Weekly Assigned Reading and Exams Improve ABS Exam Pass Rates

1
Weekly Assigned Reading and Exams ImproveABS
Exam Pass Rates

• Christian de Virgilio MD, Tony Chan MD, and Kel
  Miller MBA
• Harbor-UCLA Medical Center

2
Success on ABS Exams Linked to ABSITE Performance

• Shetler Am J Surg 1982
• High correlation between ABSITE and QE
• ABSITE lt 25th percentile in PGY 5 year
• Wade et al Surgery 1993
• Correlation between ABSITE and QE pass
• Correlation between Chief resident ABSITE and CE
  pass
• No specific ABSITE cutoff value
• Sparked interest in improving ABSITE

3
Factors Affecting ABSITE Performance

• Dean et al Am Surg 1984
• Programmed reading
• Hirvela and Becker, Am J Surg 1991
• Programmed reading
• Reading effort
• Itani et al J Surg Res 1997
• Problem based learning conference
• Individual resident self-study
• Godellas and Huang, Am J Surg 2001
• Conference attendance
• Amount of study
• Confidence

4
Harbor-UCLA ABSITE Performance

• Arch Surg 2003
• 1 year of assigned reading and weekly exams
• Mean ABSITE increased from 59th to 75th national
  percentile
• Am Surg 2005
• 3 year study
• ABSITE improvement sustainable
• Mean ABSITE remained at 75th percentile
• Unclear whether this would translate to improved
  ABS exam performance

5
Objectives

• Primary to determine whether weekly assigned
  reading and examinations, sustained over a 6 year
  period, would result in an improvement in the
  combined ABS QE and CE first-time pass rates
• Secondary to identify whether ABSITE thresholds
  were predictive of passing the ABS exams

6
Methods

• Period 1 Jan 1997 - Jun 2001
• Prior to institution of reading and exam program
• Period 2 July 2001 - Nov 2007
• After assigned reading and weekly exams
• Main outcome measures
• First time pass rates on ABS QE, CE and combined
  QE/CE
• Secondary outcomes
• Mean ABSITE national percentiles
• Number of ABSITE scores lt 35th percentile
• Overall ABSITE thresholds predictive of ABS exam
  failure

7
ABSITE Review Conference

• Instituted July 2001 and has continued for first
  7 months of each academic year
• Program director (PD) assigned chapter in
  standard textbook weekly
• 15 question exam created by PD each week
• Goal stimulate reading and simulate stress of
  exam
• Mandatory conference (PD administered exam)
• Time limit, adjacent seat partner graded exam
• PD called on residents to give correct answers
• Grades recorded, answers reviewed, top scores
  announced
• About 28 chapters reviewed each year
• Content of questions changed yearly
• Conference in 7th year, now held every other week

8
Results
One resident has not yet taken the CE
9
ABSITE lt 35th Percentile
10
ABSITE lt 30th Percentile
11
ABSITE lt 25th Percentile
12
Discussion

• How is Cognitive Knowledge Best Acquired?
• ABSITE course as structured stimulates reading
  and produces a degree of stress
• Joels et al Trends Cogn Sci 2006
• Stress facilitates learning and memory if
• stress is experienced in the context and time of
  the event to be remembered and stress not too
  powerful
• Stress hormones induce focused attention and
  improve memory of relevant information
• Ferguson and Warshaw Arch Surg 2006
• Web based educational tool (done at home) did not
  improve ABSITE performance
• Low level of usage
• ? too low stress

13
Conclusions

• A program of weekly assigned reading and
  examinations in a conference format can be
  sustained over several years
• Improved ABSITE performance
• Trend towards improved first-time pass rates on
  combined ABS QE and CE
• Labor intensive
• Reason for success of format
• Motivation to read regularly
• Active learning with appropriate stress
  facilitates memory

14
Conclusions

• Low ABSITE at any PGY level predicts failure of
  ABS exams
• ABSITE lt 35th percentile
• Trends towards failing QE
• Remediation
• ABSITE lt 30th percentile
• predicts failing QE
• ten fold increased risk
• ABSITE lt 25th percentile
• predicts failing QE and combined QE/CE
• Residencies seeking to improve ABSITE and ABS
  exam performance should consider a similar
  educational program