title: Program Factors That Influence American Board of Surgery In-Training Examination Performance: A Multi-Institutional Study.
abstract: OBJECTIVE
  To determine the influence of program strategies, such as program directors' (PD) attitudes about the American Board of Surgery In-Training Examination (ABSITE) and approach to ABSITE preparation, on residents' ABSITE performance.
  
  
  METHODS
  A 17-item questionnaire was sent to PDs at surgical residency programs. The questions were designed to elicit information regarding the educational curriculum, remediation protocols, and opinions relating to the ABSITE. Main outcome measure was categorical resident ABSITE percentile scores from the January 2014 examination. Statistical analysis was performed using the Student t-test, analysis of variance, and linear regression as appropriate.
  
  
  METHODS
  The study was carried out at general surgery residency programs across the country.
  
  
  METHODS
  In total, 15 general surgery residency PDs participated in the study.
  
  
  RESULTS
  The PD response rate was 100%. All 460 resident ABSITE scores from the 15 programs were obtained. In total, 10 programs (67%) identified as university affiliated, 4 programs (27%) as independent academic, and 1 program (7%) as hybrid. The mean number of residents per program was 30.7 (range: 15-57). In total, 14 PDs (93%) indicated that an ABSITE review curriculum was in place and 13 PDs (87%) indicated they had a remediation protocol for residents with low ABSITE scores (with differing thresholds of <30th, <35th, and <40th percentile). The median overall ABSITE score for all residents was 61st percentile (interquartile range = 39.5). The mean ABSITE score for each program ranged from 39th to 75th percentile. Program factors associated with higher ABSITE scores included tracking resident reading throughout the year (median 63rd percentile with tracking vs 59th percentile without, p = 0.040) and the type of remediation (by PD: 77th percentile, by PD and faculty: 57th percentile, faculty only: 64th percentile, with Surgical Education and Self-Assessment Program (SESAP): 63rd percentile, outside review course: 43rd percentile; p < 0.001). Programs with a remediation protocol trended toward higher ABSITE scores compared with programs without remediation protocols (median 61st percentile vs 53rd percentile, p = 0.098). Factors not significantly associated with ABSITE performance included number of structured educational hours per week and frequency of ABSITE review sessions.
  
  
  CONCLUSIONS
  Program factors appear to significantly influence ABSITE performance. Programs where the PD was actively involved in remediation mentorship and the tracking of resident reading achieved higher ABSITE percentile scores on the January 2014 examination. Counterintuitively, residents from programs with a lower ABSITE threshold for remediation performed better on the examination.
authors: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
authors: Jerry J
authors: JJ
authors: Kim
authors: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
authors: Edward D
authors: ED
authors: Gifford
authors: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
authors: Ashkan
authors: A
authors: Moazzez
authors: Department of Surgery, Iowa Methodist Medical Center, Des Moines, Iowa.
authors: Richard A
authors: RA
authors: Sidwell
authors: Department of Surgery, Loma Linda University, Loma Linda, California.
authors: Mark E
authors: ME
authors: Reeves
authors: Department of Surgery, Mount Carmel Health System, Columbus, Ohio.
authors: Thomas H
authors: TH
authors: Hartranft
authors: Department of Surgery, University of Southern California, Los Angeles, California.
authors: Kenji
authors: K
authors: Inaba
authors: Department of Surgery, Gundersen Health System, La Crosse, Wisconsin.
authors: Benjamin T
authors: BT
authors: Jarman
authors: Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Chandrakanth
authors: C
authors: Are
authors: Department of Surgery, University of California, Davis, California.
authors: Joseph M
authors: JM
authors: Galante
authors: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Farin
authors: F
authors: Amersi
authors: Department of Surgery, University of California, Irvine, California.
authors: Brian R
authors: BR
authors: Smith
authors: Department of Surgery, Stanford University, Stanford, California.
authors: Marc L
authors: ML
authors: Melcher
authors: Department of Surgery, University of New Mexico HSC, Albuquerque, New Mexico.
authors: M Timothy
authors: MT
authors: Nelson
authors: Department of Surgery, University of California, Los Angeles, California.
authors: Timothy
authors: T
authors: Donahue
authors: Department of Surgery, University of California, San Diego, California.
authors: Garth
authors: G
authors: Jacobsen
authors: Department of Surgery, Columbia University College of Physicians and Surgeons New York, New York.
authors: Tracey D
authors: TD
authors: Arnell
authors: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
authors: Steven
authors: S
authors: Lee
authors: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
authors: Angela
authors: A
authors: Neville
authors: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California. Electronic address: cdevirgilio@labiomed.org.
authors: Christian
authors: C
authors: de Virgilio
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D013502:General Surgery / Q000193:education*; D007396:Internship and Residency; D013044:Specialty Boards; D011795:Surveys and Questionnaires; D014481:United States
keywords: ABSITE; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; program director; surgery residency; surgical education