Race, Sex, and Family Status Impact Surgical Board Passage Rates

The findings of a recent study published in JAMA Surgery suggest that sociodemographic factors such as race, ethnicity, sex, and family status have an adverse impact on passing the American Board of Surgery examination.

In this national and multi-institutional prospective observational cohort study, researchers surveyed 662 general surgery trainees (65% men, 69% white, with an overall exam passage rate of 87%) beginning in 2007-2008. The researchers commenced data collection in June 2007 and completed follow-ups on December 31, 2016 before starting their analysis in September 2018. All survey responses, which served as the study’s key endpoint, were linked to American Board of Surgery passage data.

Eye-Opening Results

According to the results of the study, in a multinomial regression model, Hispanic residents were more likely to not attempt the examinations (vs passed both) than non-Hispanic trainees (odds ratio OR=4.7; 95% CI, 1.5 to 14). Juxtaposed to examinees who were married with children during the duration of their internship, examinees who were married without children (OR=0.3; 95% CI, 0.1 to 0.8) or were single (OR=0.4; 95% CI, 0.2 to 0.9) were less likely to fail the examinations.

Moreover, logistic regression revealed that white examinees compared with nonwhite examinees (black individuals, Asian individuals, and individuals of other races) (OR=1.8; 95% CI, 1.03 to 3.0) and examinees who performed better on their first American Board of Surgery In-Training Examination (OR=1.03; 95% CI, 1.02 to 1.05) were more likely to pass the qualifying examination on the first try.

Furthermore, the survey results showed that white examinees juxtaposed to nonwhite examinees (OR=1.8; 95% CI, 1.1-2.8), non-Hispanic compared with Hispanic examinees (OR=2.4; 95% CI, 1.2-4.7), and single women compared with women who were married with children during internship (OR-10.3; 95% CI, 2.1-51) were more likely to pass the certifying examination on the first try.

“In a national sample of trainees, we observed adverse impact based on sociodemographic factors on passing the board certification examinations that needs further exploration,” the research authors wrote.

“Resident race, ethnicity, sex, and family status at internship were observed to be associated with board passage rates. There are multiple possible explanations for these worrisome observations that need to be explored. Tracking demographics of trainees to help understand passage rates based on demographics will be important. The American Board of Surgery already has begun addressing the potential for unconscious bias among board examiners by increasing diversity and adding implicit bias training.”