PS4 - 01: A 15-YEAR RESIDENCY PROGRAM REPORT CARD: DIFFERENCES BETWEEN THE CRèME OF THE CROP AND THE BOTTOM OF THE BARREL ON THE AMERICAN BOARD OF SURGERY EXAMINATIONS
John L Falcone, MD, MS, FACS; 1: Owensboro Health Surgical Specialists, Owensboro KY 2: University of Louisville, Department of Surgery, Louisville, KY

Background:  Performance on the American Board of Surgery (ABS) Examinations represents an important trainee outcome metric of residency programs.  The purpose of this study was to compare established program outcomes over the last 15 years, and to see if residency program size, type, and location were potential explanatory variables between the most and least successful programs.

Methods:  This was a retrospective study from 2001 - 2016.  Examination data were obtained from the American Board of Surgery, using three consecutive five-year reports.  Programs with complete data were included.  The variables included ABS Qualifying Examination (QE) and ABS Certifying Examination (CE) outcomes, and the ABS combined Examination Index (EI), a measure of first-attempt passage of both examinations.  The top and bottom decile programs, as defined by overall EI, were compared using t-tests and Chi-square tests, using an α = 0.05.

Results:  A total of 231 programs met inclusion criteria.  The overall residency program ABS EI was 72.8% ± 11.6%.  The top decile (n = 23) outperformed the bottom decile (n = 23) on the ABS QE (96.3% ± 2.2% vs 71.4% ± 7.2% [p < 0.001]), ABS CE (93.9% ± 2.6% vs 70.0% ± 8.9% [p < 0.001]), and the ABS EI (91.0% ± 2.6% vs 51.4% ± 5.4% [p < 0.001]).  The top decile programs were larger (p = 0.001).  In the top decile residencies, there were more military programs (3 vs 0) and academic programs (14 vs 8), and fewer community programs (6 vs 15) (p = 0.01).  Geographically, there were more top decile programs in the West (4 vs 0) and fewer top decile programs in the Northeast (4 vs 13) (p = 0.02).  Over time, the ABS EI increased globally in the bottom decile programs (57%), and decreased globally in the top decile programs (70%).

Conclusion:  There are clear differences in ABS Examination performance across established residency training programs.  There are also clear demographic differences of program size, type, and location with associated ABS Examination outcome metrics.  These results essentially perform a needs-assessment for residency programs, and may invoke a competitive spirit and incentive for examination outcome improvement.