A Decade of Duty Hour Standards: Increasing Pass Rate Trends on the American Board of Plastic Surgery Written Examination

In July of 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented its first set of major duty hour standards.1, 2 It was believed that duty hour limitations would enhance the quality of resident education.1 There is a relative paucity of studies evaluating education outcomes in plastic surgery. There were no significant linear trends since 2003 on the American Board of Plastic Surgery (ABPS) Written Examination (WE) or Oral Examination (OE) in a recent study. There were also no pass rate differences comparing examinee cohorts before and after 2003 on the ABPS WE or OE.2 The purpose of this study is to critically evaluate the nature of the ABPS WE and OE with regard to pass rates surrounding 2003, hypothesizing that pass rates on the ABPS WE and OE have increased since the institution of these ACGME duty hour standards in 2003. This was a retrospective study from the 1993 to 1994 academic year to the 2012 to 2013 academic year. Examination outcomes on the ABPS WE and OE were obtained directly from published materials found through the ABPS website with previously obtained permission.3, 4 Simple linear regression and segmented regression were performed for examination pass rates over time, and surrounding 2003 respectively. Spearman’s r was also found. All statistics were performed using Stata 13 software (StataCorp, College Station, TX), using an a 4 0.05. On the ABPS WE, the overall pass rate was 4,113/ 4,992 (82.4%). The median annual pass rate was 83.5 per cent [interquartile range (80.4–84.8%)]. The pass rate before 2003 was 2,196/2,688 (81.7%) and the pass rate after 2003 was 1,917/2,304 (83.2%) (P 4 0.16). The overall ABPS OE pass rate was 4,009/4,910 (81.6%). The median annual pass rate was 81.4 per cent [interquartile range (79.5–82.6%)]. On the ABPS OE, there is an outlier in the pass rate in the 2013 to 2014 academic year. The pass rate before 2003 was 2,160/2,631 (82.1%). The pass rate after 2003 was 1,849/2,279 (81.1%) with the outlier (P 4 0.38) and 1,629/2,031 (80.2%) without the outlier (P 4 0.10). The linear regression and segmented regression analyses are shown in Figure 1. For the WE, the slope of the regression line before 2003 was less than zero (P 4 0.04) [Spearman’s r 4 –0.65 (P 4 0.04)]. The slope of the regression line after 2003 was greater than zero (P 4 0.01) [Spearman’s r 4 0.76 (P 4 0.01)]. Segmented regression showed a positive deflection in the pass rate surrounding 2003 (P 4 0.001). For the OE, the slope of the regression line before 2003 was not different than zero (P 4 0.27) [Spearman’s r 4 0.39 (P4 0.27)]. The slope of the regression line after 2003 was not different than zero with (P 4 0.46) [Spearman’s r 4 0.26 (P 4 0.46)] and without the outlier (P 4 0.26) [Spearman’s r 4 –0.42 (P 4 0.22)]. Segmented regression showed no changes surrounding 2003 with (P4 0.79) and without the outlier (P 4 0.13). There were no significant 20-year trends for the WE (Spearman’s r 4 0.22) or the OE with (Spearman’s r 4 0.03) or without the outlier (Spearman’s r 4 -0.23) (all P > 0.05). In this retrospective study, the purpose was to more clearly evaluate pass rate trends on the ABPS WE and OE with respect to the institution of the ACGME duty hour standards in 2003. With regard to the ABPS WE, there was a decreasing trend before 2003, an increasing trend after 2003, and a positive slope deflection surrounding 2003 (all P < 0.05). These conclusions are consistent with the study hypothesis, and suggest temporally that the ACGME duty hour standards are associated with an ideal reversal in pass rate trends. With regard to the ABPS OE, there are no significant trends before 2003, after 2003, or surrounding 2003 Presented as a Poster Presentation at the Surgical Education Week: Association for Surgical Education Meeting, Seattle, Washington, April 23–24, 2015. Address correspondence and reprint requests John L. Falcone, M.D., M.S., Owensboro Health Surgical Specialists, Ridgecrest Medical Park, 2801 New Hartford Road, Owensboro, KY 42303. E-mail: John.FalconeMD@owensborohealth.org.