A Longitudinal Study of the American Board of Surgery Examination Index: Can Residents Pass Both the Qualifying Examination and Certifying Examination the First Time?

BackgroundThere have been significant recent decreasing pass rate trends on the American Board of Surgery (ABS) Certifying Examination (CE) in the absence of clear trends on the Qualifying Examination (QE). The ABS examination index (ABS-EI) represents the ratio of candidates per program that passed both the QE and CE on the first attempt. The aim of this study is to longitudinally evaluate the ABS-EIs for residency programs. The hypothesis is that the ABS-EIs have also decreased over time.MethodsIn this retrospective study from 2002 to 2012, the ABS-EIs were obtained from the ABS for each of the general surgery residency programs. Nonparametric statistics were performed between early (2002-2007) and late (2007-2012) time periods for differences in ABS-EI and examination performance, using an α = 0.05.ResultsThere were 235 included residency programs in this study. The first-attempt pass rate on the QE was 3961 of 4647 (85.2%) for the early period and 4204 of 4888 (86.1%) for the late period (p = 0.29). The first-attempt pass rate on the CE was 3555 of 4097 (86.8%) for the early period and 3450 of 4243 (81.3%) for the late period (p < 0.001). The median ABS-EI per program was 0.77 (interquartile range: 0.63-0.86) (range: 0.30-1.00) in the early period and 0.70 (interquartile range: 0.61-0.83) (range: 0.19-1.00) in the late period. Matched Wilcoxon signed rank tests showed that program ABS-EI and CE performance decreased (both p < 0.001), whereas QE performance remained the same (p = 0.48) over time.ConclusionsFewer residents per program pass both the QE and CE on the first attempt, as shown by the decreasing ABS-EI over time. The ABS-EI trends may serve as a needs assessment for individual residency program education curricula and are important to residency programs and incoming general surgery applicants.