Deconstructing the roadmap to surgical residency: a national survey of residents illuminates factors associated with recruitment success as well as applicants' needs and beliefs

Non-Designated Preliminary to Categorical Resident: Is It All About the ABSITE?

INTRODUCTION

Obtaining a categorical general surgery residency position is recognized as a highly challenging process, and many aspiring surgeons find themselves matching into a preliminary position. The American Board of Surgery In-Training Examination (ABSITE) is relevant as a discriminator, as it is the only national evaluation metric that compares residents between programs. This study examines the correlation between ABSITE performance and the likelihood of obtaining a categorical position for non-designated preliminary surgery residents.

METHODS

Retrospective analysis of preliminary residents who completed the ABSITE between 2011 and 2021 at a single academic training program.

RESULTS

108 preliminary residents were included. Among preliminary residents who were successful in securing a categorical position, the average ABSITE percentile was 59 (SD = 26.7). In contrast, those who were not able to secure a categorical position, the average ABSITE percentile was 23.6 (SD = 25.3). There was a strong significant correlation between ABSITE percentile and securing a categorical position (P < 0.001). There was a significant association between citizenship and gaining a categorical position, with US citizens being significantly more likely to successfully gain a categorical position (P = 0.01; OR 3.32 (95% CI 1.28-8.56)). There was not a significant correlation between citizenship and ABSITE score.

CONCLUSION

This study presents compelling evidence that ABSITE percentile score is positively associated with the probability of securing a categorical position for preliminary general surgery residents. It is therefore imperative that both preliminary residents and their programs place a high value on ABSITE performance to enhance successful career progression.

Associations Between Program Doximity Reputation Rank and Well-Being in General Surgery Residents

INTRODUCTION

Burnout and mistreatment are prevalent among surgical residents with considerable program-level variation. Applicants consider "program reputation," among other factors, when ranking programs. Although highly subjective, the only available measure of program reputation is from a physician survey by Doximity. It is unknown how program reputation is associated with resident well-being and mistreatment.

METHODS

Resident burnout and personal accomplishment were assessed via the 2019 post-American Board of Surgery In-Training Examination survey. Additional outcomes included mistreatment, thoughts of attrition, and suicidality. Residents were stratified into quartiles based on their program's Doximity reputation rank. Multivariable logistic regression models examined the relationship between each outcome with Doximity rank quartile.

RESULTS

6956 residents (85.6% response rate) completed the survey. Higher-ranked programs had significantly higher burnout rates (top-quartile 41.3% versus bottom-quartile 33.2%; odds ratio [OR] 1.35, 95% confidence interval [CI] 1.04-1.76). There was no significant difference in personal accomplishment by program rank (OR 1.26, 95% CI 0.86-1.85). There also was no significant association between program rank and sexual harassment (OR 0.90, 95% CI 0.70-1.17), gender discrimination (OR 1.14, 95% CI 0.86-1.52), racial discrimination (OR 1.18, 95% CI 0.91-1.54), or bullying (OR 1.03, 95% CI 0.76-1.40). Suicidality (P = 0.97) and thoughts of attrition (P = 0.80) were also not associated with program rank.

CONCLUSIONS

Surgical residents at higher-ranked programs report higher rates of burnout but have similar rates of mistreatment and personal accomplishment. Higher-ranked programs should be particularly vigilant to trainee burnout, and all programs should employ targeted interventions to improve resident well-being. This study highlights the need for greater transparency in reporting objective program-level quality measures pertaining to resident well-being.