O-GlcNAcylation regulates cancer metabolism and survival stress signaling via regulation of the HIF-1 pathway.

The hexosamine biosynthetic pathway elevates posttranslational addition of O-linked ß-N-acetylglucosamine (O-GlcNAc) on intracellular proteins. Cancer cells elevate total O-GlcNAcylation by increasing O-GlcNAc transferase (OGT) and/or decreasing O-GlcNAcase (OGA) levels. Reducing O-GlcNAcylation inhibits oncogenesis. Here, we demonstrate that O-GlcNAcylation regulates glycolysis in cancer cells via hypoxia-inducible factor 1 (HIF-1α) and its transcriptional target GLUT1. Reducing O-GlcNAcylation increases α-ketoglutarate, HIF-1 hydroxylation, and interaction with von Hippel-Lindau protein (pVHL), resulting in HIF-1α degradation. Reducing O-GlcNAcylation in cancer cells results in activation of endoplasmic reticulum (ER) stress and cancer cell apoptosis mediated through C/EBP homologous protein (CHOP). HIF-1α and GLUT1 are critical for OGT-mediated regulation of metabolic stress, as overexpression of stable HIF-1 or GLUT1 rescues metabolic defects. Human breast cancers with high levels of HIF-1α contain elevated OGT, and lower OGA levels correlate independently with poor patient outcome. Thus, O-GlcNAcylation regulates cancer cell metabolic reprograming and survival stress signaling via regulation of HIF-1α.

Multi-institutional Surgical Education Interventions: A Scoping Review.

OBJECTIVE: The aim of the study was to identify and evaluate scholarship in multi-institutional interventional surgical education trials. SUMMARY BACKGROUND DATA: Most research on interventions in surgical education occurs at individual institutions. These studies typically involve a small number of learners in a unique environment, thereby limiting their generalizability. The status of multi-institutional studies in surgical education remains unknown. METHODS: We searched the Pubmed, ERIC, PsycINFO, SCOPUS, and CINAHL databases for all English language articles published from January 1, 2000 to December 31, 2015 using the keywords "medical education," "surgical education," "multi-institutional," "multi-center," and related terms. Articles published in an English language peer-reviewed journal that described an educational intervention conducted at more than one institution and involving surgeons were included. RESULTS: Of 3511 identified articles, 53 met criteria for full-text review and inclusion in this review. The median number of institutional sites was 4, with a range of 2 to 54. The 2 most common areas of focus were technical skills (43% of studies) and clinical knowledge (32% of studies). These were also the 2 most commonly measured outcomes (technical skills 32% of studies, clinical knowledge 21% of studies). Thirteen percentage of studies measured only learner attitudes and perceptions rather than learning outcomes. CONCLUSIONS: Multi-institutional surgical education studies do not uniformly incorporate characteristics of high quality research, particularly related to study design, measurable outcomes, and assessment tools used. Coordinated support, including grant funding, that addresses the challenging nature of multi-institutional surgical education research may improve the quality of these studies.

Autophagy levels are elevated in barrett's esophagus and promote cell survival from acid and oxidative stress.

Autophagy is a highly conserved mechanism that is activated during cellular stress. We hypothesized that autophagy may be induced by acid reflux, which causes injury, and inflammation, and therefore, contributes to the pathogenesis of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). Currently, the role of autophagy in BE and EAC is poorly studied. We quantitatively define autophagy levels in human BE cell lines, a transgenic mouse model of BE, and human BE, and EAC biopsies. Human non-dysplastic BE had the highest basal number of autophagic vesicles (AVs), while AVs were reduced in normal squamous cells and dysplastic BE cells, and nearly absent in EAC. To demonstrate a functional role for autophagy in BE pathogenesis, normal squamous (STR), non-dysplastic BE (CPA), dysplastic BE (CPD), and EAC (OE19) cell lines were exposed to an acid pulse (pH 3.5) followed by incubation in the presence or absence of chloroquine, an autophagy inhibitor. Acid exposure increased reactive oxygen species (ROS) levels in STR and CPA cells. Chloroquine alone had a small impact on intracellular ROS or cell survival. However, combination of chloroquine with the acid pulse resulted in a significant increase in ROS levels at 6 h in STR and CPA cells, and increased cell death in all cell lines. These findings establish increased numbers of AVs in human BE compared to normal squamous or EAC, and suggest that autophagy functions to improve cell survival after acid reflux injury. Autophagy may thus play a critical role in BE pathogenesis and progression. © 2015 Wiley Periodicals, Inc.

The importance of residency program size and location on American Osteopathic Board of Surgery In-Training Examination outcomes.

BACKGROUND: The American Osteopathic Board of Surgery In-Training Examination (AOBSITE) is administered to general surgery residency training programs. Based on findings in allopathic training, we hypothesize that larger programs will outperform smaller programs and that Southern programs will perform lower than other geographic regions. MATERIALS AND METHODS: In this retrospective study, the performance on the AOBSITE was obtained for all of the osteopathic general surgery programs from 2008 to 2012. To test if program size was related to AOBSITE performance, simple linear regression was performed. Geographic differences in median performance between states and US Census Bureau regions were evaluated using Kruskal-Wallis tests. Nonparametric statistics were performed using an α = 0.05. RESULTS: From 2008 to 2012, there were 49 general surgery residency training programs and 2278 examinees evaluated. The median raw performance by general surgery residency training program was 168.0 (IQR [161.8-177.7]). The weighted median standardized performance by general surgery residency training program was 487.8 (IQR [462.8-528.0]). Simple linear regression analyses showed that the slope of the least-square regression line was greater than zero for raw performance (P = 0.048) and standardized performance (P = 0.005). A Kruskal-Wallis test showed that there were no differences in raw performance or standardized performance by US Census Bureau Region or by state (all P > 0.05). CONCLUSIONS: Overall, larger general surgery residency training programs outperform smaller programs on the AOBSITE and that there are no geographical differences in performance by state or region.

The traveling salesman problem in surgery: economy of motion for the FLS Peg Transfer task.

BACKGROUND: In the Peg Transfer task in the Fundamentals of Laparoscopic Surgery (FLS) curriculum, six peg objects are sequentially transferred in a bimanual fashion using laparoscopic instruments across a pegboard and back. There are over 268 trillion ways of completing this task. In the setting of many possibilities, the traveling salesman problem is one where the objective is to solve for the shortest distance traveled through a fixed number of points. The goal of this study is to apply the traveling salesman problem to find the shortest two-dimensional path length for this task. METHODS: A database platform was used with permutation application output to generate all of the single-direction solutions of the FLS Peg Transfer task. A brute-force search was performed using nested Boolean operators and database equations to calculate the overall two-dimensional distances for the efficient and inefficient solutions. The solutions were found by evaluating peg object transfer distances and distances between transfers for the nondominant and dominant hands. RESULTS: For the 518,400 unique single-direction permutations, the mean total two-dimensional peg object travel distance was 33.3 ± 1.4 cm. The range in distances was from 30.3 to 36.5 cm. There were 1,440 (0.28 %) of 518,400 efficient solutions with the minimized peg object travel distance of 30.3 cm. There were 8 (0.0015 %) of 518,400 solutions in the final solution set that minimized the distance of peg object transfer and minimized the distance traveled between peg transfers. Peg objects moved 12.7 cm (17.4 %) less in the efficient solutions compared to the inefficient solutions. CONCLUSIONS: The traveling salesman problem can be applied to find efficient solutions for surgical tasks. The eight solutions to the FLS Peg Transfer task are important for any examinee taking the FLS curriculum and for certification by the American Board of Surgery.

Improved nondominant hand performance on a laparoscopic virtual reality simulator after playing the Nintendo Wii.

BACKGROUND: Video games have been shown to improve eye-hand coordination, spatial visualization, manual dexterity, and rapid mental processing, which are important in the acquisition of laparoscopic skills. This study investigated the relationship between playing Nintendo(®) Wii™ and virtual reality (VR) laparoscopic surgery simulator performance. We hypothesized that playing the Wii would improve surgical skills performance on a VR laparoscopic simulator and hoped to elucidate which tasks, in particular, would be most beneficial for nondominant hand training. METHODS: This was a single-blinded, randomized, prospective study conducted with 23 student volunteers. VR laparoscopic skills were assessed at baseline on a Simbionix LapMentor™ Surgical Simulator (Simbionix Ltd., Israel) and after the gaming period of 2 weeks. Simulator performance metrics were compared between groups using nonparametric statistics and an alpha of 0.05. RESULTS: Compared with the control group, the Wii-playing group demonstrated greater improvement of six measures, including accuracy on the eye-hand coordination task (p = 0.04), faster completion time (p = 0.04), decreased number of left-handed movements (p = 0.03), decreased left handed total path length (p = 0.03), decreased total number of grasping attempts (p = 0.04), and improved left-handed economy of movement (p = 0.05) for the bimanual clipping and grasping task. When comparing the number of measures improved upon by the Wii-playing group and the control group for all three tasks, the Wii-playing group consistently outperformed the control group in 18 measures compared with the control group's improvement in 6. CONCLUSIONS: This study further characterizes the association between video game playing and surgical performance. Improvements following the intervention were made in the most basic of surgical skills, most notably with the nondominant hand, suggesting that short-term playing of the Wii could improve bimanual dexterity and expedite the acquisition of basic surgical skills.

Equal but Separate: The Slow Assimilation of Osteopathic Surgery Residents Two Years After the Unified Match.

OBJECTIVES: The purpose of this study was to monitor the integration of general surgery residency programs before and after the 2020 unified match. We hypothesized that integration of osteopathic (DO) surgery residents would increase. DESIGN: We performed a retrospective cohort study of surgery residency programs between 2019 and 2021 utilizing data provided by the Association of American Medical Colleges. Program composition (2021) and changes in composition (2019-2021) were compared by program type. Multivariable logistic regression models assessed variables associated with DO presence (2021) and integration (2019-2021). SETTING: General surgery residency programs across the United States. PARTICIPANTS: Civilian surgery residencies that completed the 2019-2021 program survey. RESULTS: Out of 320 programs, DO residents were integrated at 69% (221/320), including 52% (63/122) university programs, 78% (101/129) university-affiliated programs and 83% (57/69) community programs (p < 0.01). Overall, 23 (8%) programs integrated DO residents from 2019 to 2021, and 9 (21%) ex-American Osteopathic Association programs integrated MD residents (both p < 0.01). The median number of DO residents was 1 (interquartile range, IQR 0-2) at university programs, 2 (IQR 1-7) at university-affiliated programs, and 5 (IQR 2-12) at community programs (p < 0.01). The median number of DO residents at all programs increased from 1 (IQR 0-5) to 2 (IQR 0-6) since 2019 (p < 0.01). Community (OR 2.6, p = 0.04), university-affiliated (OR 2.3, p = 0.02), and programs with DOs in 2019 (OR 19.0, p < 0.01) were associated with increased odds of DOs present in 2021, while DO faculty (OR 2.6, p = 0.02) was the only factor independently associated with integrating DOs after 2019. CONCLUSIONS: While some programs have integrated DO residents, progress is slow, median numbers of DO residents remain low, and familiarity with DOs is most associated with integration. We explore barriers to integration, and advance recommendations to eliminate potential disparities.

On the Eve of Integration: Community and Affiliated Residency Programs Pave the Way Towards the Assimilation of Osteopathic Surgery Residents.

OBJECTIVE: The 2020 match integrated former osteopathic and allopathic residency programs under single Graduate Medical Education accreditation. We describe the composition of general surgery residency programs prior to the 2020 integration and provide a baseline to monitor future progress. DESIGN: Retrospective, cross-sectional data provided by the Association of American Medical Colleges for the 2018 academic year were analyzed. Descriptive analyses were used to summarize the characteristics of residents by program type and program location. Logistic regression was used to estimate factors associated with the presence of osteopathic (DO) residents. An alpha of 0.05 defined statistical significance. SETTING: Data were collected and analyzed at a United States osteopathic medical school. PARTICIPANTS: All civilian surgery residencies that approved the 2018 Program Survey. RESULTS: Out of 285 programs, the percentages with at least one DO resident were significantly different among university (44.0%), university-affiliated (62.7%) and community (78.4%) programs (p < 0.001). DO residents made up 41.4% of community residents, 13.3% of university-affiliated residents, and 2.8% of university residents (p < 0.001). A significant regional difference was observed, as DO residents made up 16.9% of residents in the central region, compared to 10.4% in the northeast, 7.0% in the south and 8.9% in the west (p = 0.004). The logistic regression analysis found that the presence of DO residents at a program was significantly related to the type of program (Affiliated vs University OR = 3.1, 95% CI 1.5-6.5; Community vs University OR = 5.2, 95% CI 1.9-14.4) and the presence of DO faculty (OR = 2.7, 95% CI 1.6-4.8) (all p < 0.05). CONCLUSIONS: We observed significant differences in the presence of DO residents in different program types. As surgical education transitions to single accreditation, this study identifies opportunities for greater integration between osteopathic and allopathic surgery training programs.

Broad Needs Assessment of Pain Education in Graduate Medical Education.

This article describes a survey-based study of graduate medical residents and fellows in an integrated health system. The study explores pain curricula, learner perspectives about pain education, and learner knowledge, attitudes, and confidence. Results indicate that pain education in the graduate medical setting is inadequate to meet learner needs.

Developing dietary interventions as therapy for cancer.

Cancer cells acquire distinct metabolic preferences based on their tissue of origin, genetic alterations and degree of interaction with systemic hormones and metabolites. These adaptations support the increased nutrient demand required for increased growth and proliferation. Diet is the major source of nutrients for tumours, yet dietary interventions lack robust evidence and are rarely prescribed by clinicians for the treatment of cancer. Well-controlled diet studies in patients with cancer are rare, and existing studies have been limited by nonspecific enrolment criteria that inappropriately grouped together subjects with disparate tumour and host metabolic profiles. This imprecision may have masked the efficacy of the intervention for appropriate candidates. Here, we review the metabolic alterations and key vulnerabilities that occur across multiple types of cancer. We describe how these vulnerabilities could potentially be targeted using dietary therapies including energy or macronutrient restriction and intermittent fasting regimens. We also discuss recent trials that highlight how dietary strategies may be combined with pharmacological therapies to treat some cancers, potentially ushering a path towards precision nutrition for cancer.

Treating Alpelisib-Induced Hyperglycemia with Very Low Carbohydrate Diets and Sodium-Glucose Co-Transporter 2 Inhibitors: A Case Series.

Alpelisib is a α-selective phosphatidylinositol 3-kinase (PI3K) inhibitor approved for treatment of postmenopausal women, and men, with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-), PIK3CA-mutated, advanced breast cancer (ABC). Hyperglycemia is a common, on-target adverse effect that impairs treatment efficacy and increases the rate of treatment delays, dose reductions, and discontinuation. Currently, there are no clear guidelines on how to manage hyperglycemia due to alpelisib when metformin is not effective. In this case series, we review 3 subjects with ABC that developed hyperglycemia during alpelisib-fulvestrant therapy and were successfully managed with dietary and pharmacologic interventions. These cases provide anecdotal evidence to support the use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and very low carbohydrate diets to minimize hyperglycemia during alpelisib therapy.

The adrenal mass: correlation of histopathology with imaging.

BACKGROUND: Computed tomography (CT) and magnetic resonance (MR) imaging can help diagnose benign adrenal adenomas, but prior studies rely on nonoperative follow-up as proof of a lesion's benign nature. We examined adrenalectomy tissues to determine if imaging characteristics correlate with histopathologic findings. METHODS: We retrieved data for 196 consecutive adrenalectomies in 192 patients from 2000 to 2008. Imaging results were considered to signify benign adrenal adenoma if one or more of the following was present: Hounsfield units <10 on unenhanced CT, contrast-enhanced CT quantifying absolute contrast washout of >60% or relative contrast washout of >40%, or MR with chemical-shift imaging demonstrating loss of signal intensity on out-of-phase images. RESULTS: The sensitivity and specificity of preoperative imaging in predicting benign adrenal adenoma were 57 and 94%, respectively. Histopathology confirmed that all 66 adrenal masses with imaging characteristics suggesting benign adenoma were indeed benign lesions and included 61 benign adrenal adenomas and 5 benign nonadenomatous lesions (3 myelolipomas, 1 composite myelolipoma/adenoma, and 1 ganglioliponeuroma). The specificity of imaging in predicting benignity was 100%. Malignant adrenal lesions were diagnosed in 17/130 (13%) masses: 8 metastases, 7 adrenal cortical carcinomas, 1 epithelioid angiosarcoma, and 1 ganglioneuroblastoma. The sensitivity of imaging in identifying malignancy was 100%. No malignancies were diagnosed during postoperative follow-up (mean 6 months, range 0.2-67 months). CONCLUSION: CT or MR characteristics predicted the presence of benign lesions with 100% specificity. Every adrenal malignancy had CT or MR results that were inconsistent with benign adenoma (100% sensitivity). To exclude malignancy, adrenal masses with non-benign imaging characteristics should be resected.

Case logging habits among general surgery residents are discordant and inconsistent.

BACKGROUND: General surgery residents log operative case experience as "first assist" (FA) or "primary surgeon" (PS). This study will evaluate their quantitative and qualitative case log practices. METHODS: Modified Delphi technique was used to create a questionnaire and distributed online to institutions via the APDS. Descriptive analyses and example operative scenarios for resident case logging habits were ascertained. RESULTS: There were 363 residents from university (60%) and non-university (40%) programs; 94% did not know the definition of primary surgeon. Over 50% stated they had been encouraged to log a case as surgeon that they did not feel was warranted. Only 4% felt the current logging system is "very accurate." Given an operative scenario, residents varied how they chose to log the case. CONCLUSION: General surgery residents do not know the current definition of PS. Case logging should be an objective measure of resident operative exposure, but may actually be more complex than previously recognized.

A 15-year residency program report card: Differences between the crème of the crop and the bottom of the barrel on the American Board of Surgery examinations.

BACKGROUND: American Board of Surgery examination performance represents an important residency metric. The hypothesis is that demographic differences exist between the most and least successful programs. METHODS: This was a retrospective fifteen-year study. Data focused on program Examination Index (EI). The first and tenth decile programs were compared across demographics, using an α = 0.05. RESULTS: The first decile had a higher EI than the tenth decile (91.0% ±â€¯2 .6% vs 51.4% ±â€¯5.4% [p < 0.001]). The first decile programs were larger (p = 0.001). The first decile had more military and academic programs, with fewer community programs (p = 0.01). More first decile programs were in the West with fewer in the Northeast (p = 0.02). CONCLUSION: There are clear differences in ABS examination performance based on program size, type, and location. These results essentially perform a national needs-assessment, and may evoke a spirit of competition and collaboration.

Surgery residents recognized less frequently over time by medical students: A twelve year study of the Arnold P. Gold Humanism and Excellence in Teaching Award.

BACKGROUND: There is a decreasing institutional percentage of surgical resident recipients of The Arnold P. Gold Humanism and Excellence in Teaching Award over time. The hypothesis was that this trend was a national phenomenon. METHODS: This was a retrospective study from 2004 - 2015, utilizing data from the Arnold P. Gold Foundation. Multiple regression was performed using the estimated ratio of eligible surgical to non-surgical residents and the year as explanatory variables, utilizing an α = 0.05. RESULTS: The percentage of surgical award winners was lower in the second study half compared to the first half (40.2% vs. 47.2%) (p = 0.02). Multiple regression showed that when controlling for the number of eligible residents, the number of resident awardees decreased over time (p = 0.01). CONCLUSION: There is a clear national trend that surgical residents are receiving the Arnold P. Gold Humanism and Excellence in Teaching Award less over time.

Are the kids alright? Review books and the internet as the most common study resources for the general surgery clerkship.

BACKGROUND: To define resources deemed most important to medical students on their general surgery clerkship, we evaluated their material utilization. METHODS: A prospective study was conducted amongst third-year medical students using a 20-item survey. Descriptive statistics were performed on the demographics. Kruskal-Wallis and Mann-Whitney analyses were performed on the Likert responses (α = 0.05). RESULTS: Survey response was 69.2%. Use of review books and Internet was significantly higher compared to all other resources (p < 0.05). Wikipedia was the most used Internet source (39.1%). 56% never used textbooks. Analyses of surgery subject exam (NBME) results or intended specialty with resources used showed no statistical relationship (all p > 0.05). CONCLUSIONS: Resources used by students reflect access to high-yield material and increased Internet use. The Internet and review books were used more than the recommended textbook; NBME results were not affected. Understanding study habits and resource use will help guide curricular development and students' self-regulated learning.

Radioactive Iodine-Related Clonal Hematopoiesis in Thyroid Cancer Is Common and Associated With Decreased Survival.

Context: Radioactive iodine (RAI) has been epidemiologically associated with the development of hematologic malignancies. Clonal hematopoiesis (CH) is a precursor clonal state that confers increased risk of leukemia and occurs at an elevated rate in patients with thyroid cancer relative to other solid tumors. Objective: We explore if the high prevalence of CH may be a result of RAI exposure and whether CH may be a surrogate in the association between RAI and leukemia. Design: CH, CH-potential driver (CH-PD), and overall survival were evaluated in 279 patients with advanced thyroid carcinoma. Results: The prevalence of CH in patients with thyroid cancer was 37%, and that of CH-PD was 5.2%. Age was the strongest predictor of CH and CH-PD. For every year increase in age, there was a 5% and 13% increase in the odds of CH and CH-PD, respectively. RAI dose was significantly associated with CH and CH-PD, even after adjustment for age, external beam radiation therapy, and chemotherapy. For every 10 mCi increase in the dose of RAI administered, there was a 2% and 4% increase in the odds of CH and CH-PD, respectively. Patients with CH-PD previously exposed to RAI had a significantly poorer survival, even when stratified by age (heart rate = 3.75, 95% CI = 1.23 to 11.5, P = 0.02). Conclusions: RAI was associated with a high prevalence of CH, and CH is a precursor state of hematologic malignancies. The implications of this study may favor identification of CH in patients where the risks might outweigh the benefits of receiving RAI therapy for thyroid cancer.

A Sensitivity Analysis and Opportunity Cost Evaluation of the Surgical Council on Resident Education Curriculum.

OBJECTIVE: The study purpose is to evaluate the Surgical Council on Resident Education (SCORE) Curriculum regarding American Board of Surgery Qualifying Examination (ABS QE) outcomes. The goal is to perform effect size analyses, sensitivity analyses, and sample size analyses with opportunity cost estimates required to favor the SCORE Curriculum subscription regarding ABS QE outcomes. METHODS: Published data were used to construct 2 × 2 matrices regarding ABS QE outcome (pass/fail) and SCORE subscription status (subscriber/nonsubscriber). Post hoc analyses of effect sizes and sample sizes, with opportunity cost estimates, were performed to evaluate ABS QE outcomes favoring SCORE subscription (2-tailed and 1-tailed tests) using an α = 0.05. RESULTS: The absolute risk increase of SCORE subscription on ABS QE outcome was 1.6% (number needed to treat = 63). Sensitivity analyses showed that a pass rate difference of 4.9% to 7.5% was required to favor SCORE subscription (all p < 0.05). Sample size analyses required an 8- to 18-fold increase to favor SCORE subscription to achieve statistical significance with an opportunity cost of $6.0 to $13.5 million ($30,000-$67,000/program), not adjusting for inflation. CONCLUSIONS: The number needed to treat and pass rate differences required to favor SCORE subscription are large. The opportunity costs of SCORE subscription are substantial. Residency programs with more limited resources should determine if the subscription costs are financially sound.

The American Board of Surgery examinations: how are the Southwestern Surgical Congress programs performing compared to the rest of the United States?

BACKGROUND: Our aim was to study pass rates of the American Board of Surgery (ABS) examinations for examinees from programs in the Southwestern Surgical Congress (SWSC) compared with the rest of the United States (Non-SWSC). METHODS: A retrospective review of pass rates of ABS Qualifying Examination (QE), Certifying Examination (CE), and QE/CE index from 2005 to 2015 was conducted. RESULTS: From 2005 to 2010, SWSC outperformed Non-SWSC in QE (88% vs 85%, P < .02), CE (86% vs 82%, P < .01), and QE/CE (77% vs 72%, P < .01). From 2010 to 2015, SWSC outperformed Non-SWSC in QE (91% vs 86%, P < .01) and QE/CE (77% vs 71%, P < .01) but did not achieve statistical significance in CE (83% vs 81%, P = .09). CONCLUSIONS: SWSC programs outperformed Non-SWSC across QE and CE in the early period, but only on QE in the late period. We encourage SWSC states and regional surgical societies to evaluate performance on ABS examinations and collaborate to improve surgical training.

Favorable Trends for a Decade: Increasing Pass Rates on The American Board of Anesthesiology Examinations.

BACKGROUND: There have been some apparent increasing pass rates on the American Board of Anesthesiology Part 1 (written) and Part 2 (oral) examinations in the setting of a transition in examination format. The aim of the study is to evaluate the nature of these trends, hypothesizing that these increasing pass rate trends are significant. METHODS: In this retrospective study from 2003-2012, the first-attempt examinee pass rates on the Part 1 and Part 2 examinations were obtained from the American Board of Anesthesiology website. To evaluate the cohort of examinees, the mean United States Medical Licensing Examination scores of residents matched to anesthesia programs were also obtained. To evaluate trends over time, simple linear regression was performed with the academic year as the independent variable and examination outcome as the dependent variable, using an α = 0.05. RESULTS: The median annual pass rate on the Part 1 examination was 85.5% (Interquartile range [82.75% - 87.75%]). Regression analysis showed that the slope of the least-squares regression line was greater than zero (p = 0.008). The median annual pass rate on the Part 2 examination was 81.5% (Interquartile range [77.25% - 84.75]). Regression analysis showed that the slope of the least-squares regression line was greater than zero (p < 0.001). Regression analysis also showed increasing United States Medical Licensing Examination scores for the incoming anesthesia residents (p = 0.01). CONCLUSIONS: There have been significant increasing trends on the American Board of Anesthesiology Part 1 and Part 2 examinations over the last ten years.