The American Board of Surgery in Training Examination (ABSITE) is a formative assessment testing the medical knowledge of general surgery residents on a wide range of general surgery topics.1 This exam has been important for general surgery programs to evaluate a resident's knowledge and determine their readiness for the American Board of Surgery (ABS) Qualifying Examination (QE).2 Despite its intended formative nature, the ABSITE has, in practice, been used for high-stakes purposes. ABSITE scores have been reported as a strong factor in both fellowship candidate selection and in the selection of preliminary residents for categorical residency positions.3,4 Residency programs may require residents who perform poorly on the ABSITE to complete remediation, which can include additional non-clinical hours committed to studying and test preparation.5

Medical education is undergoing transition in learner evaluation processes. The United States Medical Licensing Exam (USMLE) has moved to a pass-fail model of grading, and an increasing number of medical schools no longer provide numeric grades or rankings.6,7 At the resident level, surgical education is also undergoing its own transition with a shift to Entrustable Professional Activities (EPAs). These evaluate residents on performance of skills that can be directly observed, such as providing a consultation or evaluating a patient with abdominal pain.8,9 Additionally, maintenance of ABS certification for practicing surgeons has changed to yearly open book examinations, replacing the previous evaluation required once every decade.10 As evaluation methods for medical learners continue to evolve, we must fully understand our current uses of and preparation strategies for the ABSITE to better understand if it remains a useful tool at current and in the future.

Multiple interventions have been demonstrated to improve ABSITE performance, including question banks (Q-banks) and the Surgical Council on Resident Education (SCORE) curriculum.11,12 While data exists on multiple individual educational strategies, much of the work surrounding the ABSITE has been limited by single-institutional nature, small sample sizes, and lack of methodological rigor.13 Due to these limitations, no evidence-based guidelines exist to assist individual residents and program directors in designing strategies to prepare for the ABSITE. While limited review has described current ABSITE preparation practices of general surgery residencies, evidence of the utility of such practices remains lacking.14

The aim of this work was to describe current national ABSITE preparation practices and evaluate the effectiveness of these preparatory strategies at the program level.