Unique performance problems in surgical residency as novel predictors of negative post-residency outcomes

Abstract Purpose: Surgical educators have an interest in ensuring graduates of residency programs are able to pass board examinations and build a surgical practice. We sought to learn if there are indicators in residency that can be used to predict propensity for difficulty, in passing boards or in later practice. Methods We reviewed the residency and post-residency (board results) files of 104 residents in our general surgery program, cataloguing performance problems using a checklist we had developed for a previous study. We then used online resources including state licensing boards to assess non-board post-residency outcomes. We used ROC analysis to determine if there were cutoff scores for ABSITE exams, seriousness of problems, and number of unique problems identified in the file. Results The 44 (42%) of residents who had documented residency performance problems were at statistically significant risk for first-time board failure, negative mentions online, and overall negative post-residency outcomes. Residents who had five or more unique problems in our check list were at statistically significant higher risk of first-time board failure and negative post-residency outcomes than residents with zero documented problems. They were also at statistically significantly higher risk than residents who had 1–4 unique performance problems documented in their files. Residents who had 1–4 documented performance problems were at statistically significantly higher risk than residents who had zero documented performance problems only for negative online mentions. Conclusion Capturing unique performance problems during residency is a novel method to assess risk for post residency problems, both in passing board exams and in mounting a successful practice.