2020 General Surgery Presentations

Christopher Dyke, MD, E. Matthew Ritter, MD, FACS; Walter Reed National Military Medical Center

Introduction: Beginning with the graduating general surgery resident class of 2018, the American Board of Surgery (ABS) released new requirements to ensure all ABS-certified general surgeons completed a flexible endoscopy curriculum and passed the Fundamentals of Endoscopic Surgery (FES) performance exam. Nationally, the first time pass rate for residents is around 84%.  We set out to evaluate the performance of military residency programs for this important milestone.

Methods: We identified 134 test takers who self-reported an association with a military training program from a de-identified test taker database obtained in collaboration with the FES program office.  Programs were classified as Army (4), Navy (2), Air Force (4), or Joint (2) to preserve program and test taker identity.  Data were then analyzed to determine pass rates and performance on individual FES tasks.  Comparisons were made between services and relationships between available variables and FES exam performance were assessed.

Results: After selecting for only resident test takers, 128 subjects remained (32 Army, 5 Navy, 52 AF, 39 Joint) including 76 men, 46 women, and 6 not reporting gender.  The overall first time pass rate for military residents was 87.5%, and no differences were seen between service associated programs (88%A, 100%N, 87%F, 87%J, p=0.9).  The most common year for FES testing was PGY 5 (36%), followed by PGY 4 (25%).  Similar to previous civilian data, first time pass rate for men was significantly higher than for women (95% v. 76%, p<0.01).  There was no difference in pass rate based on PGY level (p=0.7). On univariate logistic regression, only gender and glove size were predictive of a passing score (OR 0.2 and 7 respectively, p<0.01).  On multivariate analysis, neither variable remained a statistically discernable predictor of achieving a passing score.   By logged case volume, lower endoscopy experience was significantly associated with FES exam score, but upper endoscopy experience was not (r=0.2, p=0.03, r=0.06, p=0.3)

Conclusions: Residents in military programs perform similarly to civilian programs with respect to the FES performance exam.  Gender and glove size, as previously identified, are likely significant covariates.  Their relationship to FES exam score cannot be clarified in this sample.  Further study, with a larger sample, is needed to determine the relationship of gender and glove size to FES exam performance.