board of Surgery In-Training Examination (ABSITE) performance. This study was performed in a prospective manner over a 2-year period. A structured textbook review with testing was implemented for all residents. A focused textbook question-writing assignment and a Surgical Council on Resident Education (SCORE)-based individualized learning plan (ILP) were implemented for residents scoring below the 35th percentile on the ABSITE. Curriculum implementation resulted in a statistically significant reduction in the number of residents scoring below the 35th percentile, from 50% to 30.8% (P = .023). One hundred percent of residents initially scoring below the 35th percentile were successfully remediated over the study period. Average overall program ABSITE percentile scores increased from 38.5% to 51.4% over a 2-year period. Structured textbook review and testing combined with a question-writing assignment and a SCORE-focused ILP successfully remediated residents scoring below the 35th percentile and improved general surgery residency ABSITE performance.

National ABSITE Preparation Practices: A Survey of General Surgery Residency Program Directors

The American Board of Surgery In-Training Examination (ABSITE) was designed as a low-stakes, medical knowledge examination for US general surgery residency programs. However, in practice, this exam has been utilized for higher stakes purposes, such as resident promotion or remediation, and fellowship selection. Several studies have demonstrated the efficacy of ABSITE preparation resources, but best practices for ABSITE preparation and national preparatory habits are currently unknown. The aim of this work was to determine current residency programs' strategies for ABSITE preparation. We distributed an electronic survey to program directors or program coordinators of US general surgery programs asking them to anonymously report program ABSITE educational practices and ABSITE scores. We analyzed the proportion of responses using descriptive statistics and compared the effect of various strategies using the Mann-Whitney testing for nonparametric data. An average ABSITE percentile score was calculated for each residency based on program self-reported scores. Association of Program Directors (APDS) Listserv PARTICIPANTS: General surgery residency programs participating at the time of distribution (278). Response rate was 24% (66/278); 41 programs (62.1%) identified as university-affiliated, and 25 (37.9%) were community-based. Median intern class size was 8 (range: 3-14), including preliminary interns. Average ABSITE percentile score was 52.8% (range 36.9%-67.6%). There were no significant differences in ABSITE scores based on affiliation or program size. Educational resources utilized for ABSITE preparation included SCORE (89.3%), Q-banks (50%), and surgical textbooks (25.8%). The majority (56.1%) of programs reported using a year-long curriculum for ABSITE preparation, and 66.6% used a time-limited curriculum completed in the months immediately prior to ABSITE. Most programs reported that ABSITE scores were a low priority (63.6%) or not a priority (13.6%). The existence of a year-long curriculum for ABSITE was positively correlated with score as compared to programs without a year-long curricula (53.9% vs 48.5%, p <0.01). Programs using a time-limited curriculum demonstrated lower scores as compared to programs without time-limited curricula (51.3% v 56.1%, p < 0.01). General surgery programs use a variety of strategies to prepare residents for the ABSITE. Despite reporting that they utilize ABSITE scores for a variety of high stakes purposes including evaluation for promotion and as a predictor of the preparedness for the ABS QE, many programs reported that they consider ABSITE scores as a low priority. A year-long focused curriculum was the only strategy correlated with increased scores, which may reflect the value of encouraging consistent studying and spaced repetition. Additional work is needed to guide programs in optimal utilization of ABSITE scores for remediation and resident evaluation, as well as understanding how ABSITE preparatory strategies correlate with clinical performance.

The domino effect: the impact of gender on operative self-efficacy.

Studies suggest that there are key differences in operative experience based on a trainee's gender. A large-scale self-efficacy (SE) survey, distributed to general surgery residents after the American Board of Surgery In-Training Examination in 2020, found that female gender was associated with decreased SE in graduating PGY5 residents for all 4 laparoscopic procedures included on the survey (cholecystectomy, appendectomy, right hemicolectomy, and diagnostic laparoscopy). We sought to determine whether these differences were reflected at the case level when considering operative performance and supervision using an operative assessment tool (SIMPL OR). Supervision and performance data reported through the SIMPL OR platform for the same 4 laparoscopic procedures included in the SE survey were aggregated for residents who were PGY5s in 2020. Independent t-tests and multiple linear regression were used to determine the relationship between trainee gender and supervision/performance ratings. For laparoscopic cases in aggregate (n = 2708), male residents rated their performance higher than females (3.57 vs. 3.26, p < 0.001, 1 = critical deficiency, 5 = exceptional performance) and reported less supervision (3.15 vs. 2.85, p < 0.001, 1 = show and tell, 4 = supervision only); similar findings were seen when looking at attending reports of resident supervision and performance. A multiple linear regression model showed that attending gender did not significantly predict resident-reported supervision or performance levels, while case complexity and trainee gender significantly affected both supervision and performance (p < 0.001). Female residents perceive themselves to be less self-efficacious at core laparoscopic procedures compared to their male colleagues. Comparison to more case-specific data confirm that female residents receive more supervision and lower performance ratings. This may create a domino effect in which female residents receive less operative independence, preventing the opportunity to establish SE. Further research should identify opportunities to break this cycle and consider gender identity beyond the male/female construct.

The Association of ACGME Milestones With Performance on American Board of Surgery Assessments: A National Investigation of Surgical Trainees.

To determine the relationship between, and predictive utility of, milestone ratings and subsequent American Board of Surgery (ABS) vascular surgery in-training examination (VSITE), vascular qualifying examination (VQE), and vascular certifying examination (VCE) performance in a national cohort of vascular surgery trainees. Specialty board certification is an important indicator of physician competence. However, predicting future board certification examination performance during training continues to be challenging. This is a national longitudinal cohort study examining relational and predictive associations between Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings and performance on VSITE, VQE, and VCE for all vascular surgery trainees from 2015 to 2021. Predictive associations between milestone ratings and VSITE were conducted using cross-classified random-effects regression. Cross-classified random-effects logistic regression was used to identify predictive associations between milestone ratings and VQE and VCE. Milestone ratings were obtained for all residents and fellows(n=1,118) from 164 programs during the study period (from July 2015 to June 2021), including 145,959 total trainee assessments. Medical knowledge (MK) and patient care (PC) milestone ratings were strongly predictive of VSITE performance across all postgraduate years (PGYs) of training, with MK ratings demonstrating a slightly stronger predictive association overall (MK coefficient 17.26 to 35.76, β = 0.15 to 0.23). All core competency ratings were predictive of VSITE performance in PGYs 4 and 5. PGY 5 MK was highly predictive of VQE performance [OR 4.73, (95% CI, 3.87-5.78), P <0.001]. PC subcompetencies were also highly predictive of VQE performance in the final year of training [OR 4.14, (95% CI, 3.17-5.41), P <0.001]. All other competencies were also significantly predictive of first-attempt VQE pass with ORs of 1.53 and higher. PGY 4 ICS ratings [OR 4.0, (95% CI, 3.06-5.21), P <0.001] emerged as the strongest predictor of VCE first-attempt pass. Again, all subcompetency ratings remained significant predictors of first-attempt pass on CE with ORs of 1.48 and higher. ACGME Milestone ratings are highly predictive of future VSITE performance, and first-attempt pass achievement on VQE and VCE in a national cohort of surgical trainees.

Reported Pain at Work Is a Risk Factor for Vascular Surgery Trainee Burnout

Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Training Exam. Trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs were asked to complete a modified, abbreviated Maslach Burnout Inventory. Pain after a full day of work was measured using a 10-point Likert scale and dichotomized into none to mild pain (0-2) vs moderate to severe pain (3-9). Univariable and multivariable regression analyses were used to assess associations of pain with well-being indicators such as burnout, thoughts of attrition, and career change. Pain management strategies were included as covariables in our study. There were 527 who trainees completed the survey (82.2% response rate). After a full day of working, 38% reported moderate to severe discomfort/pain. Among those who reported moderate to severe pain, 73.6% reported using ergonomic adjustments and 67.0% over-the-counter medications. More women tended to report moderate to severe pain than men (44.3% vs 34.5%; P < .01) (Table I). After adjusting for gender, training level, race/ethnicity, mistreatment, and lack of operative autonomy (a proxy for loss of meaning in work), moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change following adjustment (Table II). Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should provide ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.Table IUnivariable associations of vascular surgery trainee characteristics and well-being with moderate to severe painModerate to severe painP valueYes (n = 200, %)No (n = 327, %)Male118 (34.5)224 (65.6)Female82 (44.3)103 (55.7).03Race/ethnicity Non-Hispanic White109 (41.8)152 (58.4) Non-Hispanic Black10 (35.7)18 (64.3) Hispanic/Latinx14 (33.3)28 (66.7) Asian45 (33.8)88 (66.2) Other12 (41.4)17 (58.6) Prefer not to say10 (37.0)17 (63.0).69Postgraduate year 123 (36.5)40(63.5) 2-344 (34.7)83 (65.3) 5-7133 (39.5)204 (60.5).62Did not feel they had appropriate level of OR autonomy16 (59.3)11 (40.7).06Thoughts of attrition29 (54.7)164 (40.4).047Thoughts of career change28 (14.5)21 (7.8).02Burnout125 (54.1)75 (25.3)<.001Mistreatment147 (79.9)132 (54.1)<.001 Open table in a new tab Table IIMultivariable associations of risk factors with burnout, thoughts of attrition, and thoughts of career change in vascular surgery traineesBurnoutAttritionCareer changeOR95% CIP valueOR95% CIP valueOR95% CIP valueModerate to severe pain2.521.48-4.260.0011.690.77-3.700.192.100.92-4.820.08Gender MaleRefRefRef Female0.960.53-2.740.900.540.22-1.320.180.540.22-1.360.19Race NH WhiteRefRefRef NH Black1.040.29-3.740.950.330.02-4.510.411.470.22-9.720.69Hispanic/Latinx0.430.16-1.180.100.850.20-3.650.830.650.12-3.450.62 Asian0.800.43-1.490.491.540.62-3.820.360.910.32-2.610.84 Other0.590.36-4.060.361.640.31-8.570.561.790.33-9.720.50 Prefer not to say1.210.36-4.060.761.140.25-5.110.872.330.56-9.620.24Postgraduate year level 1RefRefRef 2-31.760.70-4.410.230.690.20-2.400.560.810.21-3.110.76 4-71.150.50-2.640.740.670.22-2.040.490.910.27-3.020.88Pain management OTC medications1.270.75-2.170.370.540.24-1.200.130.590.26-1.350.21Orthotics (eg, brace, footware, etc)1.350.72-2.530.350.910.37-2.200.832.200.77-6.320.14 Yoga/Pilates0.790.43-1.450.440.950.39-2.290.910.510.21-1.240.14 Physiotherapy3.061.02-9.140.0453.950.44-35.40.223.650.41-32.700.25Massage/chiropractic/acupuncture0.770.43-1.400.400.540.23-1.270.160.830.35-1.980.67Ergonomic adjustments0.700.40-1.230.211.520.68-3.410.310.980.42-2.310.96Did not feel they had appropriate level of operative autonomy9.892.02-48.40.0111.856.07-35.54<0.0019.993.31-30.11<0.001Any form of mistreatment2.621.42-4.800.0025.201.40-19.310.015.501.21-25.080.03CI, Confidence interval; OR, odds ratio; Ref, reference; OTC, over the counter; NH, non-Hispanic/Latinx. Open table in a new tab

Defining sources and ramifications of mistreatment among female vascular surgery trainees

ObjectiveMistreatment among vascular surgery trainees is a known risk factor for physician burnout. This study aims to characterize forms of and identify sources of mistreatment. MethodsThis is a cross-sectional study of United States vascular surgery trainees who voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between genders. Logistic regression was used for multivariable analysis. ResultsRepresenting all 125 vascular surgery training programs, 510 trainees (66.9% male) participated in the survey (83.6% response rate). Mistreatment was reported by 54.8% of trainees, with twice as many women reporting as men (82.3% vs 41.0%; P < .001). Women reported higher rates of being shouted at (44.1% vs 21.1%; P < .001); repeatedly reminded of errors (24.3% vs 16.1%; P = .04); ignored/treated hostilely (28.9% vs 10.5%; P < .001); subjected to crude/sexually demeaning remarks, stories, jokes (19.2% vs 2.1%; P < .001); evaluated by different standards (29.3% vs 2.1%; P < .001); and mistaken for a non-physician (75.2% vs 3.5%; P < .001). Among trainees reporting bullying, attendings were the most common source (68.5%). Patients and their families were the most common source of sexual harassment (66.7%), gender discrimination (90.4%), and racial discrimination (74.4%). Compared with men, women identified more patients and families as the source of bullying (50.0% vs 29.7%; P = .005), gender discrimination (97.2% vs 50.0%; P < .001), and sexual harassment (78.4% vs 27.3%; P = .003). Compared with men, women more frequently felt unprepared to respond to the behavior in the moment (10.4% vs 4.6%; P = .002), did not know how to report mistreatment at their institution (7.6% vs 3.2%; P = .04), and did not believe that their institution would take their mistreatment report seriously (9.0% vs 3.9%; P = .002). On multivariable analysis, female gender was an independent risk factor for both gender discrimination (odds ratio, 56.62; 95% confidence interval, 27.89-115) and sexual harassment (odds ratio, 26.2; 95% confidence interval, 3.34-14.8) when adjusting for children, training year, relationship status, and training program location. ConclusionsA majority of vascular surgery trainees experience mistreatment during training. Sources and forms of abuse are varied. Understanding the sources of mistreatment is critical to guide intervention strategies such as faculty remediation and/or sanctions; allyship training for staff, residents, and faculty; and institutional procedures for patient-initiated abuse.