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Passing the Boards: can USMLE and Orthopaedic in-Training Examination scores predict passage of the ABOS Part-I examination?

Passing the written and oral examinations is a requirement for certification for the American Board of Orthopaedic Surgery (ABOS). Residents and residency program directors alike consider passing “The Boards” to be a priority. Part I of the ABOS examination consists of over 300 multiple-choice questions designed to test the candidate's knowledge in general orthopaedics, basic science, and the application of this knowledge. Part II is an oral examination administered to evaluate the candidate's competence in areas such as data gathering and interpretation, diagnosis, treatment, and technical skills. Passing the ABOS Part-I examination the first time is crucial to avoid delays in taking Part II and attaining board certification. In 2002, 553 (89%) of 623 first-time test-takers passed the ABOS Part-I examination. If one were to include repeat examinees, 637 (79%) of 805 passed1. The passing rate after one or more failures is dramatically lower than that for first-time examinees. In 2002, there were 182 repeat test-takers, of whom ninety-eight failed (a 54% failure rate), demonstrating the importance of passing the first time1. This suggests that inadequate training and preparation of an orthopaedic knowledge base for this examination during residency may be difficult to correct after an initial failure of the ABOS Part-I examination.

The ABOS Part-I examination represents one standardized test in a long battery of examinations already taken by graduating residents, which include the Standardized Admission Test; Medical College Admission Test; United States Medical Licensing Examination (USMLE) Steps I, II, and III; and Orthopaedic In-Training Examination (OITE) administered during postgraduate-years (PGY)-1, 2, 3, 4, and 5. Since orthopaedic residency applications are extremely competitive (in 2000, there were 1116 candidates for 554 positions), it can be inferred that orthopaedic residents have generally performed well on these previous examinations2. Indeed, it may be the unofficial …