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

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

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

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?

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

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)

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

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

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 = -0.150 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 = -0.179 p = 0.476 r = -0.399 p = 0.113 r = -0.060 p = 0.838 * Statistically significant

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

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

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;199:216-22. 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.

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.

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.

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

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

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

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