R. A. Marmor1, E. Hastings2, R. Galzote1, J. T. Unkart1, J. K. Sicklick1, G. R. Jacobsen1 1University Of California – San Diego,Surgery,San Diego, CA, USA 2University Of California – San Diego,Economics,San Diego, CA, USA
Introduction: Prior research has demonstrated a thought-provoking paradox: despite increasing average case numbers completed during general surgery residency, the rate of passing the ABS Certifying Exam has decreased. As such, there is a need for better understanding of the relationship between case volume in organ/disease content areas and concurrent resident knowledge in those areas. Our null hypothesis was that there was no association between surgery resident case volumes and ABSITE scores.
Methods: We obtained ABSITE score reports, ACGME case logs, and USMLE Step 1 scores for all categorical general surgery residents (n=69) in a single academic general surgery program (2010-2015). Multivariate mixed-linear regression was used to identify predictors of ABSITE success including: 1) absolute percent correct; 2) ABSITE percentile score; and 3) index category score created according to ACGME case log classification). Two coders, blinded to resident identities, reviewed all incorrect ABSITE answers and assigned them to a corresponding case log index category. For each exam year, a list of all organ/disease content area questions was generated from ABSITE reports. Each resident’s index score for a given exam year was calculated as 1 – percent incorrect (defined as the number of questions a resident got wrong in an index category divided by the total number of questions in that category).
Results: Consistent with several prior studies, USMLE Step 1 scores were significant predictor of ABSITE performance, although this association decreased with training time. On univariate analysis, absolute ABSITE percentage and percentile score did not correlate with total annual case volume as self-reported by residents in ACGME case logs. However, index case volume was a significant predictor of ABSITE index category score (p<0.05) (e.g. increased number of alimentary cases was associated with higher scores on alimentary questions).
Conclusion: For the first time, our study suggests that there is a direct correlation between increased resident performance of cases in defined American Board of Surgery categories and improved performance on the parallel content areas tested during the annual ABSITE. Validation of this finding with a larger sample size is warranted.