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J Surg Res. 2017 May 12. pii: S0022-4804(17)30291-3. doi: 10.1016/j.jss.2017.05.034. [Epub ahead of print]

Relationships between study habits, burnout, and general surgery resident performance on the American Board of Surgery In-Training Examination.

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Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address:
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut.
Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
Department of Surgery, University of California - Davis, Sacramento, California.
Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
Department of Surgery, Hofstra-Northwell Lenox Hill Hospital, New York, New York.
Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
Department of Surgery, Boston University, Boston, Massachusetts.
Waterbury Hospital, Waterbury, Connecticut.



The American Board of Surgery In-Training Examination (ABSITE) is used by programs to evaluate the knowledge and readiness of trainees to sit for the general surgery qualifying examination. It is often used as a tool for resident promotion and may be used by fellowship programs to evaluate candidates. Burnout has been associated with job performance and satisfaction; however, its presence and effects on surgical trainees' performance are not well studied. We sought to understand factors including burnout and study habits that may contribute to performance on the ABSITE examination.


Anonymous electronic surveys were distributed to all residents at 10 surgical residency programs (n = 326). Questions included demographics as well as study habits, career interests, residency characteristics, and burnout scores using the Oldenburg Burnout Inventory, which assesses burnout because of both exhaustion and disengagement. These surveys were then linked to the individual's 2016 ABSITE and United States Medical Licensing Examination (USMLE) step 1 and 2 scores provided by the programs to determine factors associated with successful ABSITE performance.


In total, 48% (n = 157) of the residents completed the survey. Of those completing the survey, 48 (31%) scored in the highest ABSITE quartile (≥75th percentile) and 109 (69%) scored less than the 75th percentile. In univariate analyses, those in the highest ABSITE quartile had significantly higher USMLE step 1 and step 2 scores (P < 0.001), significantly lower burnout scores (disengagement, P < 0.01; exhaustion, P < 0.04), and held opinions that the ABSITE was important for improving their surgical knowledge (P < 0.01). They also read more frequently to prepare for the ABSITE (P < 0.001), had more disciplined study habits (P < 0.001), were more likely to study at the hospital or other public settings (e.g., library, coffee shop compared with at home; P < 0.04), and used active rather than passive study strategies (P < 0.04). Gender, marital status, having children, and debt burden had no correlation with examination success. Backward stepwise multiple regression analysis identified the following independent predictors of ABSITE scores: study location (P < 0.0001), frequency of reading (P = 0.0001), Oldenburg Burnout Inventory exhaustion (P = 0.02), and USMLE step 1 and 2 scores (P = 0.007 and 0.0001, respectively).


Residents who perform higher on the ABSITE have a regular study schedule throughout the year, report less burnout because of exhaustion, study away from home, and have shown success in prior standardized tests. Further study is needed to determine the effects of burnout on clinical duties, career advancement, and satisfaction.


ABSITE; Burnout; General surgery; Residency; Study habits

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