The Competitive Edge: Improving American Board of Surgery In-Training Examination Scores Through a Team-Based Competition

Background The American Board of Surgery (ABS) In-Training Examination (ABSITE) scores are predictive of passing the ABS qualifying exam and have become a marker of residency education success. A competitive team-based approach to encourage self-studying and didactic participation is a novel method of ABSITE preparation. We aimed to determine if this method significantly improves residents' percentile performances on the ABSITE. Methods Retrospective review of ABSITE percentile scores were compared before and after implementation of a purchased online question bank (TrueLearn LLC, Mooresville, NC), a team-based competition, and a virtual format of the team-based competition. Results The median ABSITE percentile at the program level increased from 40.0 (IQR 21.0-67.0) in 2011 to 77.0 by 2022 (IQR 60.0-91.0) (P < 0.0001). After implementation of the team-based competition, ABSITE median percentile rose significantly from 67.0 (IQR 31.5-85.5) to 84.5 (IQR 60.8-91.0) (P = 0.026). This did not change significantly after a transition to a virtual format of the team-based competition in 2021 (P = 0.146) and 2022 (P = 0.335). There was no significant relationship between the number of TrueLearn questions taken and ABSITE scores specifically before and after implementation of the team-based competition (AUC = 0.0002, Spearman's r (67) 0.064, P = 0.605). Furthermore, the team-based competition was well received by residents and was believed to be beneficial to their studying. Discussion The team-based competition is easy to implement and improves ABSITE performance through means other than encouraging residents to take more practice questions. The team-based competition is well-received by residents and may prove beneficial to board examination preparation and pass rates.