Jessica:  Hi, welcome back. This is Jessica, the host of The Absite Smackdown podcast. I'm here with Dr. David Kashmer

David:  Hi Jessica. Thanks for having me back on the program. It's good to be back with you today to talk more about the ABSITE and study strategies for it.

Jessica:  Well, thanks for being here with me as always. So today I want to just kind of go over the basics of what the ABSITE is just because we are six months, six months until test time. And that seems like a long time, but it's really not.

David:  It is amazing how fast it creeps up on you every year, especially this year with everything that's going on with COVID and around the world this year, it feels like it's come up on us faster than ever.

Jessica:  I mean, I would definitely agree with you. that's actually one of the things I wanted to talk about, cause today's daily news just going into it, you know, it's time to go back to school and what's going to be happening with that because of COVID.

David:  It's amazing. And first I'd like to share that the resident staff never stopped kind of going to school. The way we train residents is not exactly like medical school or high school or any of the schools being talked about in the news. Our resident colleagues have helped with COVID patients. They've lived through this unusual time where elective surgical procedures are canceled or at least greatly changed. And they've never stopped learning this entire time. Now some of the ways we teach them are a bit different now, whether that's because we don't have lectures all together, whether we use asynchronous ways to deliver lectures like online content or whether groups are using things like Absite SmackDown, the video course, that comes with the review book, that just allows residents to be anywhere anytime, and to learn what they need for the ABSITE, whichever way they're doing it. These residents have never stopped going to school. Unquote, they'd been learning the whole time they've been in there working with patients the whole time and whether with a textbook or an asynchronous platform, they sure have been learning what they need to throughout this whole time. So for them it's business as usual.

Jessica:  Right world hasn't stopped for them--just the rest of us. So, a lot of people maybe don't really understand the ins and outs of the ABSITE test. So I thought maybe today we could just go over the basics:  what it is, what it stands for, how many questions--just the normal information that, you know, people may not know.

David:  Well, I'm happy to hit some of those talking points. Just the facts about the ABSITE.  ABSITE is American Board of Surgery In Service Training Exam. It was originally designed for us as program directors to learn how well our education program is doing for the residents. That was the idea, sort of the intent upfront, and then pretty quickly it morphed into a referendum on how the residents are doing and what they're learning on their own.

I've seen, unfortunately, sometimes program directors don't look at their education system as much as they should based on the feedback via the ABSITE.  Instead of kind of being critical of ourselves and looking to improve, sometimes we take it as a comment on the residents didn't study hard enough or they didn't do whatever. You'll notice a lot of what we talk about on the podcast is things that residents can't always directly control.

Like they can influence, but maybe not directly control, when their vacation, resources available for how they practice for the exam (because many of those come from the residency) and other factors that the residency structure promotes or chooses.

That's what our podcast talks about in part, in addition to all these other things. So there are these ways to modify score that aren't directly dependent on the resident's effort.  A lot of things are dependent on the resident's effort, whether they do questions, how many they do. But the bottom line is a lot of our other content on the podcast focuses on things that residents can maybe influence but also things they can't et cetera.

Other talking points?  It's 250 questions or thereabouts. And several years ago, before 2014, it was actually two tests. One test was an upper year test for the more senior residents.  And that was more focused on clinical diagnostics, clinical situations.

And then there was a junior level test, which was more focused on what was called basic science, those facts like, "Oh, tyrosine is the amino acid that goes to make dopamine and norepinephrine and epinephrine...".  Hardcore science facts.

Okay. Now since about 2014, it's back to one test. And in the Absite Smackdown book, we have a chapter devoted to specifics on the test, a link to a practice test from the ABS, a link to the interface, and a link to the sheet that the ABS puts out to show the breakdown of the test by content (eg what's abdominal, how much is preoperative management, et cetera).

So those are just some of the talking points, long answer to a short question, but those are some of the facts about the episode.

Jessica:  That's really helpful.  Especially the content sheet to know exactly where they should be focusing their studies on. And then also I think you break it down in there. like you said before, when there was two tests, now there's only one test and you broke down in the book, what the percentages are for that test, that 80% is clinical management. 20% is the applied science, the basic science.

David:  That's the idea nowadays, just as you say, but the way they get at it is sort of interesting.  You can have an entire question written to sound very clinical, but it really gets at a hardcore basic science fact. So it's fascinating.

And just a couple of the other talking points:  the test is given in January, like you said, we're about six months away. And again, it's amazing how quickly it's caught up to us.

Your program gets your results back in February, approximately, but March at the latest and the programs don't always give you your results right away. Sometimes it takes some time for the faculty to look at them. That depends on your program, but in general, your program will receive the scores back about a month after you take the exam and it'll come with benchmarking versus all test takers to show your percentage questions correct.

And then your percentage, versus all tests takers.  Typically, centers and programs will use about 35%, percentile score as a trigger for saying you're at risk to not pass your boards on the first try. If you get that 35 or less at any time during your residency, there's some literature that you are statistically significantly less likely to pass your boards on the first take.  But that doesn't mean you won't pass. It doesn't mean you're guaranteed to fail. Just means that the probability of you failing is significantly higher. But still, even though it's significantly higher, most people do pass even if they've scored 35 or lower.

Jessica:  So I think we actually did a podcast or a blog on that before today.

David:  Yeah. That's another thing we talked about, we actually did the math to say, if you did score less than that, what's your probability of not passing boards on the first try? It was kind of heavy on the math. That's one of our early podcast episodes and it's also on the blog.

Jessica:  Cool. So check that out if you want more info on that. So back to the actual ABSITE test. Like you said, 250 questions takes about five hours. I don't know if people realize the program, whatever program you're in there, who you take the test through.

David:  Yeah. a lot of people do realize that their residency administers the test. Most residents know.  Different centers take it in different time zones and there can be testing irregularities where clusters of wrong answers are tracked and you can see, oh, well, residents at one center maybe talked to another that took the test earlier and similar things. So the ABS looks for that. And one thing we stress in our book is "don't cheat". Take the test straight up. It only hurts your program. 

It doesn't help your education to cheat. Just study for the exam, use the materials, do the best you can. If a center is found to have significant testing irregularities, the American Board of Surgery asks your program director to investigate. And depending what they find for a sort of lack of a better term they dispense justice. The American Board of Surgery will sometimes really chastise your program. So you're hurting everybody if you get caught. And it's just a shame when you see it. So bottom line don't cheat...study instead. It only helps you in your patients

Jessica:  As a program director. Did you ever have to deal with that?

David:  I was so fortunate. I never did. I did see it in another residency that I worked with where I was not the program director. So that was a learning experience for me and really focused me on just how important and serious it is. But fortunately, I never have encountered that as a program director.

Jessica:  Oh, that's wonderful. Do you think maybe seeing that as a program director, you took from it things you could do better so that your students don't need to cheat?

David:  Absolutely. That's exactly what I did. I mean, we're kind of off book here...but on a personal note, I think people tend to cheat when they feel a bunch of pressure, have no good options and just have their back is sort of against the wall, and are scared and desperate.

It doesn't mean that it's okay when they do that. But that's sort of when I think a good program that reviews consistently and has materials and coursework like SCORE the Surgical Council On Resident Education curriculum and uses textbooks and does questions together and uses something like Absite Smackdown whether the product out from you all or not. But just something like that, those residents build confidence. They do more questions throughout the year, which leads to a better score. They don't feel desperate when they come to the website because they just know they haven't had the education they need. I think the program goes a long way toward preventing cheating by just doing a good job, right

Jessica:  I mean, and again, that's why we're doing this. You have six months.  Six months to study.  Six months to get ready.  Six months to prep, to look at your score, to use your Absite Smackdown, to get it done.

David:  That's exactly right. And we even have in some other podcasts, some evidence based strategies for how to do the best you can, you need to cover the content. And then beyond the content, focusing on questions is very useful. Absite Smackdown is adding questions all the time. Well, I know you guys are going to be adding more to the courses, but reviews focused on questions after you've learned the material seem to propel your score ahead. So I can't say enough about how you have to master the content. Then you need to do a lot of questions.

Jessica:  We take in and we're learning all the time. If you are just on your social media and you go through any of our social media sites, you're going to get your Daily.Absite.Fact of the day, just like a word of the day calendar. And so like every day you remember something new.  Take five minutes, you're on Instagram, you're on LinkedIn, you're on whatever. And that's, you know, your 30 seconds of studying every single few hours that you can get in.

David:  I think you're right. And that pattern hasn't been studied. Most of the series look at strategies that are questions and then ones versus less questions. And then one versus just attending lectures only. And in those people who do more questions overall do better, but what hasn't been evaluated well, as a third pathway or whatever you like to call it is blending your review in with what you do every day. Intuitively makes a lot of sense. It just hasn't been as completely studied in the context of surgical education. But look, if you're going to be on Instagram, daily.absite.fact will pop up a useful high yield ABSITE fact in your feed.

You're on Facebook, same thing.  You're on LinkedIn, same thing. So this has really been great to see our residents use it because it just becomes part of what you're doing every day.  Little reviews every day when you're doing other stuff, just like when people are on social media for other things.  It's really been super useful that I've seen.

Jessica:  And then just the connection to the actual website, all the little community that we're building there with the blogs and with material.  You do a lot of free things that you give to be helpful. Like the, audiobook that you released.

David:  Well, yeah, really you guys did the job on it.  But yes, I really appreciated it because one of the things I've been focused on for education is sharing as much as we can and just am putting it out there. And so yeah, you guys really helped polish and finish and adrenal review for free as an ebook. That's available on AbsiteSmackDown.com also on LinkedIn, on the company page Absite Smackdown. I know you guys put it there and there's also a thyroid review. That's at the podcast home on SoundCloud, Spotify. I think it's on iTunes and it has, really a great thyroid review, a great trauma review, colorectal review and that adrenal review and they're all free. That's exactly what it should be for as much as we can to put it out there in a way that's convenient for the staff. So that's been great.

Jessica:  I mean, you make it easy for us to do our jobs. That's all I'm going to say. All right, well again, thank you for joining us today. This has just been a brief overview on exactly what the Absite is, what it contains, and of course, how you can do better. Thank you, Dr. Kashmer for coming to stay with us today. I appreciate you.

David:  Yeah, it's always great to be on and to chat with you about all these things. Just I'll tell you, like you said, six months is right around the corner. So I invite anybody who hears us to get out there. And if you haven't started in earnest for the Absite.  Use some of the free stuff from us. Look at the free stuff from the American Board of Surgery. It's time to really turn it up if you can. And these are just some convenient ways to do it.

Jessica:  Exactly. All right. Well, thanks again, you guys have a great day and #AbsiteSmackdown!