Transcript Weekly Assigned Reading and Examinations During Residency

Weekly Assigned Reading
and Exams Improve
ABS Exam Pass Rates
Christian de Virgilio MD, Tony Chan MD, and
Kel Miller MBA
Harbor-UCLA Medical Center
Success on ABS Exams Linked
to ABSITE Performance
 Shetler Am J Surg 1982
High correlation between ABSITE and QE
 ABSITE < 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

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
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
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3 year study
ABSITE improvement sustainable
 Mean ABSITE remained at 75th percentile
 Unclear whether this would translate to
improved ABS exam performance

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
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 < 35th percentile
 Overall ABSITE thresholds predictive of ABS exam
failure
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
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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
Results
Median
ABSITE
Percentile
% ABSITE
< 35th
Percentile
ABS
QE Pass
Rate
ABS
CE Pass
Rate
ABS
QE/CE
Pass Rate
Period 1
16
residents
62nd
18%
23/126
81%
81%
67%
Period 2
28
residents
79th
7%
12/159
93%
93%†
89%
0.4
0.4
0.07
p value
< 0.001
0.01
†One resident has not yet taken the CE
ABSITE < 35th Percentile
ABSITE < 35th
percentile
ABSITE  35th
percentile
P Value
QE
Fail
5/24 (21%)
1/25 (4%)
0.1
CE
Fail
3/23 (13%)
3/25 (12%)
1.0
QE/CE
Fail
7/24 (29%)
4/26 (15%)
0.57
ABSITE < 30th Percentile
ABSITE < 30th
percentile
ABSITE  30th
percentile
P Value
QE
Fail
5/15 (33%)
1/34 (3%)
0.01
CE
Fail
3/20 (15%)
3/27 (11%)
0.47
QE/CE
Fail
7/21 (15%)
4/26 (15%)
0.55
ABSITE < 25th Percentile
ABSITE < 25th
percentile
ABSITE  25th
percentile
p Value
QE
Fail
5/15 (33%)
1/34 (3%)
0.01
CE
Fail
3/14 (21%)
3/34 (9%)
0.34
QE/CE
Fail
9/17 (53%)
2/31 (6%)
0.001
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
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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
Conclusions
 A program of weekly assigned reading and
examinations in a conference format can be
sustained over several years


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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
Conclusions
 Low ABSITE at any PGY level predicts failure
of ABS exams
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ABSITE < 35th percentile
 Trends towards failing QE
 Remediation
ABSITE < 30th percentile
 predicts failing QE
 ten fold increased risk
ABSITE < 25th percentile
 predicts failing QE and combined QE/CE
 Residencies seeking to improve ABSITE and
ABS exam performance should consider a
similar educational program