1. Weekly Assigned Reading and Exams Improve ABS Exam Pass Rates
PRESENTATION IS LIMITED TO 10 MIN. Five minutes of Q & A follow.
Bring this presentation on a jump drive or CD and give it to the audio-visual guys the day before if possible.
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Christian de Virgilio MD, Tony Chan MD, and Kel Miller MBA
Harbor-UCLA Medical Center

2. Success on ABS Exams Linked to ABSITE Performance
Shetler Am J Surg 1982
High correlation between ABSITE and QE
ABSITE < 25th percentile in PGY 5 year
Wade et al Surgery 1993
Correlation between ABSITE and QE pass
Correlation between Chief resident ABSITE and CE pass
No specific ABSITE cutoff value
Sparked interest in improving ABSITE

3. Factors Affecting ABSITE Performance
Dean et al Am Surg 1984
Programmed reading
Hirvela and Becker, Am J Surg 1991
Reading effort
Itani et al J Surg Res 1997
Problem based learning conference
Individual resident self-study
Godellas and Huang, Am J Surg 2001
Conference attendance
Amount of study
Confidence
Segue: “Of note, one reason why programmed reading as opposed to passive learning improves ABSITE performance comes from the field of cognitive science, which has demonstrated that memory is facilitated by active learning and stress - de Kloet Joels - which leads to our experience with educational conferences designed at Harbor-UCLA…” and then on to next slide…

4. Harbor-UCLA ABSITE Performance
Arch Surg 2003
1 year of assigned reading and weekly exams
Mean ABSITE increased from 59th to 75th national percentile
Am Surg 2005
3 year study
ABSITE improvement sustainable
Mean ABSITE remained at 75th percentile
Unclear whether this would translate to improved ABS exam performance

5. Objectives
Primary: to determine whether weekly assigned reading and examinations, sustained over a 6 year period, would result in an improvement in the combined ABS QE and CE first-time pass rates
Secondary: to identify whether ABSITE thresholds were predictive of passing the ABS exams

6. Methods Period 1: Jan 1997 - Jun 2001 Period 2: July 2001 - Nov 2007
Prior to institution of reading and exam program
Period 2: July Nov 2007
After assigned reading and weekly exams
Main outcome measures
First time pass rates on ABS QE, CE and combined QE/CE
Secondary outcomes
Mean ABSITE national percentiles
Number of ABSITE scores < 35th percentile
Overall ABSITE thresholds predictive of ABS exam failure

7. ABSITE Review Conference
Instituted July 2001 and has continued for first 7 months of each academic year
Program director (PD) assigned chapter in standard textbook weekly
15 question exam created by PD each week
Goal: stimulate reading and simulate stress of exam
Mandatory conference (PD administered exam)
Time limit, adjacent seat partner graded exam
PD called on residents to give correct answers
Grades recorded, answers reviewed, top scores announced
About 28 chapters reviewed each year
Content of questions changed yearly
Conference in 7th year, now held every other week

8. Results Median ABSITE Percentile % ABSITE < 35th Percentile ABS
QE Pass Rate
CE Pass Rate
QE/CE Pass Rate
Period 1
16 residents
62nd
18%
23/126
81%
67%
Period 2
28 residents
79th 7%
12/159
93%
93%†
89%
p value
< 0.001
0.01
0.4
0.07
†One resident has not yet taken the CE

9. ABSITE < 35th Percentile
0.57
4/26 (15%)
7/24 (29%)
QE/CE
Fail
1.0
3/25 (12%)
3/23 (13%) CE
0.1
1/25 (4%)
5/24 (21%) QE
P Value
ABSITE  35th percentile
ABSITE < 35th percentile

10. ABSITE < 30th Percentile
0.55
4/26 (15%)
7/21 (15%)
QE/CE
Fail
0.47
3/27 (11%)
3/20 (15%) CE
0.01
1/34 (3%)
5/15 (33%) QE
P Value
ABSITE  30th percentile
ABSITE < 30th percentile

11. ABSITE < 25th Percentile
p Value QE
Fail
5/15 (33%)
1/34 (3%)
0.01 CE
3/14 (21%)
3/34 (9%)
0.34
QE/CE
9/17 (53%)
2/31 (6%)
0.001

12. Discussion How is Cognitive Knowledge Best Acquired?
ABSITE course as structured stimulates reading and produces a degree of stress
Joels et al Trends Cogn Sci 2006
Stress facilitates learning and memory if:
stress is experienced in the context and time of the event to be remembered and stress not too powerful
Stress hormones induce focused attention and improve memory of relevant information
Ferguson and Warshaw Arch Surg 2006
Web based educational tool (done at home) did not improve ABSITE performance
Low level of usage
? too low stress

13. Conclusions
A program of weekly assigned reading and examinations in a conference format can be sustained over several years
Improved ABSITE performance
Trend towards improved first-time pass rates on combined ABS QE and CE
Labor intensive
Reason for success of format
Motivation to read regularly
Active learning with appropriate stress facilitates memory

14. Conclusions Low ABSITE at any PGY level predicts failure of ABS exams
ABSITE < 35th percentile
Trends towards failing QE
Remediation
ABSITE < 30th percentile
predicts failing QE
ten fold increased risk
ABSITE < 25th percentile
predicts failing QE and combined QE/CE
Residencies seeking to improve ABSITE and ABS exam performance should consider a similar educational program