Outcomes for the American Board of Thoracic Surgery In-Person and Virtual Certifying Examinations

Purpose: The American Board of Thoracic Surgery (ABTS) conducts an oral Certifying Examination (CE) as the final component for certification to evaluate judgement, experience, and safety through a series of clinical scenarios. We examined the effect of specific demographics, certification pathway, and exam format (virtual vs. in person) on CE outcomes.

Methods: The ABTS Directors and Guest Examiners conducted four sequential CE (2018 – November 2021) and evaluated the outcomes achieved with in-person (2018, 2019) and virtual (September and November 2021) formats. Each CE was structured with three sets of four questions. The CE format (in-person or virtual), candidate gender, medical school location (US or International), certification pathway (cardiothoracic or general thoracic), and program (traditional 2 years, 2.5 years, or 3 years vs. Integrated 6-year and "Four+Three" programs) were reviewed for outcomes associated with first-time examinees. Differences between groups were determined by chi-square analyses. Specific characteristics associated with passing the CE are described.

Results: A total of 575 candidates were examined between 2018 and November 2021. There were 462 first-time candidates (462/575, 80.3%; 371 men, 91 women; age 37.9 ± 3.1 years) whose outcomes were reviewed. Characteristics of repeat CE candidates were not analyzed. Overall pass-rates for first-time CE candidates (365/462, 79%) ranged from 76% - 86% and were similar in range to prior years’ results. 113 candidates took their initial CE in 2018 with a pass-rate of 77.8% (88/113); 125 in 2019, 76% (95/125); 127 in September 2021, 77% (98/127); and 97 in November 2021, 86.5% (84/97). Candidates were 10 ± 3.1 years following medical school graduation. No differences in pass-rates were identified based on CE format (in-person 183/238, 76.9%; virtual 182/224, 81.3%; p=0.25), gender (men 287/371, 77.3%; women 78/91, 85.7%; p=0.07); or certification pathway (cardiothoracic 276/351, 78.6%; general thoracic 89/110, 80.9%; p=0.61). Differences were identified in pass-rates based for candidates graduating from Integrated 6-year and “Four+Three” programs (traditional 2 years, 2.5 years, or 3 years, 258/343, 75.2%; Integrated 6-year and “Four+Three” candidates, 107/119, 89.9%; p< 0.001); and candidates completing medical school education in the United States (US 322/396, 81.3%; international 43/66, 65.1%; p=0.003).

Conclusion: The ABTS successfully transitioned from an in-person CE to a virtual CE format in September 2021. CE outcomes from 2018 to November 2021 were independent of format, candidate gender, or certification pathway. Higher pass-rates were associated with US medical school education and candidates graduating from Integrated 6-year and “Four+Three” programs, although these outcomes may reflect candidate selection bias and/or training program differences.

Identify the source of the funding for this research project: No external funding.