Continuing medical education activity and American Board of Surgery examination performance

J Am Coll Surg. 2003 Apr;196(4):604-9; discussion 610; author reply 610. doi: 10.1016/S1072-7515(03)00008-5.


Background: Surgical knowledge is the basis of successful clinical problem solving, so is thought to be an important component of overall clinical ability. Continuing medical education (CME) reinforces basic knowledge and provides exposure to new knowledge within a field. Specialty board examination performance measures this knowledge but few studies have investigated a link between such performance and CME activity. This study assessed that link on the American Board of Surgery Recertification Examination.

Study design: The study sample comprised 278 randomly chosen applicants for the 2000 examination. Study variables included practice type, career activity, age, gender, other Board certifications, examination attempts, community size, geographic region, nationality, and ethnicity.

Results: The study sample was remarkably similar to the total candidate cohort with regard to study variables. Of the 245 sample Diplomates who took the Recertification Examination, 10.2% failed. The Pass group reported 53% more total CME hours and 38% more Category I CME hours than the Fail group. The vast majority of Category I activities were surgical, clinical. Analyzed by quartiles of total CME hours, the failure rate was only 3.4% for the highest quartile but 25.8% for the lowest quartile. For Category I hours, respective failure rates were 4.8% and 19.4%. When further stratified by practice type, the failure rate of those in solo practice was 6% for those in the highest quartile of total CME hours and 37% for those in the lowest quartile. For Category I hours, the respective failure rates were 0% and 31%.

Conclusions: There is a strong relationship between CME activity and performance on the American Board of Surgery Recertification Examination. Low CME activity and practice type appear to be independent risk factors for examination failure. The relationship of these findings to patient care outcomes has important implications.

MeSH terms

  • Analysis of Variance
  • Certification
  • Chi-Square Distribution
  • Demography
  • Education, Medical, Continuing*
  • Educational Measurement*
  • Female
  • General Surgery / education*
  • Humans
  • Male
  • United States