Analysis of Surgeon and Program Characteristics Associated with Success on American Board of Surgery Examination Outcomes

BACKGROUND: Existing research exploring predictors of success on American Board of Surgery (ABS) examinations focused on either resident or residency program characteristics, but limited studies focus on both. This study examines relationships between both resident and program characteristics and ABS qualifying (QE) and certifying examination (CE) outcomes. STUDY DESIGN: Multilevel logistic regression was used to analyze the relationship between resident and program characteristics and ABS QE and CE first attempt pass and eventual certification. Resident characteristics were gender, international medical graduate (IMG) status, and previous performance, measured by the first attempt US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge and Step 3 scaled scores. Program characteristics were size, %female, %IMG, and program type. The sample included surgeons with QE and CE data from 2007 to 2019 and matched USMLE scores. RESULTS: Controlling for other variables, previous medical performance positively related to all ABS examination outcomes. The relationships between USMLE scores and success on ABS examinations varied but were generally strong. Other resident characteristics that predicted ABS examination outcomes were gender and IMG (QE first attempt pass). The only program characteristic that significantly predicted ABS outcomes was %IMG (QE and CE first attempt pass). Despite statistical significance, gender, IMG, and %IMG translated to small differences in predicted probabilities of ABS examination success. CONCLUSIONS: This study highlights resident and program characteristics that predict success on ABS examinations. USMLE scores consistently and strongly related to ABS examination success, providing evidence that USMLE scores relate to future high-stakes consequences like board certification. After controlling for previous performance, gender, IMG, and program %IMG significantly related to ABS examination success, but effects were small.