American Board of Surgery Examinations: Can We Identify Surgery Residency Applicants

Who Will Pass the Examinations on the First Attempt?

John L. Shellito, M.D., Jacqueline S. Osland, M.D., Stephen D. Helmer, Ph.D., Frederic C. Chang, M.D.

Department of SurgeryUniversity of Kansas School of Medicine – Wichita

Introduction: The Importance of Board Certification

• One of the key demonstrations of the effectiveness of a residency’s training program

• ACGME Program Requirements-Surgery– 65% first attempt pass rate for both the

qualifying and certifying exam

Objective

This study was performed to identify and evaluate factors which predict successful completion of both the American Board of Surgery Qualifying Exam (QE) and Certifying Exam (CE) on the first attempt

Methods

• Retrospective review – University of Kansas SOM-Wichita

Surgery Residency Program– Included residents entering the program from

1990-2001

Pre-Admission Measures

• Age and gender• Class rank• AOA status• Honors in third year surgery clerkship• Interview scores• National Board of Medical Examiners (NBME)

Part 1 and Part 2 scores or United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores

• Rank list number

Post-admission Measures

• American Board of Surgery In Training Examination (ABSITE) scores

• Resident awards (Research, Teaching, Outstanding Senior Resident)

• Faculty evaluations of the 5th year residents

Statistical Analysis

• Univariate analyses were performed using Fischer’s exact test for the dichotomous variables (i.e. gender, AOA status, honors)

• Two-sample Wilcoxon rank-sum test was used for continuous variables (i.e. scores, age) and ordinal data

• Logistic regression analysis was performed on the pre-admission variables

Results

• 77 medical students and residents– 15 subjects excluded

• 5 NBME or USMLE scores not available • 8 Left the program• 2 never attempted the QE (both plastic surgeons)

• 62 subjects remained after exclusions

UKSM-W Surgery Residency Program 1990-2001

• >90% of our graduates attended medical school in the Midwest (50% from KU)– One foreign medical graduate

• 16% (10/62) AOA• Pass rates

– First time: 77.4%– Eventual: 96.8%

• 2/62 (plastic surgery)

• Majority entered private practice (73%)• No difference in first time pass rates over the

study period

Results

• No significant difference based on gender• 50 (80.7%) were male• First time pass rate

– 74% for males/ 91.7% for females (p=0.179)

• Residents who successfully passed were slightly younger at time of application

• 27.1 years vs. 28.6 years (p=0.047)

Effect of Class Rank on First Attempt Pass Rates

Class Rank Group Number Percent

Top 1/3rd 22/23 95.7%

Middle 1/3rd 14/22 63.6%

Bottom 1/3rd 3/5 60.0%

P=0.0073

Effect of Step 1 scores on First Attempt Pass Rates

Step 1 Group

Number Percent

Top 50% (>200)

36/42 85.7%

Bottom 50% (<200)

12/20 60.0%

P=0.0247

Effect of Step 2 scores on First Attempt Pass Rates

Step 1 Group Number Percent

Top 3 Quartiles (>186)

44/55 80.0%

Bottom Quartile (<186)

2/5 40.0%

P=0.0447

Results

• Cumulative scores for step 1 and 2– >382 (top 2/3rds)

• 81.1% first time pass rate

– <382 (bottom 1/3rd)• 42.9% first time pass rate

Results

Logistic regression analysis showed Step 1 scores to be the only independent predictor from the group of pre-admission factors for first time pass rates

Effect of ABSITE on First Attempt Pass Rates

ABSITE Group Number Percent

PGY-1 >50th percentile 41/50 82.0%

<50th percentile 5/10 50.0% P=0.044

PGY-3

>50th percentile 36/40 90.0%

<50th percentile 12/22 54.5% P=0.002

Effect of ABSITE on First Attempt Pass Rates

ABSITE Group Number Percent

PGY-4

Top 1/3rd 19/22 86.4%

Middle 1/3rd 23/26 88.5%

Bottom 1/3rd 6/14 42.9%P=0.009

PGY-5

Top 1/3rd 23/24 95.8%

Middle 1/3rd 15/21 71.4%

Bottom 1/3rd 10/17 58.8%P=0.004

Results

• Residents winning an award during residency had a higher first time pass rate – 92% versus 67%

• Faculty evaluations of 5th year residents did not predict board success

Results

• Pre-admission factors that failed to predict success for first time pass rates– Honors in 3rd year surgery clerkship– AOA status

• 10/10 first time pass rate, p=0.061

– Interview score– Ranking in the match

Discussion

• Clerkship grades• Honors grade in third year surgery

clerkship• Dean’s letters• Letters of recommendations• Interview Score• Class rank• USMLE scores

Discussion

• Xu 1998– Positive correlation between eventual board

certification status and past academic performance– Included other surgical specialties in addition to

general surgery

• Silber 2005– Step 2 score single most important predictor for

eventual OB/GYN board certification– Graduates from a single medical school, multiple

residency programs

Summary

This is first study to examine factors predicting first time board certification rates for general surgery residency graduates for both the QE and CE

Limitations

• Small sample size

• Bias injected from our selection process– No information about the success or failure of

applicants who were excluded by our selection committee

• Single residency training program

Summary

• Academic aptitude by itself does not predict the multifaceted state of competence of a surgeon

• Professionalism, manual dexterity, communication abilities, and integrity are not measured by standardized tests

• Sorting applicants that are above a certain threshold of intellectual capacity solely by test scores may not be a good way to obtain the best residents

Conclusion

Our study indicates a positive correlation between class rank, USMLE scores, ABSITE scores and first time pass rates for ABS certification