American Board of Thoracic Surgery examination: Fewer graduates, more failures

Background: The American Board of Thoracic Surgery (ABTS) has noted a yearly decrease in the number of examination certificates being awarded, with only 93 certificates awarded in 2011. In 2003, the Accreditation Council for Graduate Medical Education required all programs to implement the 80-hour residency workweek. We hypothesized that this requirement has resulted in trainees being less capable of becoming successfully certified. Methods: We examined the ABTS board scores, both written and oral, from 2000 to 2011. We divided the interval into 2 periods: 2000 to 2005, representing the 6-year, pre-80-hour workweek, and 2006 to 2011, the 6-year period post-80-hour workweek implementation. We analyzed whether a significant difference would be present in the pass rate before and after the 80-hour workweek for both the written and the oral boards. Results: An inflection point of examination failures was found that started in 2006, correlating with the first examination year the 80-hour workweek would have affected. The written examination failure rates increased from 2006 to 2009 but have since decreased. The actual percentage failing the written component was less than the percentage failing the oral examinations in both periods. The oral examination failure rates have continued to increase at an alarming rate. Conclusions: An increase has occurred in the failure of the ABTS board examinations that has been significantly greater after implementation of the 80-hour workweek. The failure rate for the written examination was not as significant as that for the oral examination. Because we are now training fewer, and perhaps less successful, cardiothoracic surgeons, it is our duty to develop strategies to improve and promote innovation in the methods of training.