Development of vascular surgery skills during general surgery training

Purpose: We previously have shown that performance on the National Board of Medical Examiners (NBME) part II examination does not reflect clinical ski lls. Many training programs use the American Board of Surgery In-Service Tr aining Examination (ABSITE) as the only objective measure of clinical knowl edge. This study evaluates the utility of the ABSITE and an objective struc tured clinical examination (OSCE) in measuring vascular clinical skills dur ing general surgery residency training. Methods: Residents' mean scores on the vascular section of an OSCE were com pared with their mean overall scores on the OSCE by using a two-way analysi s of variance (ANOVA). Residents' performance on each clinical section of t he ABSITE (body as a whole; gastrointestinal, cardiovascular, and respirato ry systems; genitourinary/head and neck/musculoskeletal, and endocrine) and a vascular subsection (VASC) were evaluated by using ANOVA. Results: Mean vascular scores were significantly lower than mean overall sc ores for residents at all levels of training (P < 0.0001). Fischer's PLSD ( plausible least significant difference) post hoc test revealed that signifi cant improvement occurred between the intern and junior years (P < 0.05), b ut not between the junior and senior years. In contradistinction, VASC ABSI TE scores were better than all other scores for both junior and senior resi dents, but not for interns (senior: VASC = 96%, other = 79%, P = 0.04; juni or: VASC = 84%, other = 64%, P = 0.02; intern: VASC = 63%, other = 50%, P = 0.12). Conclusions: It is assumed that residents completing residency training are competent to perform clinical vascular examinations. Our findings paradoxi cally showed that although residents scored highest on the clinical vascula r section of the ABSITE, they scored lowest. on the vascular section of the OSCE. Although both tests found evidence of improvement between the intern and junior years, neither test found a significant improvement in vascular performance between the junior and senior years. These results emphasize t hat ABSITE scores do not necessarily correlate with clinical competence, an d they demonstrate the need for providing more objective measures of clinic al performance.