1. Daniel Farkas, Kamal Nagpal, Ernesto Curras, Ajay Shah, John Cosgrove
The Use of a Surgery Specific Written Examination in the Selection Process of Surgical Residents
Daniel Farkas, Kamal Nagpal, Ernesto Curras,
Ajay Shah, John Cosgrove
Department of Surgery
Bronx-Lebanon Hospital Center
Albert Einstein College of Medicine

2. Background
Choosing residents for a surgical residency program is difficult and time consuming
Programs are looking for many characteristics, and among them is the ability to acquire surgical knowledge
Programs are required by the RRC to have 65% of their residents pass the ABS exams on the first try
These pass rates are available online to prospective candidates

3. Background
Many programs use a candidates USMLE scores to help identify their ability to gain surgical knowledge
Some studies have found a correlation between USMLE scores and ABS exams passing scores
Some conflicting evidence as to whether step 1 or step 2 is the better test
In addition, the USMLE is broad based and not surgery specific

4. Study Purpose
The purpose of this study was to look at a different method of assessing a candidate’s ability to gain surgical knowledge
Would using a surgery specific written exam (SSWE) be a better assessment of this ability as compared with the USMLE?

5. SSWE 50 question multiple choice SSWE was created
Questions made by a faculty member, using standard surgical textbooks
Residency candidates were given this exam on their interview day
Each exam scored out of 100% and added to candidates folders

6. Study Design
Retrospective study of residents in our program between 2004 and 2012
Academic folders were reviewed and pre-residency information was collected
USMLE part 1 score (USMLE-1)
USMLE part 2 score (USMLE-2)
SSWE score
Intra-residency data collected
ABSITE score in PGY 1 through PGY 5 (ABSITE-1 to ABSITE-5)

7. Study Design
Residents with all three pre-residency scores were included in the study
Correlation coefficients were calculated between the pre-residency exam scores and the intra-residency exam scores
P values of less than 0.05 were considered significant

8. Results 53 residents had partial information
43 residents had all three pre-residency scores and were included in the study
38 had an ABSITE-1 score
24 had an ABSITE-2 score
18 had an ABSITE-3 score
17 had an ABSITE-4 score
14 had an ABSITE-5 score

9. ABSITE-1 ABSITE-2 ABSITE-3 ABSITE-4 ABSITE-5 USMLE-1 USMLE-2 SSWE
ABSITE-1
ABSITE-2
ABSITE-3
ABSITE-4
ABSITE-5
n = 38
n = 24
n = 18
n = 17
n = 14
USMLE-1
r = 0.327
p = 0.045*
r = 0.321
p = 0.126
r = 0.346
p = 0.160
r = 0.165
p = 0.527
r =
p = 0.610
USMLE-2
r = 0.314
p = 0.055
r = 0.187
p = 0.381
r = 0.415
p = 0.086
r = 0.245
p = 0.343
r = 0.044
p = 0.880
SSWE
r = 0.656
p < 0.001*
r = 0.275
p = 0.194
r =
p = 0.476
r =
p = 0.113
r =
p = 0.838
* Statistically significant

10. ABSITE-1 ABSITE-2 ABSITE-3 ABSITE-4 ABSITE-5 n = 21 r = 0.573
ABSITE-1
ABSITE-2
ABSITE-3
ABSITE-4
ABSITE-5
n = 21
r = 0.573
p = 0.007*
n = 15
r = 0.850
p < 0.001*
n = 12
r = 0.593
p = 0.042*
n = 9
r = 0.870
p = 0.02*
n = 17
r = 0.906
n = 14
r = 0.904
n = 11
r = 0.765
p = 0.006*
r = 0.824
r = 0.682
p = 0.015*
r = 0.406
p = 0.150
* Statistically significant

11. Results - Summary
USMLE may correlate with ABSITE-1 scores, but a SSWE has a much stronger correlation with ABSITE-1 than either step 1 or 2
ABSITE-1 scores correlate significantly with ABSITE scores in future years

12. Discussion
Identifying residents that will do well on their board exams is critical to the success of a surgical residency program
Part of a resident’s academic achievement is due to the educational activities within the program
However, studies have shown that residents with poor USMLE scores have higher chances of failing the boards.1,2
Shellito JL, Osland JS, Helmer SD, Chang FC. American Board of Surgery examinations: can we identify surgery residency applicants and residents who will pass the examinations on the first attempt? Am J Surg. 2010;199:
de Virgilio C, Yaghoubian A, Kaji A, et al. Predicting performance on the American Board of Surgery qualifying and certifying examinations: a multi-institutional study. Arch Surg. 2010;145:852-6.

13. Discussion
Corneille et al1 showed that a targeted surgery exam during residency was able to predict which residents would do well on the ABSITE
Our study showed that by giving this exam to residency candidates, we could predict which candidates were more likely to do well on the ABSITE
Corneille MG, Willis R, Stewart RM, Dent DL. Performance on brief practice examination identifies residents at risk for poor ABSITE and ABS qualifying examination performance. J Surg Educ. 2011;68:246-9.

14. Limitations Correlation only significant with ABSITE-1
Possible with a bigger sample size this would change
ABSITE-1 correlated with ABSITE scores in later years
ABSITE scores have been shown to correlate with board passing rates1
SSWE scores were absolute whereas other exams were percentile scores
Makes it harder to compare between years
de Virgilio C, Yaghoubian A, Kaji A, et al. Predicting performance on the American Board of Surgery qualifying and certifying examinations: a multi-institutional study. Arch Surg. 2010;145:852-6.

15. Limitations SSWE only useful for surgical knowledge
5 other competencies
Many other important skills in being a successful surgical resident and a successful surgeon
Not practical for every program
Many candidates are wooed by other programs on their interview day
Good potential candidates could be turned away by getting an extra exam

16. Conclusions
Notwithstanding the limitations, the SSWE is a very strong predictor of who will do well on ABSITE-1
Higher ABSITE-1 scores is correlated with higher ABSITE scores in later years
Higher ABSITE scores can predict who will pass their board exams on the first chance

17. Final Conclusion
Residency programs looking for residents who will pass their boards on the first attempt are more likely to find these residents using a SSWE than by using the USMLE

18. Acknowledgements Kamal Nagpal Ernesto Curras Ajay Shah John Cosgrove
Saundra King
Nancy Rivera