Certain sociodemographic factors are associated with rates of passing board examinations for general surgery trainees, according to study data published in JAMA Surgery. Specifically, resident race, ethnicity, sex, and family status at internship correlated with performance on examinations. Researchers suggest that efforts to address these discrepancies at the institutional level are needed to better represent minority groups in the field of academic surgery.
This prospective observational cohort enrolled 1048 general surgery trainees in the 2007 to 2008 entering class at multiple programs across the United States. Trainees completed a baseline survey that queried sociodemographic and program characteristics. Interns were followed up after 8 years. The primary outcome measure was the pass rate for American Board of Surgery-administered qualifying and certifying examinations. A multinomial regression analysis was performed to identify associations between trainee characteristics and the likelihood of attempting or passing an examination. Logistic regression analyses were used to calculate the likelihood of passing examinations on the first attempt, expressed as odds ratios (ORs).
Among 662 examinees with complete follow-up data, 443 (65%) were men and 459 (69%) were white. Overall board passage rate was 87% (n=578). According to multinomial regression analysis, Hispanic trainees were more likely to not attempt the examinations compared with non-Hispanic trainees (OR, 4.56; 95% CI, 1.51-14.4). Compared with trainees who were married with children during their internship, examinees who were married without children (OR, 0.3; 95% CI, 0.1-0.8) or single (OR, 0.4; 95% CI, 0.2-0.9) were less likely to fail the examinations. Results of logistic regression showed that white examinees were more likely to pass the qualifying examination on the first try compared with black individuals, Asian individuals, and individuals of other races (OR, 1.8; 95% CI, 1.03-3.0). Trainees with better scores on their first American Board of Surgery In-Training Examination were also more likely to pass the qualifying examination on their first try (OR, 1.03; 95% CI, 1.02-1.05). White examinees were more likely to pass the certification examination on the first try compared with nonwhite examinees (OR,1.8; 95% CI, 1.1-2.8). Additionally, greater likelihood of passing the certifying examination on the first try was observed among non-Hispanic vs Hispanic individuals (OR, 2.4; 95% CI, 1.2-4.7) and among single women vs women who were married with children (OR, 10.3; 95% CI, 2.1-51). Notably, no difference in passage rates was observed among men who were single vs men who were married with children.
These data highlight significant correlations between trainee demographics and American Board of Surgery passage rates. As for study limitations, investigators noted that their surveys could not capture intern study habits, nor intern performance on prior standardized examinations. Even so, these results support recent efforts from the American Board of Surgery to reduce unconscious and implicit bias among board examiners. Though, further inquiry into the factors influencing the rate of passing board examinations discrepancies is needed.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures
Yeo HL, Dolan PT, Mao J, Sosa JA. Association of demographic and program factors with American Board of Surgery qualifying and certifying examinations pass rates [published online October 16, 2019]. JAMA Surg. doi:10.1001/jamasurg.2019.4081