Preparation Strategies for the American Board of Anesthesiology In-Training Examination and Indicators of Success: A National Survey
George W. Williams*1, Kristin Guy2, Katherine Normand3, and Amy Graham Carlson4
1Assistant Program Director of Anesthesiology Residency and Assistant Professor, Department of Anesthesiology, University of Texas Medical School, USA
2Resident, Department of Anesthesiology, University of Texas Medical School, USA
3Assistant Professor, Department of Anesthesiology, University of Texas Medical School, USA
4Clinical Assistant Professor, Pediatrics, Department of Anesthesiology, University of Texas Medical School, USA
Methods: We conducted a nationwide survey of anesthesiology residents to assess the preparation for the AnesthesiologyIn-Training Examination (ITE) and to evaluate the success rates of various preparation strategies. Specifically, the questionswere designed to further investigate residents 1) who’s study techniques performed by those that performed greater thanthe 75th percentile, 2) that had a large improvement in examination on the ITE or 3) that passed the American Board of AnesthesiologyWritten Examination (ABAWE) on their first try.
Results: Residents that started off performing well during residency tended to continue to perform well. More than 1/3 ofrespondents reported no routine study time. Cramming was a common preparation strategy, but more time spent studyingresulted in better performance. There was not a statistically significant difference in performance based on gender or textbookchoice.
Conclusions: We conclude that a reading and question based preparation strategy employed throughout residency is themost effective way to ensure passing the ABAWE. More studies are needed to determine the most effective strategies for theresident population at large.
Keywords: American Board of Anesthesiology; In Training Examination; Anesthesiology Resident Study Strategy; Board Review; Anesthesiology Resident Study Techniques
Most residency programs place an emphasis on preparation for the certification examination for the relevant board in that given specialty. Preparation for the American Board of Anesthesiology written examination (ABAWE) is a significant component of residency training effort, especially after the intern year of training has been completed. While board scores from medical school or factors considered during interviews has previously been thought to be a significant predictor of success, this has been shown to not necessarily be accurate [1-3]. In anesthesiology resident training, the American Board of Anesthesiology (ABA) administers a yearly examination, called the in-training examination (ITE), at a fixed date on a yearly basis starting during intern year. The content of this examination closely reflects the content of the actual ABA examination that a graduating senior will see when they sit for certification. Contrary to pre-residency predictors of success, there is data suggesting a relationship between ITE performance during residency and success rates upon initial attempts to pass the ABAWE [4,7]. Furthermore, residents that spend 10.5 hours per week studying have improved success rates on the ITE . Professional behavior is another known factor to correlate with increased clinical knowledge . Given the importance of ‘in-training’ and board examination preparation, there is a relative paucity of literature assessing the preparation strategies that anesthesiology residents use for this purpose? Strategies to prepare for the examination are of great interest to residents, and many times the actual strategies are dependent on institutional culture. Our survey of anesthesiology residents is intended to assess both the recent trends in preparation for the ITE and to evaluate the success rates of the various strategies utilized by anesthesiology residents throughout the United States (US).
Details of each of the responses are unabridged in Appendix 2; the following is a summarization of the most pertinent results obtained. When including For the CA-1 year, the 33.9% of respondents (33.9%) achieved greater than the 75th percentile. For the CA-2 year, 20.7% achieved greater than the 75th percentile. During CA-3 year the 10.3% achieve greater than the 75th percentile. 9 of 10 post-graduates passed the ABAWE on the first attempt. The top three study materials used included ‘Hall’, ‘Morgain & Mikhail’, and ‘Baby Miller’. When study materials where stratified by the top three by year of training, CA-1 year included ‘Hall’, ‘Morgain & Mikhail’, and ‘Baby Miller’, CA2 year included ‘Hall’, ‘ACE’ and ‘Morgain & Mikhail’, and CA-3 year included ‘Hall’, ‘ACE’, and ‘Big Blue’. 11 respondents (6.5%) attended Niels Jensen’s board prep course; otherwise, 158 (94%) respondents did not attend a review course. The general consensus of board review courses was that they are moderately helpful based on the comments.
Figure 1. Study Patterns for CA-3s who reported a regular study pattern
With regards to study habits, cramming vs. studying were evenly distributed (39.5% - 47.2% range, the highest fraction of “crammers” studied on a regular basis in CA-1 year). The vast majority studied between 1-6 hours/week regardless of the year of training. Most crammers studies between 1-6 hours/week (53.5%) for a period of less than 2 months regardless of the year of training. Most applicable respondents (67.3%) did a combination of regular studying with cramming the last month prior to the actual ABAWE, and most (91.1%) studied alone and at home (75.3%). More than a third of residents (37.7%) had no routine study time. While faculty mentorship was common (84.8%), relative few respondents found mentor’s advice helpful to them in preparing for the examination (33.5%).
Figure 2. Study Patterns for CA-3s who reported a ‘cramming’ study pattern
There was a strong preference to the presence of a learning curriculum, particularly for subspecialty rotations.
For respondents that achieved significant improvement (>30% increase in score) in their ITE performances, studying consistently, earlier (>8 weeks before the examination) and inclusion of Hall or ACE questions was reported. For respondents who scored >75% percentile in any given year, ‘ACE’ (18), ‘Morgan and Mikhail’ (17) and ‘Baby Miller’ (11) where the most common texts cited as being the main source for preparation. The same three texts were cited by the 3 responds that passed the ABAWE on the first attempt and reported their texts used for preparation.
Following analysis of the responses, respondents who did well CA-1 year were more likely to do well CA-2 and CA-3 year, and if good performance CA-2 year was likely to translate into the same CA-3 year (p < 0.001). Female respondents did not perform better than men (p = 0.13), positive marital status did not improve performance (p = 0.34), there was no different based on textbook choice between ‘Hall’ and ‘Morgain & Mikhail’ (p = 0.41). Cramming for more time (> 8 weeks) increased the likelihood of improving performance (p = 0.048) and respondents from the South performed better (p = 0.013).
It is clear that ‘Hall’ (Anesthesia: A Comprehensive Review, Brian Hall, et al), ‘ACE Questions’ (Anesthesiology Continuing Education (ACE) Program, American Society of Anesthesiologists), and ‘Baby Miller’ (Basics of Anesthesia, Ronald Miller, et al) are heavily used by successful residents in ITE examination preparation.
4.Brian L. Marasigan. Predictability of ABA Board Scores and Passing Rates Based on Previous In-Training Exam Scores Poster A1527 From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists.
Cite this article: Williams G W. Preparation Strategies for the American Board of Anesthesiology In-Training Examination and Indicators of Success: A National Survey. J J Anes Res. 2014, 1(1):003.