M. R. Smeds1, C. R. Thrush1, F. McDaniel1, R. Gill1, M. K. Kimbrough1, B. D. Shames2, J. J. Sussman3, J. M. Galante4, C. M. Wittgen5, P. Ansari6, S. R. Allen7, M. S. Nussbaum8, D. Hess9, F. R. Bentley1 1University Of Arkansas For Medical Sciences,Department Of Surgery,Little Rock, AR, USA 2University Of Connecticut School Of Medicine,Department Of Surgery,Farmington, CT, USA 3University Of Cincinnati,Department Of Surgery,Cincinnati, OH, USA 4University Of California – Davis Medical Center,Department Of Surgery,Sacramento, CA, USA 5Saint Louis University School Of Medicine,Department Of Surgery,St. Louis, MO, USA 6Hofstra-Northwell Lenox Hill Hospital,Department Of Surgery,New York, NY, USA 7Penn State Hershey Medical Center,Department Of Surgery,Hershey, PA, USA 8University Of Florida College Of Medicine – Jacksonville,Department Of Surgery,Jacksonville, FL, USA 9Boston University,Department Of Surgery,Boston, MA, USA
Objectives: The American Board of Surgery In-Training Examination (ABSITE) is used by programs to evaluate knowledge and readiness of trainees to sit for the general surgery certifying examination. It is often used as a tool to promote residents and may be used by fellowship programs to evaluate candidates. Burnout has been associated with job performance and satisfaction; however its presence and effects on surgical trainee’s performance is not well studied. We sought to understand factors, including burnout and study habits, that may contribute to performance on the ABSITE examination.
Methods: Anonymous electronic surveys were distributed to all residents at nine surgical residency programs (n=307). Questions included demographics, study habits, career interests, residency characteristics, and burnout scores using the Oldenburg Burnout Inventory, which assesses burnout due to both exhaustion (B-E) and disengagement (B-D). These surveys were then linked to individual 2016 ABSITE and USMLE step I and II scores provided by the programs in order to determine factors associated with successful ABSITE performance.
Results: 47% (n=143) of the residents completed the survey. Of those completing the survey, 37 (26%) scored in the highest ABSITE quartile (>75th percentile) and 106 (74%) scored less than the 75th percentile. Those in the highest ABSITE quartile had significantly higher USMLE step I and step II scores (p<.01), had a regular reading schedule for the ABSITE (p<.05), more disciplined study habits (p<.01) and were more likely to use active rather than passive study strategies (p<.05). Overall, sources most commonly used were ABSITE review books and other sources of practice questions (90% and 61% respectively). Increased studying (“cramming”) prior to the examination was not associated with higher ABSITE scores. Residents on the whole showed a moderate level of burnout, particularly in the exhaustion domains, and those in the highest ABSITE quartile had significantly lower mean burnout scores on both B-D and B-E scales (p<.05). Residents who were on a research year and those planning to go into an academic surgery careers had significantly higher ABSITE scores (p<.01), whereas those who attended a non-U.S. medical school had significantly lower ABSITE scores (p<.01). Other individual characteristics and program characteristics were unrelated to ABSITE performance (age, gender, having children, advanced degree, reported study barriers, protected study time, PGY level, duty hour violations, previously completed a research year).
Conclusions: Residents who perform higher on the ABSITE have a regular study schedule throughout the year, are more disciplined in their study habits using active versus passive study strategies, and report less burnout due to exhaustion or disengagement from work. Further study is needed to determine the effects of burnout on clinical duties, career advancement and satisfaction.